Understanding, Locating and Treating Myofascial Trigger Points F10200-Prelim.Qxd 6/1/06 3:23 PM Page Ii

F10200-Prelim.qxd 6/1/06 3:23 PM Page i A MASSAGE THERAPIST’S GUIDE TO Understanding, locating and treating myofascial trigger points F10200-Prelim.qxd 6/1/06 3:23 PM Page ii For Elsevier: Senior Commissioning Editor: Sarena Wolfaard Associate Editor: Claire Wilson Project Manager: Joannah Duncan Senior Designer: George Ajayi Illustration Manager: Bruce Hogarth Illustrators: Barking Dog Studios, Graeme Chambers F10200-Prelim.qxd 6/1/06 3:23 PM Page iii A MASSAGE THERAPIST’S GUIDE TO Understanding, locating and treating myofascial trigger points With accompanying DVD Leon Chaitow ND DO Registered Osteopathic Practitioner and Honorary Fellow, University of Westminster, London, UK Sandy Fritz BS MS Director, Health Enrichment Center, School of Therapeutic Massage, Lapeer, MI, USA Foreword by Robert K. King Illustrations by Graeme Chambers BA(Hons) Medical Artist EDINBURGH LONDON NEW YORK OXFORD PHILADELPHIA ST LOUIS SYDNEY TORONTO 2006 F10200-Prelim.qxd 6/1/06 3:23 PM Page iv Notice Neither the Publisher nor the Author assume any responsibility for any loss or injury and/or damage to persons or property arising out of or related to any use of the material contained in this book. It is the © 2006, Elsevier Ltd. All rights reserved. responsibility of the treating practitioner, relying on independent expertise and knowledge of the patient, to determine the best The right of Leon Chaitow and Sandy Fritz to be identified as treatment and method of application for the patient. authors of this work has been asserted by them in accordance with the The Publisher Copyright, Designs and Patents Act 1988 No part of this publication may be reproduced, stored in a retrieval system, or transmitted in any form or by any means, electronic, mechanical, photocopying, recording or otherwise, without either the prior permission of the Publishers. Permissions may be sought directly from Elsevier’s Health Sciences Rights Department, 1600 John F Kennedy Boulevard, Suite 1800, Philadelphia, PA 19103- 2899, USA: phone: (+1) 215 239 3804, fax: (+1) 215 239 3805, e- mail: [email protected]. You may also complete your request on-line via the Elsevier homepage (http://www.elsevier.com), by selecting ‘Support and contact’ and then ‘Copyright and Permission’. First published 2006 ISBN 0443 10200 7 ISBN-13 978 0 443 10200 4 British Library Cataloguing in Publication Data A catalogue record for this book is available from the British Library Library of Congress Cataloging in Publication Data Printed in China A catalog record for this book is available from the Library of Congress F10200-Prelim.qxd 6/1/06 3:23 PM Page v Contents The CD-ROM accompanying this text includes video Chapter 4 Maps and other ways of locating trigger sequences of all the techniques indicated in the text by points 45 the icon. To look at the video for a given technique, click on the relevant icon in the contents list on the Chapter 5 ‘Measuring the pain’ 59 CD-ROM. The CD-ROM is designed to be used in conjunction with the text and not as a stand-alone Chapter 6 Finding trigger points by palpation 69 product. Chapter 7 How to treat trigger points manually 89 Foreword vii Preface ix Chapter 8 Integrating trigger point application into Acknowledgements xi massage 125 Chapter 1 Myofascial and other pain 1 Chapter 9 Non-manual trigger point deactivation methods 151 Chapter 2 How trigger points start – the big and the small picture 19 Glossary 163 Chapter 3 Different trigger point characteristics 39 Index 165 F10200-Prelim.qxd 6/1/06 3:23 PM Page vi F10200-Prelim.qxd 6/1/06 3:23 PM Page vii Foreword ome 20 years ago, while browsing through a British tender points and hypertonicity in rectus capitis pos- Salternative health journal, I first stumbled across terior minor and the adjacent sub-occipitals. The Leon Chaitow’s essay entitled ‘Whole Body May Be chronically stiff neck is significantly relieved by Trigger Point’. The article succinctly asserted what I trapezius and levator scapula trigger point therapy. intuitively knew: that the entire surface, indeed the Deactivating trigger points as part of a whole body total landscape of the body, was potentially an area, soft tissue approach is now a commonly accepted ther- however minute, of a nasty form of soft tissue dysfunc- apeutic modality. tion that possessed pain-generating characteristics. Even today, Swedish Massage, or more appropri- Since the entire encasement of our physical struc- ately Relaxation Therapy, is the primary reason why ture is a potential source of this peculiar irritating pain clients seek the services of massage therapists at our that, when provoked, stimulates noxious impulses in school clinic in Chicago. Clients intuitively know they predictable ways, new and highly efficacious manual need to relax, and that relaxation is profoundly thera- protocols are called for. peutic. But they want something more: ‘could you I am, therefore, honored to write the foreword to spend a little more time on the back of my neck‘ or ‘I this vital and long overdue work. A Massage Therapist’s strained my back pushing a piano last week’ or ‘I Guide to Understanding, Locating and Treating Myofascial twisted a rib muscle while lifting my dog’ or ‘I’m just Trigger Points by Leon Chaitow and Sandy Fritz is a beginning a new job and find it painful to take a deep valuable and timely contribution to the field of breath’. These are all indicators that the public wants, manual therapy. I predict that almost every reader of and expects, the massage session to be tailored to their this book will find new information and innovative personal needs: their familiar aches, pains and areas of methods for developing their hands-on skills and dysfunction and stress. This book will significantly enhancing their clinical outcomes. This book is articu- help to fill that gap. late, detailed, sequential, profoundly instructive and A Massage Therapist’s Guide to Understanding, breathtakingly thorough. Locating and Treating Myofascial Trigger Points features a Trigger point approaches consistently yield pow- thorough discussion of myofascial and other forms of erful therapeutic results. Stubborn cases of thoracic pain and how stress can exacerbate pain symptoms. outlet are successfully resolved by neutralizing sca- Causal factors and pain aetiology are presented and lene and pectoralis minor trigger points. Trochanteric range from postural compensations to the chronic bursitis, all too often injected with cortisone (yielding somatization described so vividly by Latey and others. little long-term success), is often cleared within three Upper- and lower-crossed syndromes are discussed, visits of treating quadratus lumborum and vastus lat- providing regional, not just local, assessments of eralis trigger points. The sensation of having an ice altered physiology, pain and dysfunction. Theories pick in the mid-thoracic region upon deep inhalation of trigger point development explain the evolution of is eradicated with trigger point work on the serratus this phenomenon and charts, maps and illustrations posterior superior. ‘Brain pain’ from sub-occipital provide the visual learner with important clues to pal- trigger points is effectively treated by normalizing pation accuracy. F10200-Prelim.qxd 6/1/06 3:23 PM Page viii Palpation for practitioners will assume a new enormous. At health clubs, spas and resorts, the dimension after reading this book. Texture, tempera- public can now expect a multi-dimensional approach ture, tonicity, trophic skin changes, attachments and to healing that combines the relaxation response with musculotendinous junctions assume new clinical sig- trigger point release techniques. This is a union long nificance. Pressing, frictioning, stretching and direct overdue! pressure are but a few of the manual methods pre- The deactivation of pain-causing trigger points is sented in order to detect deep, hidden, cryptic areas of both a science and an elegant art form. Congratulations longstanding pain. to authors Chaitow and Fritz for an innovative contri- As a massage therapy practitioner for the past three bution to this marriage of science and art. decades, what I find most important is how trigger point protocols can be incorporated into basic massage Robert K. King, Founder & Past President, protocols and sequences. The implications of this are Chicago School of Massage Therapy, 2006 F10200-Prelim.qxd 6/1/06 3:23 PM Page ix Preface t has become ever more obvious that trigger points ● how to locate trigger points by palpation (see Iproduce a great deal of the pain being treated by Chapter 6) massage and manual therapists. ● how to locate trigger points by using ‘pain maps’ One of the main problems busy therapists face (see Chapter 4) is keeping up to date with research evidence that ● how to know if trigger points are significant (are explains the way trigger points develop, the way they they part of the patient’s problem?) once they have create pain and dysfunction, and the best ways of been located (see Chapters 2, 4 and 7) deactivating them. ● when trigger points can be seen as functionally This book has been compiled precisely to meet that useful – for example if they are close to an unstable need; to help the therapist and the student to have joint (see Chapter 7) a clear idea of what research and clinical experience ● how to deactivate trigger points using one of a has taught us in recent years. variety of ways – including use of muscle energy, To effectively manage trigger points it is necessary positional release, spray and stretch, and many to know: more (see Chapter 7) ● how to integrate the methods described (and ● why trigger points develop (see Chapters 1 and 2) others) into a massage context (see Chapter 8) ● where they develop (see Chapters 1 and 2) ● what other methods exist for treating trigger points ● the nature and behavior of trigger points (see outside of a massage therapist’s scope of practice Chapter 3) (see Chapter 9) ● the difference between active, latent, central, ● what to advise the patient regarding home manage- embryonic and attachment points – and why you ment methods (see Chapter 7).

Load more