Trigger Point Compression Release and Massage

Trigger Point Compression Release and Massage

TPCR was formerly known as ischemic compression. TPCR is generally considered to be the primary manual therapy technique for MTrPs and has been described for most muscles. TPCR is believed to compress the contracted sarcomeres when pressure perpendicular to the MTrP is applied, leading to longitudinal elongation of the sarcomere. No research has been published to support this hypothesis. There is also likely to be a reflex neural component that may, in part, offer some insight into the technique. With respect to the shoulder, the muscle to be treated is positioned for the best access and comfort for the patient. The muscle is placed, when appropriate, in an optimal resting tension position, to expose the taut fascia for adequate palpation in relation to the surrounding muscle tissue. Physicians should be familiar with regional practical anatomy, including muscle attachments, fiber direction, muscle layers, and surrounding anatomical landmarks. Precautions should be taken to avoid inappropriate stretching, compression or occlusions of neurovascular structures, such as the brachial plexus and subclavian artery. When the patient is in the correct position, the PGM is located by palpation transversely to the direction of the muscle fiber of the accessible shoulder muscle. Some muscles are difficult to access and make palpation difficult. For example, the physician should compare the palpation accessibility of the supraspinatus or subscapularis with that of the infraspinatus or deltoid. Palpation through the muscle fibers allows for optimal exposure of the narrow fascia in relation to the surrounding muscle fibers and helps to identify the tender lump in the narrow fascia. When MTrP is identified, it is compressed with the doctor's finger or thumb using flat palpation or forceps. The intensity of the compression can be in the region of 7/10 on the pain scale reported by the patient and this compression is maintained until the patient feels a reduction in discomfort; this change can take 20 to 60 seconds or more. This compression can also be administered at low pressure below the patient's pain threshold for a prolonged period (90 seconds) or at high pressure for a shorter period (30 seconds). The immediate reduction in the MTrP sensitivity of TPCR is evidenced by an increase in the pain pressure threshold (PPT) and is not caused by a reduction in palpatory pressure by the physician.

Similar effects were observed for TPCR and transverse friction massage, as described by Cyriax, for MTrP with a similar reduction in visual analog scale (VAS) score and an increase in PPT for both treatments. In clinical practice, it would be prudent to evaluate treatment based on the individual patient's ability to tolerate manual treatments. Self-induced TPCR on the upper back, with a plastic self-release device, was effective in reducing the irritability of MTrP. Similarly, a home stretching and TPCR program was effective in reducing MTrP sensitivity and pain intensity in people with neck and upper back pain. Clearly, it is important to consider education in a self-directed treatment program at home.

Trigger Point Compression Release: Infraspinatus and Teres Minor

Rationale This technique targets one of the most common muscles in the shoulder region (infraspinatus) that develops MTrPs. The referred pain pattern is expansive and may include the shoulder, forearm, and hand. The infraspinatus muscle is flat, thin, and relatively expansive. To assess the infraspinatus muscle and its neighboring teres minor, the therapist palpates all over the infraspinatus fossa on the

posterior scapula.

Patient Position The patient is sitting, side lying (side up), or prone. The shoulder is positioned to place optimum tension on the muscle for MTrP palpation.

Therapist Position The therapist stands behind the patient.

Procedure The infraspinatus muscle is palpated by flat palpation perpendicular to the muscle fiber direction against the infraspinous fossa. In the upper portion, the fibers run in a direction similar to that of the spine of the scapula and more obliquely in the outer lower portion. The clinician assesses the muscle for taut bands with spot tenderness to identify MTrPs. The procedure is similar for the teres minor. The muscle is located on the lateral aspect of the infraspinous fossa and runs in an oblique direction to the posterior shoulder inserting into the greater tubercle of the humerus

Trigger Point Compression Release:

Supraspinatus

Rationale Palpation of supraspinatus is difficult because of its depth and its position under the trapezius. However, the supraspinatus is an important muscle to be able to identify. Patient Position The patient is sitting or side lying (side up). The shoulder is positioned to place optimum tension on the muscle for MTrP palpation.

 

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