Review and Recomendation: The Trigger Point Therapy Workbook

This is a review of Trigger Point massage, and a particular self-help book about applying the technique:  The Trigger Point Therapy Workbook by Clair Davies. I've been trying self-applied Trigger Point massage for a while now, using this book as my guide. I've found it to be a useful technique, and I recommend trying it. I've used it for back pain and hip pain, but the book contains sections for almost all areas of the body. 

The theory behind trigger point therapy is that muscles get knotted up in very specific locations in the body, and that the stress caused by these knots causes referred pain to nearby parts of the body where those muscles attach.  The Trigger Point Therapy Workbook  shows you where all these trigger points are, and the pattern of referred pain associated with each point. In addition, for each set of trigger points there is a lengthy discussion of the typical causes of problems at those points, how to locate the points by touch, and how to treat the trigger points. 

The treatment is almost always the same: high pressure massage of the muscle around the location of the trigger point. Exactly how the massage is done probably doesn't matter that much, so long as you get the spot right. The book's advice, however, can be helpful for figuring out how to get sufficient leverage and pressure for each point.  In many cases, the suggested massage tool is just a regular tennis ball, though sometimes more fancy tools like the thereacane are suggested. 

The book is a useful resource for finding the trigger points because the pain is usually referred. You may massage near the area of pain, but usually the actual point where the massage is needed is outside the area which aches. Interestingly, however, once you know the general area to search for the points, it's much easier to find them by touch than by religiously following the diagrams in the book. Nonetheless, the diagrams are important for figuring out the right areas to start searching. 

The book is very clearly written. It is intended to be read by pain sufferers, and while it doesn't dumb down the topic, care is taken to not be overly technical. It does suffer from overly grandiose claims for all the different conditions it might treat - in one section it even speculates that dyslexia may some day be treated by trigger point therapy.  Don't be too turned off, however, as in contrast to dyslexia, trigger point therapy really does seem to help chronic pain. On the other hand, I'm going to go out on a limb and suggest that there is less than 1% chance that trigger point therapy will ever provide a measurable help to dyslexics.  Oh well, like most self-help books you have to learn how to filter the good from the bad. 

In the end the book wouldn't be worth reading if it didn't help. Luckily, it does. In my own life, I've found that trigger point massage can significantly reduce my acute back pain around 30% of the time I apply it, and makes for at least some improvement almost every time I try it.  That's a pretty impressive level of improvement, in my book. It's well worth the $15 that it costs to buy it from Amazon (or other good online booksellers).  And, given that the only other tools you really need are a tennis ball, and perhaps a bottle opener, it's a very economical way to treat your pain.

Good posture for sitting

One of my reader's suggested I check out his website: www.lower-back-pain-toolkit.com. It turns out to have lots of interesting information, and has inspired me to put up a post about 'good' posture.

First, what is good sitting posture? The general/traditional view is that you want to sit upright, with a gentle s-curve in your lower spine from a lumbar role. See this link for a much more detailed discussion. Whenever this 'good' posture is illustrated, the person is almost always sitting with a 90 deg. angle between their legs and their torso. Undoubtedly, this is better than the forward slouch, where your back slowly curves forward and your chin ends up nearer your kneecaps than your hips.

This traditional view, however, may not be quite right, at least with respect to the 90 deg. angle between your hips and your back. MRI scans have revealed that when you sit in this posture, you actually put a lot of strain on the disks in your lower back. It may be significantly better to lean backward at a greater angle, such as 135 deg. See this BBC article for an example of this posture, and a short discussion of the science behind it.

In my personal experience, less than 90 deg. can quickly lead to pain. Exactly 90 deg. feels much better, at least in the short term. Greater than 90 deg. seems, however, to be the least painful of all. It can be hard to get a > 90 deg. position in a regular upright chair, however, without also leaving your back unsupported and hanging, leading to a reduction of lumbar lordosis. One way to avoid this is to role up a towel and sit on it. This will increase the angle between your hips and your back, while still maintaining the good lordosis. Another option is to slouch backwards, and then support your lower back by placing both of your arms behind your back.

Idea: trigger point massage in the bathtub

I've recently discovered trigger point massage. The basic idea is finding painful points on your muscles and applying deep pressure which is initially quite painful, but quickly reduces your overall level of pain in that area. This page has a neat trick, which I will try as soon as I have a bigger bathtub: take a rubber ball into the bathtub and combine the relaxing power of heat with the effects of trigger point massage. See http://saveyourself.ca/articles/bath-trick.php for the full article.

Cheap theracane alternatives

I've recently been trying trigger point massage for my lower back pain. I'll post more once I have had more experience. Trigger point therapy requires a fairly deep massage, which is rather hard to do with your hands, let alone if the points are behind your back.

The Theracane is basically a cane with some hand-holds, which is meant to make it easier to massage areas like your back. Experimenting in the store, I did not feel it was really suited to deep, high pressure massage, but it would still probably be a useful tool. Check out their website if you haven't seen the Thera cane before. The problem is that it goes for between $50 and $30, usually without any return policy. I've come up with a couple of $1-$5 alternatives which work pretty well.

First, you could always try doing a tennis ball massage, (just trap the ball between the wall and your body, and wiggle around). This works OK, but doesn't really make for a deep massage because the ball is too big. Also it can be difficult to pinpoint the spot you want on your body this way.

So, what I really suggest is to go to a kitchen store (I went to IKEA) and find a short kitchen tool which has a round handle, as in the picture to the right. The one I found cost 99 cents. Now, since it's not rounded on both sides, it may be kind of hard to hold comfortably, especially when applying lots of pressure. Solution: cut open a tennis ball, and stick the non-round part into it. Now, you have a nice soft handle, and a good, hard massage point. For extra force, I put the tennis ball up against the wall, and then lean into the rounded handle of the tool.

That works pretty well for the lower back. It's a bit hard to position the tool, since it's all happening behind your back, but your arms can be flexible enough to make it happen.

Much harder is to massage your upper back or neck. Perhaps you really need a Thereacane? No, there's a cheaper alternative, on the order of $5 at your local hardware store. Get a storage hook (here's one link, but it's probably better to check it out in your local store first). See picture below for a suggested model, but I'm sure you can use your own judgment on this one! It's really crazy how much you will get charged for "health related" items, as compared to everyday products that are just as good but have to appeal to the more cost-minded general consumer.

About.com: Back and Neck Pain Treatments info

I just found this guide on about.com (I can still remember when they were the miningco.com). Unlike some guides, they have actual info, not just links to other websites. For instance, here's a link to a relatively nice description of how to do a pelvic tilt exercise. BTW, another good place to go if you are looking for illustrated back exercises is youtube. It's often a lot easier to see what you are supposed to do than try to puzzle it out from text and a line drawing. Here, for instance, is a relatively nice pelvic tilt video.

Tennis ball massage

Tennis balls can make great self massage tools.

The simplest method is to stand with your back to a wall, trap a tennis ball between the wall and your body, and then just wiggle around. This works great for your lower-back, but can be much harder to do if you have upper back pain because the tennis ball will tend to pop out and fall to the floor. This is easy to get around - take a thin sock (the thinner the better), and stick a tennis ball inside. Now you have a handle which you can use to pull the tennis ball around, which will prevent it from popping out, most of the time. I've even been able to massage my neck using this technique, something you cannot do with a plain tennis ball.

You can also give your hips or lower back a great deep-tissue massage by trapping the ball between you and the floor, and using your body weight to supply the pressure. I find, however, that this can be too much pressure. To spread the weight out a bit, I use 3 tennis balls, stuck in a row inside a sock, with the sock pulled as tight as possible and tied off. This gives you a relatively hard tube/roll that you can place under you, and roll around on. You'll need a relatively tough sock that isn't too stretchy.

7 steps to a pain-free life : how to rapidly relieve back and neck pain using the McKenzie method

A Book recommendation:

7 steps to a pain-free life : how to rapidly relieve back and neck pain using the McKenzie method by Robin McKenzie

If you haven't read this book, you should right away. It goes over a treatment method which most Physical therapists will teach you, but does so in much more detail that you would get from a 1 hour session with a PT. It is worth going to a PT, for sure, but get this book as well.

The McKenzie method can be summarized as careful bending backwards (aka extension) but there is much more to it than can be summarized in one sentence. In addition to the stretches they prescribe, there is also a range of useful information, from how to sit correctly, to how to cough with less pain. Don't just read an online summary - get a copy of it yourself. Most libraries have it, and it's easy to find for sale online (click the link at the start of this post, for instance).

The book certainly presents itself in a slightly too self-aggrandizing tone. Reading the book, you may start to wonder a bit if it's some sort of snake-oil miracle cure, which I assure you that it is not - I know many people who it has helped. BUT: it doesn't help everybody, and those it does help don't necessarily find them selves completely cured. Myself, for instance. I'm glad I read this book, but it's only improved my situation maybe 20%. But every 20% counts!

Maybe you will be one of the lucky ones who find this is a complete cure to your problem. Maybe you won't. But it's only 300 pages, easy to read, and extremely cheap. Give it a try.