When Do-It-Yourself Does Yourself In

I’m a DIY person. And as my friends will confirm, I’m also sort of obsessive compulsive. When I read Claire Davies’ The Trigger Point Therapy Workbook, I was excited to find an alternative to the gloomy surgical track offered by conventional medicine in the treatment of herniated disc. The book’s diagrammed predictions of referred pain were as fascinating as they were accurate. But I didn’t exactly heed the book’s recommendations for massage repetitions (6-12 strokes) or frequency (3-6 times per day) and I zealously attacked those trigger points night and day – prodding, poking, and using a rubber ball or an umbrella handle. Probably not wise as on one occasion I might've compromised my median nerve, resulting in weakness in my fingers for a day or two where I couldn’t button my button fly jeans or use a key. In June I had my first experience with neuropathic edema (build up of tissue liquid as a result of neuropathy) under my armpit area. I rested my hand over it and slowly deflated the mass. It is odd how I never told anybody about this serious medical issue but then again I felt like I would have difficulty explaining it to people and even myself. Did I imagine this happened? (I didn’t imagine it, as I would discover later).

Often late at night, when I’m completely relaxed and there is no extra tension produced from other parts of my body in opposition (because I'm lying down), I am often able to bring those pesky trigger point knots to complete release. On several occasions, I cried “Eureka! I’ve done it! I’ve released my trigger points!” I’d imagine sharing my experience in the blogosphere with explanations of how I did it. Unfortunately, I would discover a problem: trigger points retighten. And in my case, almost immediately. Some may assert that the cause of the retightening was hyper irritation of the nerves through excessive massage. That might be true but the more likely explanation is that my cervical herniated disc is in a steady state of nerve compression. This is the difficult part of assessing therapy - what is the level of disc herniation and nerve compression? And how much can a scan show that pressure? Without being able to jump into the Fantastic Voyage pod and look, you can never know for sure. And there is so much variation in people’s experience.

Claire Davies solved his own frozen shoulder problem (the injury was brought about by his career as a piano tuner) by studying the Travell and Symons volumes and employing intuitive self-trigger massage. He might have had cervical herniation or he might not have. But he is lucky he didn’t heed advice to operate on his disc because he solved his problem for good without it and found a new profession as a licensed massage therapist to boot. And it is this aspect that sparks debate. Is cervial herniated disc a catch-all diagnosis given that patients can fully recover from pain while still having herniation? Because the neuropathic symptoms are identical. Some people’s herniation is more severe (at least how it appears on the MRI) and yet they do not have the painful symptoms I have felt most recently. Like relating smoking and cancer, the cause and effect gap varies from case to case. Some people smoke all their lives and don't get cancer. The disc-nerve and muscle pain link is generally established fact, but the specifics and differences of each person's illness can be subtle and costly for patients who choose a treatment that ultimately doesn't work. It is the opinion of Dr. Jonathan Kuttner there is a link between the two, that damaged disc switches on trigger points. Some of Dr. Kuttner’s website, marketing and email communications are a little unorthodox but a video he posted teaches an interesting new approach to trigger point massage, which for lack of better name I call “trigger point dissolving”. A video showing the method is here. I have been able to employ this method with some success.

For most massage therapists, the scalene muscles and especially the sternocleidomastoid (or SCM for short) are a no-no. “Stay away from them!” is usually the reply. Most of the trepidation has to do with the sensitive glands in the region and most importantly, the close proximity of the carotid artery. Any type of excessive pressure in the area can cause a serious reaction called syncope which can lead to dizziness, nausea and fainting. One day I gave myself a syncope molotov cocktail by relaxing in an extremely hot tub and slowly working out my neck triggers. I didn’t feel I was pressing on the carotid as I know where it is, but as I arose from the hot water to dry off I found myself under the sink for a very long time without realizing it. The episode lasted for about a half hour and was a little frightening. I learned my lesson about the dangers of vasodilatation. Nevertheless, I am absolutely convinced that the scalene and neck muscles are the lynchpin of the entire operation, as my experience with late night massage will clearly demonstrate. Caution, however. Anyone reading this should not attempt to do this on their own. I have made myself my own guinea pig, but in no way recommend that for anyone else, as these massage techniques carry considerable risks. If you do insist on trying it, touch yourself with the lightest possible touch (as recommended by the Kuttner video above).

The most important concept for me is the “top down” principle of triggers. It is best to work the knots at the top of the chain to ensure release of the lower ones. This is also mentioned in Claire Davies book. If you work those, the ones below tend to release as the muscles lengthen. From a common sense perspective, you can see how this should be true if you imagine a rope with knots in it. I’ve had about 6-7 nearly marble sized triggers deep in the neck muscles for a quite a while now. There are just too many and touching any one of them tends to make them yank and seize on their trigger brethren, growing even harder. Still I imagine a day when these little devils in my neck will be a thing of the past.

One night, (following the "top down principle") I decided to locate the highest trigger point in my scalene muscles and tackle this issue with with them once and for all. Moving up, I took my left thumb and gently pushed higher and higher towards the bottom of my jaw. Once I relaxed I found myself releasing the entire muscle group to the side of the jaw line and I worked my way further up until eventually I traced the muscle tension over the ear and to the little depression in the skull. With a gentle push I completely relaxed my jaw. I had no idea it was so clenched. (As a mental aside, I thought to myself, is this a dental problem? Does my unconscious jaw clenching cause the attaching scalene muscles to tighten?) With this key relaxation I then worked my thumb back down, gently pushing the now releasing scalene triggers over to the right. I felt my lower triggers in my shoulder and forearm beginning to release even before I got there. Little by little, I worked my way down, pushing away and releasing the knots down the chain, eventually reaching the attachment at the clavicle and underneath the rib cage, where the muscles then work through the thoracic region. I continued to work the trigger point path working through the bicep and over the forearm to the fingers. Essentially the entire region is like one continuous line extended from the jaw down through the rib cage, the arm and the fingers. And then suddenly I had done it. I completely released it. I regained full range of motion through my shoulder. Previously I had been unable to lay flat on my back due to the thoracic ache and swelling on my right side. Now I was able to do this completely comfortably. I was in heaven. Not only could I trace the entire muscle network, but I could sense correctly the entire nerve pathway of my neck and arms. It was like I could almost feel the electric current underneath my skin. I imagined a theory of trigger points, that they were like resistors, modulating and dividing up the current and bunching up in response, lessening the flow but causing pain in the process. But this was also an uncomfortable feeling as my arm felt like an ungrounded wire. All these deep concentration imaginings aside, I was happy enough with the result and I lay myself to sleep for the rest of the morning hours.

When I awoke, all the muscle knot triggers were back. I was crestfallen. Recently, in the midst of my worst suffering (I will recount my experiences in a follow-up blog), I repeated the same trigger point release actions and eventually got the same result, only this time, no sooner did I get to the end of this trigger point row ending in my hand that the top knot in the neck began to reform and seize up again. I held my just released hand trigger down as I went back up and re-relaxed the neck trigger. But it was like having a tiger by the tail. Something was hitting the button to fire up these muscle spasms and there wasn’t a blessed thing I could do about it. Like little weeds on steroids, they all came back within a few minutes.

So all told, I would say I have had essentially zero success with trigger point massage. But there is sort of seduction when you get into it, as with any physical habit of futzing with your body in ways you shouldn’t. Haven’t we all popped our zits or picked a scab? You think, this time I can get it to release. And you keep trying and this goes on for months. Again some might say I have failed by either overmassage or missing the trigger point entirely. As stated I think that trigger massage can be successful for those who don't have excessive nerve compression and have muscles that can relax. Sadly I am not that fortunate in this regard. I am trying to keep an open mind as to the cause however, as there are some other possible reasons for my spasmodic muscles outside of the nerve compression model that I am currently exploring. I will talk about them in a future blog.

Next time: To Hell and Back