CROSSFIT LONDON UK - Trigger Point Wod

According to Christian Lemburg ( Crossfit Journal 2005 issue 37 What are trigger points? According to some statistics, skeletal muscle accounts for 40-50 percent of body weight, and about 85 percent of human pain complaints. In athletes, most chronic pain issues are of myofascial (muscle- or sinew-related) origin. This is not surprising, since athletes tend to use their muscles and sinews much harder than the average population. What is surprising is that when athletes go to the doctor because of some annoying pain that won?t go away, hardly ever are their muscles examined and screened for problems. Instead, the doctor usually looks at their tendons and joints, and, in the end, the problem is likely to be blamed on some type of ?-itis??tendinits, bursitis, arthritis, you name it. In this article, I want to draw your attention to a more likely cause of your pain?one that is directly related to your muscles. I am talking about trigger points. Trigger points are small, localized muscle cramps with a variety of causes, most notably excessive loads, direct trauma, or repetitive or prolonged muscle contractions. The cramp does not normally affect the whole muscle but is usually confined to one or two small muscle fibers within the main body of the muscle. You can actually feel the cramp as a hard lump or knot in your muscle. Sometimes, especially in small muscles, the whole muscle will feel like a cable made from hard rubber. Trigger points are not related to acupuncture points, energy points, or other esoteric concepts. Trigger points can be seen in the microscope. They can be felt as hard knots in your muscles. And oh yes, they hurt when pressed. Trigger points differ from other causes of pain in that they often produce pain in other sites in the body. This is called referred pain, and it can be a very annoying and perplexing problem. For instance, you may have pain in your elbow that is caused by a trigger point in your shoulder, your forearm muscles, or in the triceps. A trigger point in the peroneus muscle (which is at the outside of the lower leg and makes the foot move down and outward) will cause pain in the ankle, not at the side of the leg where the muscle is. Trigger points in the quads will make your knees hurt. And trigger points in the calves will usually cause pain under your foot. Referred pain is mediated through spinal cord mechanisms. ?Sneaky things, these trigger points,? you might say? and you would be right. Most people in the medical profession have been slow to learn about trigger points. Rarely do you find a good physiotherapist who is able to identify and treat the problem. This is why self help is so important for dealing with trigger points. Trigger points arise at predictable places in the muscle and cause predictable patterns of referred pain. This makes it possible to make up a catalog of trigger points and show for each muscle the trigger points it usually has together with the sites of the referred pain it causes. As a side note, it is good to know that many muscles, especially slender and long ones or those with  of 4 ? CrossFit is a registered trademark of CrossFit, Inc. ? 2006 All rights reserved. Subscription info at Feedback to Trigger Point Massage (continued...) a feathered fiber orientation, may develop multiple trigger points. Typically, a trigger point will develop in the middle of a muscle. But since muscles are made up of many fibers, sometimes with different orientations, trigger points can occur at multiple sites within a single muscle. To identify trigger points, physiotherapists or physicians compare your complaints to the pain pattern of trigger points they know and to catalogs of common trigger points and then feel around in your muscles for hard knots in the likely places. They will know that they found something when you twitch in agony when the knot is pressed. What can I do about trigger points? Trigger points can be treated by several methods: injection, spray and stretch, and massage. In the injection method, a small dose of local anesthetic is injected into the trigger point. In the spray and stretch method, the trigger point is iced with a vapocoolant spray and then stretched. Neither of these methods is suitable for self- help. Massage treatment of trigger points, however, is very effective and you can easily do it yourself. Here are some guidelines for how to massage a trigger point: ? Massage with short, slow strokes in one direction, applying deep pressure. ? Aim for a pain level of about 7 on a scale of 1 to 10, where 1 is hardly noticeable and 10 is unbearable. ? Massage often but only for a short time (twelve to twenty strokes is usually sufficient per session) ? Don?t try to ?kill? the trigger point in one session; perform several brief sessions per day. ? Continue massage sessions until pain has subsided to about pain level 3 (this will often take several sessions). Referemce Davies, Claire, with Amber Davies. The Trigger Point Therapy Workbook: Your Self-Treatment Guide for Pain Relief. 2nd Edition. Oakland, CA: New Harbinger, 2004. Just get this book. It will save you much pain and possibly a lot of money, too. The Pain Navigator web page may help you to pin down the cause of your pain. It details trigger points according to the site of the referred pain. The Coventry Pain Clinic?s web page contains excellent pictures and detailed, up-to-date information about trigger points. Note the other sections as well (e.g., the section on joints contains articles about tennis elbow and golfer?s elbow). Of course, all instructions presented here are for informational purposes only. The author is not a medical professional and is not liable for any damage you cause by applying this information to yourself or others. If you are unsure about any information presented here, please consult your physician. According to Wikipedia The term "trigger point" was coined in 1942 by Dr. Janet Travell to describe a clinical finding with the following characteristics: Pain related to a discrete, irritable point in skeletal muscle or fascia, not caused by acute local trauma, inflammation, degeneration, neoplasm or infection. The painful point can be felt as a nodule or band in the muscle, and a twitch response can be elicited on stimulation of the trigger point. Palpation of the trigger point reproduces the patient's complaint of pain, and the pain radiates in a distribution typical of the specific muscle harboring the trigger point. The pain cannot be explained by findings on neurological examination. Practitioners do not necessarily agree on what constitutes a trigger point. A study by Gerwin et al. found that independent examiners were generally able to identify myofascial trigger points (MTrP), but only with sufficient training and agreement on the definition and features of MTrP's. They said: Three previous studies (Nice et al., 1992; Wolfe et al., 1992; Njoo and Van der Does, 1994) have examined this problem, and none of them could establish the reliability of MTrP examination in all of its major manifestations. ... The present study shows that four examiners can achieve statistically significant agreement, at times almost perfect agreement, about the presence or absence of five major features of the MTrP and on the presence or absence of the TrP, whether it be latent or active. This establishes the MTrP as a reliable clinical sign. The present study also shows that these features are identified with greater or lesser reliability depending on the specific feature and the specific muscle being examined. ... A training period was found to be essential in order to achieve these results.[3] A 2007 review of diagnostic criteria used in studies of trigger points concluded that there is as yet limited consensus on case definition in respect of MTrP pain syndrome. Further research is needed to test the reliability and validity of diagnostic criteria. Until reliable diagnostic criteria have been established, there is a need for greater transparency in research papers on how a case of MTrP pain syndrome is defined, and claims for effective interventions in treating the condition should be viewed with caution.[2] references REFERENCES 1. Imamura ST, Fischer AA, Imamura M, Teixeira MJ, Tchia Yeng Lin, Kaziyama HS, et al. Pain management using myofascial approach when other treatment failed. Phys Med Rehabil Clin North Am. 1997;8:179?96. 2. Cole TM, Edgerton VR. Musculoskeletal disorders. In: Cole TM, Edgerton VR, eds. Report of the Task Force on Medical Rehabilitation Research: June 28?29, 1990, Hunt Valley Inn, Hunt Valley, Md. Bethesda: National Institutes of Health, 1990:61?70. 3. Hong CZ, Hsueh TC. Difference in pain relief after trigger point injections in myofascial pain patients with and without fibromyalgia. Arch Phys Med Rehabil. 1996;77:1161?6. 4. Simons DG, Travell JG, Simons LS. Travell & Simons' Myofascial pain and dysfunction: the trigger point manual. 2d ed. Baltimore: Williams & Wilkins, 1999:5. 5. Han SC, Harrison P. Myofascial pain syndrome and trigger-point management. Reg Anesth. 1997;22:89?101. 6. Ling FW, Slocumb JC. Use of trigger point injections in chronic pelvic pain. Obstet Gynecol Clin North Am. 1993;20:809?15. 7. Mense S, Schmit RF. Muscle pain: which receptors are responsible for the transmission of noxious stimuli? In: Rose FC, ed. Physiological aspects of clinical neurology. Oxford: Blackwell Scientific Publications, 1977:265?78. 8. Hopwood MB, Abram SE. Factors associated with failure of trigger point injections. Clin J Pain. 1994;10:227?34. 9. Fricton JR, Kroening R, Haley D, Siegert R. Myofascial pain syndrome of the head and neck: a review of clinical characteristics of 164 patients. Oral Surg Oral Med Oral Pathol. 1985;60:615?23. 10. Simons DG, Travell JG, Simons LS. Travell & Simons' Myofascial pain and dysfunction: the trigger point manual. 2d ed. Baltimore: Williams & Wilkins, 1999:94?173. 11. Rachlin ES. Trigger points. In: Rachlin ES, ed. Myofascial pain and fibromyalgia: trigger point management. St. Louis: Mosby, 1994:145?57. 12. Fischer AA. Injection techniques in the management of local pain. J Back Musculoskeletal Rehabil. 1996;7:107?17. 13. Simons DG, Travell JG, Simons LS. Travell & Simons' Myofascial pain and dysfunction: the trigger point manual. 2d ed. Baltimore: Williams & Wilkins, 1999:11?93. 14. Yunus MB. Fibromyalgia syndrome and myofascial pain syndrome: clinical features, laboratory tests, diagnosis, and pathophysiologic mechanisms. In: Rachlin ES, ed. Myofascial pain and fibromyalgia: trigger point management. St. Louis: Mosby, 1994:3?29. 15. Sola AE, Bonica JJ. Myofascial pain syndromes. In: Bonica JJ, ed. The management of pain. 2d ed. Philadelphia: Lea & Febiger, 1990:352?67. 16. Rachlin ES. History and physical examination for regional myofascial pain syndrome. In: Rachlin ES, ed. Myofascial pain and fibromyalgia: trigger point management. St. Louis: Mosby, 1994:159?72. 17. Hong CZ. Lidocaine injection versus dry needling to myofascial trigger point. The importance of the local twitch response. Am J Phys Med Rehabil. 1994;73:256?63. 18. Ruoff GE. Technique of trigger point injection. In: Pfenninger JL, Fowler GC, eds. Procedures for primary care physicians. St. Louis: Mosby, 1994:164?7. 19. Fischer AA. New approaches in treatment of myofascial pain. Phys Med Rehabil Clin North Am. 1997;8:153?69. 20. Zohn DA, Mennell JM. Musculoskeletal pain: diagnosis and physical treatment. Boston: Little, Brown, 1976:126?9,190?3.




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