ROCKSHOULDERS – Page 8 – Rock climbing injury rehab & prevention

You want to know how to do trigger point therapy? Then you're in the right place. Trigger points are hyperirritable spots within your muscles and can provoke dull and sharp shooting pain. They can make your muscle feel tense, sensitive, and on top of that, they can reduce your mobility and strength. This means that besides provoking discomfort, trigger points can thus also reduce your climbing performance. Luckily, there are plenty of ways to treat trigger points. That’s why in this blog you’re going to learn about trigger point therapy for climbing, which types of myofascial release there are, and for which you need to see a therapist and which you can do yourself. Before you can treat a myofascial trigger point though, you need to know what they are and where to find them. So, that’s where we’re going to start. Are you ready? Let’s go. 1. What is a Myofascial Trigger Point? Let's start with a quick look at definitions and the scientific discussion around trigger points. It’ll only take a minute. First, it's good to know what “myofascial” means. Because, in the scientific literature, trigger points are often described as “myofascial trigger points”. Myofascial means muscle (myo) and connective tissue (fascia). Thus, you can find a myofascial trigger point in the muscle and connective tissue. The official definition of a trigger point is: A myofascial trigger point is a hyperirritable spot within a taut band of skeletal muscle that is painful on compression, stretch, overload, or contraction of the tissue which usually responds with a referred pain that is perceived distant from the spot.[i] But then this: even though trigger points were first described in 1999 there’s still no agreement on the (real) origin of a trigger point. Some people believe the above, others that it’s a neurologic dysfunctionQuintner JL, Bove GM, Cohen ML. A critical evaluation of the trigger point phenomenon. Rheumatol (United Kingdom). 2015;54(3):392-399. doi:10.1093/rheumatology/keu471, and again others think it’s a muscle spindle dysfunction.Partanen J V, Ojala TA, Arokoski JPA. Myofascial syndrome and pain: A neurophysiological approach. Pathophysiol Off J Int Soc Pathophysiol. 2010;17(1):19-28. doi:10.1016/j.pathophys.2009.05.001 Does this matter to you as someone who wants to do trigger point therapy to treat and prevent climbing injuries? I believe not. Why? Because I know from my experience as a Physical Therapist that I can reduce pain and discomfort with the help of trigger point therapy. And that as a result, the patient experiences increased mobility, better coordination, and improved strength. 2. What are the Symptoms of a Trigger Point? There are 2 types of myofascial trigger points: Active. A trigger point you feel without actively provoking it. This type of hypertension can be the source of your shoulder or forearm pain for example. Passive. A passive or latent myofascial trigger point only produces pain when you provoke it. For example, if you start pressing into your trapezius muscle right now, there’s a chance you’ll find a tender spot that produces radiating pain. This would be a passive trigger point. Both active and passive myofascial trigger points have similar symptoms: They produce a sharp or dull painThe pain can be felt in a different location than where the trigger point is atIn the case of an active trigger point, when you press into a muscle the tender spot produces a familiar painWhen pressing into a muscle you notice a tout band within a muscle fiber 3. How do Myofascial Trigger Points Come into Being? When you climb, you mostly exert your forearm and shoulder muscles pulling on small holds. And on top of that, often in awkward body positions. This requires a lot of muscle tension which over time can generate an overload resulting in trigger points. At the site of a trigger point, there’s a different chemical balance than in places without them.Shah JP, Phillips TM, Danoff J V., Gerber LH. An in vivo microanalytical technique for measuring the local biochemical milieu of human skeletal muscle. J Appl Physiol. 2005;99(5):1977-1984. doi:10.1152/japplphysiol.00419.2005 For example, chemicals like substance P and TNF-alpha are more present.Shah JP, Gilliams EA. Uncovering the biochemical milieu of myofascial trigger points using in vivo microdialysis: an application of muscle pain concepts to myofascial pain syndrome. J Bodyw Mov Ther. 2008;12(4):371-384. doi:10.1016/j.jbmt.2008.06.006 These are chemicals that you otherwise find at the site of an inflammatory response. Say, due to a cut in your arm or a torn muscle. Thus, on a microscopical level, there’s an inflammatory response and a lack of blood flow in the muscle fiber. This stimulates nerve endings and sends a pain signal to your brain. Since a trigger point prohibits normal blood flow, it’s hard for the body to clean out the inflammatory chemicals. This, then, leads to continuous stimulation of pain receptors. Do you see how this is a vicious cycle? The inflammatory chemicals provoke pain. The brain notices the pain and tenses the muscles in return. This makes it even harder to clear out the chemicals which results in more stimulation of pain receptors. Which your brain responds to, again, with an increase in muscle tension. Now you know what a trigger point is. Let’s see where you can find them throughout the body. 4. Where are Myofascial Trigger Points? Trigger points can be found in every muscle of the body. As a rule of thumb, mostly at a third or at two-thirds of the length of a muscle. Here are some trigger points and their referred pain patterns that often occur in climbers. Levator Scapulae Muscle Source: Davies, C - The Trigger Point Therapy Workbook: Your Self-Treatment Guide for Pain Relief - 2001 Trapezius Muscle (Ascending Part) Source: Davies, C - The Trigger Point Therapy Workbook: Your Self-Treatment Guide for Pain Relief - 2001 Infraspinatus Muscle (Rotator Cuff) Source: Davies, C - The Trigger Point Therapy Workbook: Your Self-Treatment Guide for Pain Relief - 2001 Source: Davies, C - The Trigger Point Therapy Workbook: Your Self-Treatment Guide for Pain Relief - 2001 Flexor Digitorum (Profundus & Superficialis) Source: Davies, C - The Trigger Point Therapy Workbook: Your Self-Treatment Guide for Pain Relief - 2001 5. What is Trigger Point Therapy? Trigger point therapy for climbing can be done in several ways. Manually by: Manual Friction Massage (MFM)Pin and Stretch/Activate Techniques But also, with tools like: Dry NeedlingInstrument Assisted Soft Tissue Mobilization (IASTM) ToolsFoam Rollers and BallsMassage Guns 5.1 Manual Friction Massage MFM is often combined with stretching between and at the end of releasing the myofascial trigger point. At least that’s how I was taught to apply trigger point therapy in University. Here’s an example of how that goes down: 60 Seconds of MFM on the affecting muscle30 Seconds of stretching the muscleRepeat 3 times The purpose of stretching the affected muscle is to help restore range of motion and support blood flow. Nowadays though, I prefer to combine MFM with activating the muscle. A typical treatment would look like this: 2-3 Minutes of MFM in the affected muscle20-30 seconds circular massage to increase more blood circulation, to rest my fingers, and give the patient time to recover from the treatmentRepeat 3-5 timesI select an isolation exercise that specifically targets the muscle I treated and do 3x25-30 repetitions with low weight. In the case of a trigger point in the supraspinatus muscle this could be an “Outie”, and in the case of the supraspinatus muscle a later abduction until 70 degrees. This will enhance blood circulation and provide your brain with a signal that the muscle is functioning. This, in turn, helps break the pain-spasm cycle. 5.2 Pin and Stretch/Activate Release Pin and Stretch and Activate is a type of MFM combined with either stretching the muscle or activating it. This can be done passively (by a therapist) or actively (by the patient). For example, if you want to release the right descending trapezius muscle, apply fiction to the trigger point. Then, pull the head of your patient slowly to the left side. This will stretch the muscle tissue under your finger. If you want to do it actively, you can ask the patient to move their head slowly to the left. This is pin and stretch. Pin and activate would work like this: apply pressure, again, to the trigger point in the right descending trapezius muscle. Now, slowly elevate the right shoulder. This will activate the muscle you’re applying friction to. Be sure to slowly contract so that you can maintain your pressure. And even more importantly, aim to relax the muscle entirely on the way down. As things go, when a muscle was tense for long you might’ve forgotten how to relax it. The better you or your patient can relax though, the more effective the trigger point therapy. 5.3 Dry Needling In the case of dry needling, a therapist will insert a needle right into the myofascial trigger point. The purpose is similar to that of friction massage. In research where they looked if dry needling or manual massage was more efficient for neck and shoulder pain there was no difference between the two strategies. Both seemed to work equally well.De Meulemeester KE, Castelein B, Coppieters I, Barbe T, Cools A, Cagnie B. Comparing Trigger Point Dry Needling and Manual Pressure Technique for the Management of Myofascial Neck/Shoulder Pain: A Randomized Clinical Trial. J Manipulative Physiol Ther. 2017;40(1):11-20. doi:10.1016/j.jmpt.2016.10.008 5.4 Instrument Assisted Soft Tissue Release (IASTM) IASTM can be used as a tool for trigger point therapy for climbing but isn’t limited to trigger points alone. It’s a way to release soft tissue, like muscles, ligaments, tendons, and other connective tissue in general. There are many types of IASTM tools. They can be from stone but are mostly made of stainless steel. And come in all forms and shapes to aid you in releasing soft tissue all over the body. The pen-shaped ones are best for trigger point therapy in climbing. Since they allow to apply pressure very specifically. IASTM can be applied by a therapist, or by doing self-myofascial release. 5.5 Foam Rollers and Balls By now, I barely know anyone that’s into sports and doesn’t have a foam roller. They’re the ultimate trigger point therapy tool for climbers. Since they’re super light, easy to use, and help you take control of your injury prevention. On top of that, foam rollers, balls, knobs and you name it, are easy to bring along. Allowing you to use them while warming up at the crag as well.When it comes to trigger point therapy, you’re best at using a ball-shaped foam roller, a tennis ball, or a lacrosse ball. These help you penetrate muscles better and thus allow you to apply friction to a trigger point. Then, it’s up to you, if you apply MFM or Pin and Stretch/Activate techniques. Since this is super useful information, but a subject on its own. Click to read my blog about foam rolling and how to use it as a climber. 5.6 Massage Guns Even though I don’t have any experience with massage guns myself, I do think they look very promising. They seem to be great in targeting specific trigger points, and if they can generate enough force, they might help you with your trigger point therapy. In the future, I’ll have a look at good massage guns, and tell you all about it! 6. What to do after Trigger Point Therapy for Climbing? To enhance the effect of trigger point therapy for climbing there are several things you can do: Stretch the affected muscle for 30-60 seconds between bouts of pressureActivate the muscle with an isolation exercise after you finished trigger point therapy. Aim for a high number of repetitions with a weight you can easily handle.Do hot-cold therapy with ice and a shower or just a shower alone. Switch between 1 minute hot and 1 minute cold for 3 to 5 times to boost blood flow in the region you just treated.And last, but not least, act like if you weren’t feeling any pain. As things go, trigger points can provoke annoying sensations which might make you look for positions and movements to reduce them. But this will only lead to more tension in the affected muscle and the ones around. So, the more natural you move, the sooner you’ll be relieved from your discomfort. 7. Important Take-Aways Trigger point therapy in climbing is a highly effective way to maintain or regain muscle and joint health. Remember to look for trigger points at one-third and two-thirds of your muscles. Then, try to nail down the point which provokes the most pain. If you’re applying pressure in the right spot, you’ll experience a sharp or dull radiating pain that gets less after maintaining pressure. If you have a trigger point that doesn’t want to go to, be sure to go see a physiotherapist. He or she can then apply MFM or Dry Needling for you. Then, for best results, complement your treatment with the self-myofascial release strategies discussed in this blog. 8. Citations Quintner JL, Bove GM, Cohen ML. A critical evaluation of the trigger point phenomenon. Rheumatol (United Kingdom). 2015;54(3):392-399. doi:10.1093/rheumatology/keu471Partanen J V, Ojala TA, Arokoski JPA. Myofascial syndrome and pain: A neurophysiological approach. Pathophysiol Off J Int Soc Pathophysiol. 2010;17(1):19-28. doi:10.1016/j.pathophys.2009.05.001Shah JP, Phillips TM, Danoff J V., Gerber LH. An in vivo microanalytical technique for measuring the local biochemical milieu of human skeletal muscle. J Appl Physiol. 2005;99(5):1977-1984. doi:10.1152/japplphysiol.00419.2005Shah JP, Gilliams EA. Uncovering the biochemical milieu of myofascial trigger points using in vivo microdialysis: an application of muscle pain concepts to myofascial pain syndrome. J Bodyw Mov Ther. 2008;12(4):371-384. doi:10.1016/j.jbmt.2008.06.006De Meulemeester KE, Castelein B, Coppieters I, Barbe T, Cools A, Cagnie B. Comparing Trigger Point Dry Needling and Manual Pressure Technique for the Management of Myofascial Neck/Shoulder Pain: A Randomized Clinical Trial. J Manipulative Physiol Ther. 2017;40(1):11-20. doi:10.1016/j.jmpt.2016.10.008