Online Telehealth Appointments

What is telehealth physiotherapy? 

This is the delivery of health care information and services specific to you and your needs via electronic communication. That is management and treatment of your musculoskeletal, pain and pelvic health issues . 

 What are the benefits of telehealth physiotherapy? 

There are numerous benefits it can offer, that is
– Able to receive to expert physiotherapy advice and treatment in the comfort of your home,
– Provides convenience 
– Easy access to specialized services 
– Empower yourself and take control over your recovery  

Will I be covered under my insurance or ACC?

ACC has recently approved funding for patients to access physio via telehealth during the Covid-19 Lockdown to stop the spread. Most insurance companies have followed suit, but it may take just a phone call to clarify they include the service.  

 

Exercise prescription telehealth

Can anyone in the world access these services? 

No, this is only valid for people residing in New Zealand. 

Will my session be recorded?

No. This can be arranged on request. We will be using a secure online platform called physitrack that is encrypted. We ask that you download the app  via this link prior to the session on to your device (smartphone or tablet) or via this link if using a desktop computer.   

What equipment will I need?

All you need is a good internet connection and a webcam and a private quiet space. The physiitrack app will enable us to set up customized exercises with pictures, videos and instructions as well as educational materials and questionnaires as required. 

If you have any further questions contact on 096346469 or ONLINE BOOKING

Physio Auckland

Preparing for the Open

During the CrossFit Open, you need to be prepared for anything. Whether you’re scaling or going Rx, you will be challenged both physically and mentally.


Physio Auckland


Book Appointment

Visit our Location

16 Morgan Street, Newmarket


Give us a Call

09 529 0990


Send us an Email

admin@fundamentalphysio.co.nz


Opening Hours

Mon – Friday: 8:30am – 6pm

Preparing for the CrossFit Open

Preparing for the CrossFit Open​

The 2019 CrossFit Open registration has been released. Are you competing this year? Is this your first time or are you a seasoned Vet? To succeed at whatever level, it’s important to know what you’re up against and how to prepare.

What is the CrossFit Open?

The Open is the first Qualifying stage to make it to the CrossFit Games. It’s an opportunity for participants of all skill levels to pit their wits. Lasting 5 weeks, with a new workout each week, announced midday Friday (NZT). Athletes have until Tuesday at noon to complete the workout and register their score.

The format of qualifying for the Open has changed this year.

The Games are broken down into these stages:

The Open – Initial 5-week stage of competition, anyone can compete. The top 20 athletes qualify for the games.

Sanctioned events – 3-day invitational competition for the top athletes. The winners move on to The Games.

The Games – 4-day competition consisting of 40 men, 40 women, 40 teams. The Winner of each is earns the title, Fittest on Earth.

A large emphasis from the CrossFit brand is the community feel within each gym. The Open encompasses this on a global scale, as everyone can participate in the Open. It allows you to push a little harder, work on weakness’ and compare yourself against others.

What to expect from Open workouts

During a regular week of training it’s typical to expect the core foundational movements of CrossFit and WOD’s (Workout Of the Day) that you’re familiar with. The Open provides level of suspense in the wait for its announcement on the day. While keeping the foundational skills of CrossFit they always throw in unexpected movements to throw you off guard.

Sometimes they will repeat a workout from a previous Open, or use a new piece of equipment. In 2017 was the introduction of dumbbells to the WOD’s, which threw a lot of athletes off guard. 

How many times can I do an Open workout?

You have 4 days from Friday midday to Tuesday Noon to attempt the workout as many times as you want. This also depends on your gyms Open policy, as some only offer certain time periods.

Realistically though, you’re likely to attempt it only twice, sometimes three times depending on the workout. You’ll need time to recover from the first attempt by at least 1-2 days.

While it’s important to get the best result you can do. It’s also important to spend time at the gym to offer your mates moral support and help out as judges.

Prepare a workout strategy

If you’re doing this for the first time or just started training in CrossFit speak with your coach about a plan. Coaches will know your abilities and be able to offer you a realistic strategy to get the best result. The main thing for first timers, is to enjoy the experience.

For the more experienced athlete, you have trained long enough to know your limitations, your burn outs, you understand pace setting and max lifts. From this knowledge, whatever workout is announced you should be able to form an air tight strategy to get the best out of your ability.

Think about things like:

  • Where do I exert the most energy
  • How many reps before breaking
  • How to transition between equipment the fastest
  • What pace should I keep to maintain the best time
  • How long to take for a breather

Note: Once you’ve formed a plan let your judge know so they understand. You may also want to write it down to remain strict as you start to fatigue.

Being mentally and physically prepared

Preparing before the Open with only a few weeks to go, it’s unlikely you will learn new skills. Try to focus on the current ones you’re capable of and become more efficient at them. If you plan to do extra training, make sure you’re not over training. Try to focus the extra work on cardio, skill-based training or mobility.

The Open is equal if not more challenging to your mental capacity. This often is what sets two athletes apart. The ability to silence the voice inside that is telling you to stop. Strategies higher reps in your workouts leading up to Open before breaking. Also use visualisation techniques to be prepared in both mind and body.

Embrace the embarrassment or work on your weakness’

In CrossFit they call them goats. The movements you least enjoy and likely the ones your avoiding the most. The Open has the ability of exposing your weakness’. So rather than being exposed put in a little extra time after training to work on that skill. Whether it’s a double under you keep snagging or Olympic lift you’re struggling to catch. Getting better at these will improve your overall placement.

The Open does a good job at showing where your weak links are. Accept it and move on. The silver lining is that it provides you with an understanding of what needs more work for the new year.

Whether it’s your first or tenth time, embrace the experience. Put in a good effort have fun and support the other athletes.

How can Physio help

As mentioned the Open challenges you in so many ways and knowing where you’re failing already provides a tonne of information about which body part could be at fault and how to direct your treatment plan. If you find yourself struggling with an injury leading up to the Open or throughout the competition have a look online.

Throughout the Open as each workout is announced I will be uploading videos of mobility drills to help prepare you for the whats to come. Keep an eye on Facebook and Instagram. 

Copyright 2017 © All rights Reserved.

Managing an acute injury

Knowing how to immediately look after an injury for the first few days can speed up its recovery. In this blog we look at a more up to date protocol on how to help you manage it.

Many of us are well versed on the R.I.C.E acronym (Rest, Ice, Compression, Elevation). Which eventually was upgraded to P.R.I.C.E (P = Protect). Over the last few decades the advice on the management of acute injuries has rarely been contested. However, with growing research there has been a change in the way clinicians deliver advice on acute injuries to patients. With more recent research there is a new acronym called P.O.L.I.C.E. Standing for Protect Optimal Loading Ice Compression Elevation.

What’s changed?

The term REST can be completely misinterpreted. While it’s important to have a balance of rest AND loading. Too much rest can lead to
deconditioning of tissues, stiffness and weakness. By OPTIMALLY LOADING tissue it provides the right levels of stress to encourage tissue healing, while assisting with the drainage of swelling.

What is the right amount of load?

Firstly, you must listen to the pain and not try to push through it. But if in doubt seek advice from a health professional, whether it be a Dr or Physio. Assessing the injury will help clear any serious problems, like fractures or ruptures. After having the serious issues cleared, you can be guided on the appropriate movements or weight bearing exercises to perform.

If in doubt seek advice from a Health professional

Additionally, to help provide the right loading you may require a moon boot, crutches, brace or strapping for support. Before being gradually weaned off.

Ice

I’ve previously questioned the value of applying ice for reducing swelling. There is growing evidence that shows that we need some swelling to aid in the healing process and  by using ice to minimise swelling, we could be slowing down the rate of tissue healing. 

See: hold the ice in RICE

But using the ice instead to reduce pain, by limiting nerve conduction and lowering tissue temperature. This can be effective within 5-10 minutes of application. Doing this every hour will bring pain levels down allowing you to move or load the tissue as tolerated.

Side note: Make sure you regularly check tissue quality while icing to avoid frost bite.

Compression and Elevation

These two are the least controversial in their benefit of recovery from acute injuries. Having compression helps maintain swelling to a manageable level and the area can still move normally. Making sure the compression is tight but not causing pain or numbness. You can use crape bandaging or a tubigrip.

Elevation, particularly for the lower limb helps again at minimising excessive swelling. While elevated it helps to be gently moving the
area, which also assists with tissue healing and swelling.

Anytime you’re dealing with a new injury it’s important follow the most up to date advice to help you recover as quickly and safely as possible. By seeking physio, we can offer you that guidance and support as you progress. At Fundamental Physio Newmarket, you’ll be thoroughly assessed to identify the extent of your injury, then put on the right treatment plan to help you return to normal activity. 


References

Bleakley et al 2012 PRICE needs updating, should we call the POLICE? Br J Sports Med 

Algafly et al. 2007. The effect of cryotherapy on nerve conduction velocity, pain threshold and pain tolerance. Br J Sports Med

Malanga et al 2015. Mechanisms and efficacy of heat and cold therapies for musculoskeletal injury. Postgrad Med

Top 5 Posts of 2017

Entering the new year here’s a look back at last years 5 most popular blogs.

Happy New Year – 2018 is already under way. Hope you all had a great break.

Last year was a busy year with the blogs. Here are the top 5 posts from last year in case you missed them.

5. The Office WOD

  • How many of us at work get stuck in the same position and forget to move?
  • This post was offering some general strengthening and postural awareness exercises to follow regularly at work.
  • Try getting into a routine with these types of exercises. It should help prepare you better for training.

4. Trigger Points – what are they?

  • Those knots felt in your traps after a busy day at work are more than likely trigger points.
  • This blog goes into explaining what they are, how they’re caused and how they’re treated.

3. Recovering from DOMS

  • This was a popular topic as we all love a bit of DOMS.
  • Understanding how to manage your recovery and training while in the DOMS phase will make it more tolerable.
  • Also knowing the difference of pain between DOMS and an injury will help avoid making anything worse.

2. Improving front rack position

  • After doing many mobility assessments, the front rack shape is what most people struggled to hold passively without a bar.
  • This was one of a 4 part series of shoulder shapes we should be achieving to help make movement more efficient.
  • It offered a range of mobility exercises to open the shoulder into the front rack.

1. Anterior knee pain in CrossFit

  • One of the most common injuries in sports and top 3 with CrossFit athletes is a knee injury.
  • This blog looked at anterior knee pain and the common causes. It offers some basic suggestions to self managing the injury.

The purpose of these blogs has been to provide a wider understanding of your body and give you more control of it. Wishing you all an injury free 2018 and keep checking for the new blogs.

What’s causing my muscle tightness?

Muscular tightness is one of the disruptions to normal movement and if not managed well can lead to possible injury. Identifying your tightness and using specific strategies will help relieve tension.

One of the main issues patients struggle with is muscular tightness. They get a feeling of pain or tightness and an inability to relax the muscle.

What is tightness?

When looking at patients I need to find out if they have mechanical stiffness or the “feeling” of tightness or a combination of both, as this would direct my treatment plan.

Is the range of movement limited? does it have a soft or hard end feel? Are movements a struggle at end range, feeling heavy? What’s the rest feeling like, is it a constant tightness?

While we can have mechanical tightness of a joint or muscle, there are also the “feelings” of tightness. You might get your hands to the floor with your legs straight and feel the hamstrings tightening. While another person could do the same, get to their knees and not have tightness.

What causes the feeling of tightness?

Tightness is a sensation like many others, including pain. What we understand from pain is that this is not always brought on physically, but also by the perception of threat.

pathway-of-a-pain-message-via-sensory-nerve-in-injured-muscle,2324600

So like pain, tightness is a protective mechanism from the central nervous system to avoid danger. On a number of levels it detects stressor’s that expose the whole body or specific region to threat.

Examples of this…..

  • Prolonged sitting, without movement we often notice tightness in certain areas, possibly through reduced oxygen supply and increased metabolic toxicity.
  • Stressful situations cause rising cortisol levels and increased activity of the Vagus nerve leading to muscular tightness.
  • Repetitive movement over a period of time causes increased tension.
  • Posture muscle tightnessInjury or pre-existing weakness can cause a guarding response from the nervous system.

Using tightness as a warning sign for these potential threats might allows us to acknowledge the situation and quickly act upon it.

What will help my tightness?

Like all movement patterns, we improve with practice. The same goes for muscle tightness. If we regularly bombard it with neural messages to remain tight we develop trigger points and chronic tightness through a process called central sensitisation. Which makes the tissues more sensitive to pain and tightness.

If we can regularly supply our nervous system with input that is non-threatening we can slowly help desensitise the muscle. But this takes time and regular repetition.

Stretching

Most people with tightness, especially after prolonged rest feel the need to stretch out. But depending on our intended goal there are different types of stretches.

  • Static stretches
  • Active stretches
  • Dynamic stretches
  • PNF (Contract-relax)

While these stretches will help, it might only be temporary without regular repetition and reinforcing the nervous system with good movement.

Strengthening

There is a misconception that resistance training causes our muscles to feel tighter. Mainly due to the effect of DOMS. That feeling of soreness you have the day after a hard workout. But some recent studies have shown that strengthening can be equally, if not more beneficial than stretching.

Improvements in flexibility coming from improved ability to handle higher levels of metabolic stress and lower levels of inflammation. By lowering the threat to the nervous system through increased strength, it allows you to work the muscle through a wider range, without getting a stretch reflex.

Massage and other soft tissue work

Another way to help desensitise these tight muscles is to apply pressure. This could be with the use of a foam roller/lacrosse ball or other manual therapy techniques like deep tissue massage, myofascial release, trigger point release, dry needling.

Relaxation techniques and breathing mechanics

Like in the previous blog, an overactive or dominant sympathetic nervous system can cause muscle tightness. Finding ways of breaking poor postures or shallow breathing using a range of methods like kapalbhati, wim-hof, meditation, yoga etc. Using these methods are just part of the process to lowering overall tightness.

Usually, just following one of these methods individually is not going to be as effective as combining them together. Try to deal with the tightness from all angles.

If guidance is required or manual therapy techniques feel free to call 09 5290990.

Understanding your Nervous System

A healthy nervous system allows us to perform at a high level. Using particular methods we can tap into the subconscious side to improve the running of vital bodily functions.

You can’t control the wind, but you can adjust your sails

Our nervous system has a connection to all structures in the body. Without a healthy working nervous system most bodily functions suffer, our performance in life situations and sport are hindered and recovery from injury is impacted.

The Nervous system

Part of our central nervous system, within our subconscious is a mechanism for handling stressful situations. This is called the Autonomic Nervous system. It branches into two parts; the Sympathetic NS (SNS) and Parasympathetic NS (PNS). The SNS stimulates the bodily functions preparing us for the “fight, flight or freeze” in life threatening situations. The PNS is the other branch that prepares us for “rest, digest and heal”. It’s the PNS that should be the primary driver of our physiology.

B_B6BaNUsAAC6-G

Using the mailman and dog as an example. Most canines are territorial and when unknown visitors arrive they become defensive, will bark and jump at the door. It’s ready to fight. When the postman leaves, the dog quickly forgets what happened and is able to fall asleep within minutes. It recognises the threat has gone and can immediately relax.

Consider yourself in the same situation, feeling threatened of an intruder. You might shout at them to leave or prepare to engage with them. When the person retreats could you relax straight away or will you be on edge for hours or even days?

The SNS is important but only has a purpose for the short term, to allow us to deal with threatening situations. Unfortunately with hectic lives, our brain interprets these physical and mental stresses as life threatening, which frequently triggers the SNS on a daily basis. Constantly stimulating SNS can lead to chronic issues…

  • Anxiety
  • Fatigue
  • Irritability
  • Sleep disorder
  • Non-working muscular tension
  • Hyperventilation
  • Adaptation failure
  • Cognitive dysfunction

The brain struggles to identify physical stress’ and imagined stress’. Anxiety of an electricity bill, job cuts at work or relationship issues will fire up the SNS.

Throughout exercise/sport our PNS and SNS working in balance. Depending on particular stressors like speed, distance, duration, the SNS may start to have a greater influence. It’s important to get into our PNS state for improved decision making, better oxygen delivery and for achieving optimal recovery.

Ways of Activating the Parasympathetic Nervous System

The PNS is the system we should be using most frequently . Therefore finding methods of staying in this state even when put under perceived levels of stress are important.

1. Breathing Mechanics

The way we breath has a deep connection to the autonomic nervous system. Shallow, apical breathing has a direct link to our SNS. But taking Deep diaphragmatic breaths stimulates the PNS. Using breathing exercises daily can help train you into a more relaxed state.  Methods such as….

Wim Hof Method

Apnea Breathing

Kapalbhati Breathing

2. Meditation Practices

Through channeling your thoughts and breathing, meditation can help induce a state of relaxation. Following this 5-10 minutes daily can help improve many different functions. Easy to use apps for this are…

Head Space

Wildflowers

                      SoundCloud – Mindfulness Works

3. Muscle relaxation

Using methods like meditation or yoga are ways of achieving muscle relaxation. Having massages and soaking in a hot bath also offers a way of relaxing muscles. The release of tight muscles indirectly sends signals to the brain to activate the PNS and switch off the SNS.

Continue reading “Understanding your Nervous System”

Iliotibial Band Syndrome

Whether your running, rowing cycling or lifting. Repeated knee flexion may irritate structures on the outer knee. It is important to get on top of this condition to stop it hindering your training.

Setbacks are the perfect opportunity to grow

Iliotibial band syndrome is most commonly experienced with runners. But also in all sports that require repetitive knee flexion under high load. Early signs and symptoms often go unnoticed (or ignored) until it’s blown up into a fully-fledged injury.

What is the Iliotibial Band?

Iliotibial band

The Iliotibial Band (ITB) is a thick fibrous band of strong connective tissue running down the lateral side of the thigh. Its attachment points at the hip are from the Glutes at the back and Tensor Fascia Latae at the front. The bottom connection feeds into the outer border of the knee and patella. It’s at this attachment point that pain and inflammation develops and would be classed as Iliotibial Band Syndrome (ITBS).

The role of the ITB is to provide the knee with stability and to abduct the hip outwards. When we walk, run or squat it’s working hard to keep the knee in the correct position and force is distributed evenly.

What are the symptoms of ITBS?

Problems arise when the lower limb moves in abnormal directions repeatedly, causing the band to flick over bony structures of the knee, leading to irritation. It may also get tighter than normal through shortening or over activity of the Glutes and Tensor Fascia Latae. This results in the ITB becoming a tighter band pulling more at its attachment and compressing other tissue around it.

ITBS usually is a sharp pain or burning sensation in the lateral knee. Generally, felt during exercise when the knee flexes repeatedly through mid-range. This range of 30-40 degrees is when pressure of the ITB against the bone is at its highest. If this movement is repeated enough, it causes friction and irritates the tissue.

What causes ITBS?

There are a number of factors that can cause a stir up of ITBS. Physically there could be a muscle imbalance, with tightness or weakness around the pelvis, hip or knee, reduced balance, and reduced ground reaction time. Mechanically, often due to the physical limitations that cause incorrect movement patterns, poor weight transferring and distribution of load.

On top of this are issues with training error. How quickly a programme is progressed, especially if it involves load or speed. From running to weight lifting, training loads need to be gradually increased to reduce the risk of injury.

Management of ITBS

Initially you may be restricted from doing the activity that caused your pain while your body recovers. An assessment will help you identify what factors are triggering your ITBS. Treatment will be multifaceted providing advice for tissue loading, gait retraining and specific muscle strengthening and stretches. Additionally, soft tissue manipulation, strapping and dry needling.

With the improved running form, increased strength and flexibility you will gradually be introduced back into the activity. This will make you overall better at your sport and reduce the risk of this problem returning.

Evidence shows that ITBS responds well to conservative management with a success rate as high as 92%.

If you’re struggling with recovering on your own contact me on 09 5290990

Study: Resistance training on neck pain

This study found positive results with strengthening exercises to reduce muscle tension and pain with office workers suffering with neck pain.

Lindegaard 2013

Working in the office you’re bound to suffer with neck pain at some stage. If poorly managed this can progressively become chronic. Not only can this impact your function, but interferes with your levels of concentration and performance at work. This then feeds into your mood and becomes a negative loop which is then difficult to break.

When treating a patient with chronic neck pain there’s a range of manual techniques that have strong evidence to support them. But in addition to hands-on therapy, exercises are provided to assist in the recovery. These could be in the form of stretches, postural setting or strengthening.

This study focused on strengthening exercises using a resistance band  (Theraband). Over a 10 week period they performed lateral raises with the resistance band once per day to the point of fatigue or up to 2 minutes. They found at the end of the 10 weeks through EMG testing the neck muscles were more relaxed and had reduced pain levels.

Original Abstract

Background: This study investigates the acute and longitudinal effects of resistance training on occupational muscle activity in office workers with chronic pain.

Methods: 30 female office workers with chronic neck and shoulder pain participated for 10 weeks in high-intensity elastic resistance training for 2 minutes per day (n = 15) or in control receiving weekly email-based information on general health (n = 15). Electromyography (EMG) from the splenius and upper trapezius was recorded during a normal workday.

Results: Adherence to training and control interventions were 86% and 89%, respectively. Comparedh with control, training increased isometric muscle strength 6% (P < 0.05) and decreased neck/shoulder pain intensity by 40% (P < 0.01). The frequency of periods with complete motor unit relaxation (EMG gaps) decreased acutely in the hours after training. By contrast, at 10-week follow-up, training increased average duration of EMG gaps by 71%, EMG gap frequency by 296% and percentage time below 0.5%, and 1.0% EMGmax by 578% and 242%, respectively, during the workday in m. splenius.

Conclusion: While resistance training acutely generates a more tense muscle activity pattern, the longitudinal changes are beneficial in terms of longer and more frequent periods of complete muscular relaxation and reduced pain.

Lidegaard M, et al. Effect of brief daily resistance training on occupational neck/shoulder muscle activity in office workers with chronic pain: randomized controlled trial. Biomed Res Int. 2013.

CrossFit – How can Physio help?

CrossFit has its share of injuries like any sport. An experienced physio with knowledge of the training can get an athlete functioning pain free quickly and performing back to their best.

To perform at your best you need a strong mindset, great coaching staff that are strict with your technique and an experienced physio to prevent aches and pains

Most Kiwi’s are pretty tough, with a ‘she’ll be right” mentality when it comes to injury. You’d think that would be a perfect combination with the image CrossFit portrays. But when you’ve been carrying that niggle for so long and it starts getting worse, it could shut you down completely from training.

Physio and CrossFit work well together

Physio’s are specialists in movement analysis and CrossFit itself is a training regime that goes through gross fundamental movement patterns. So putting yourself through these movements and identifying your weakness’ gives me a lot more insight into where your problem could be coming from.

What are the common complaints?

There have been interesting studies done over the last few years into injuries within CrossFit. Interestingly the studies correlated similar with the same common areas being involved:

  • Shoulder
  • Lower back
  • Knee

Some injuries being severe enough to stop some from working, training and competing. These are the most common areas of injury I see come into the clinic from CrossFit, but I also see others suffering from:

  • Neck and thoracic strains
  • Ankle sprains and hypomobility
  • Hip impingement
  • Patella dysfunction from quad heavy squats
  • Wrist strains

How can Physiotherapy help?

As a physio it’s my job to get you functioning pain free as quickly as possible. Being a Crossfitter myself, who performs daily and understands the training styles, philosophy and terminology I can relate to the frustrations that you may face with limitations in training. Also working on site I can take you into the gym, look at techniques of different movements and provide you with additional drills to perform before your WOD.

What do I offer a CrossFit athlete?

  • An assessment of your movement patterns looking for weakness, asymmetry and any underlying mobility issues.
  • Hands on therapy for immediate pain relief, this may involve soft tissue massage, joint mobilisations and dry needling.
  • Localised taping of problem areas to assist you during your next training session
  • Diagnosis and ongoing management for acute or severe injuries, including referrals for further tests such as x-rays/ultrasounds, scans or to a specialist.
  • Educating you on what caused your injury or pain and steps to prevent further problems.
  • A personalised rehabilitation program – listing corrective, strengthening and stretching exercises to assist your recovery.
  • Liaising with and providing regular updates of your progress directly to your coach or trainer to ensure you get a coordinated approach to your rehabilitation. This also ensures that you are scaling or modifying WOD’s as required.

For an appointment, call on 095290990 

Montalvo et al (2017) Retrospective Injury Epidemiology and Risk Factors for Injury in CrossFit. Journal of Sports Science and Medicine

Keogh et al (2016) The Epidemiology of Injuries Across the Weight-Training Sports. Sports Medicine

Weisenthal et al (2014) Injury rate and patterns among CrossFit athletes. Journal of Orthopaedic Sports Medicine, Arthroscopy, and Knee Athroplasty

Trigger points – what are they?

Trigger points are the most common source of muscle pain. There are many factors that affect a trigger point and for best results they should all be identified.

I’m going to put a wild bet out there that everyone has a trigger point in at least one muscle of their body. Some have more than others. Who of you are regularly rubbing their shoulders or elbows? More and more we are sitting at the computer or looking down at our phones (sorry for writing this blog) causing prolonged tension on muscles around the neck and shoulder, resulting in the development of trigger points.

What is a Trigger point?

It is defined as a hypersensitive palpable nodule in taut bands of muscle fibers. Meaning very small bundles of muscle fiber have become contracted/”knotted” due to a chemical imbalance within the tissue.  The area is very painful and can cause you to jump or cramp on palpation. It can cause referred pain, weakness and restriction through movement. Which makes doing normal activities and training difficult.

Triger Point diagram
Diagram of trigger points within a muscle

Trigger points of individual muscles have a very specific referred pain pattern and can mimic other problems. For example pain in the forearm and wrist can be referred from Infraspinatus, a shoulder muscle. Without a detailed assessment and clearing other areas this could be misconceived as a tennis elbow.

What causes a trigger point?

A TP can be brought on in a number of ways. 

  • Poor postures held for a prolonged period, causing certain muscles to work harder while trying to support structures like the head, eventually causing TP’s.
  • Repetitive strain on muscles from overuse over multiple days, weeks and months. How many clicks of the mouse or typing are your doing? How much swiping of the smartphone? These repetitive movements take their toll.
  • Emotional stress and poor sleep can cause muscle tension. Particularly the neck and shoulder muscles.
  • A lack of movement will develop TP’s when sitting or on bed rest for a prolonged time.
  • Heavy lifting can cause the development of TP’s when the muscle is placed under excessive loads which it is not familiar with.
  • Trauma to a muscle, either as a reflex to pain or overcompensating for the weak and injured structure. This is quite common with car accidents or sports injuries.

Our muscles sit within a biochemical “soup” of  hormones, nerve transmitters and chemicals, all affecting the PH and Oxygen levels of the tissue. Your body knows the perfect recipe to keep everything balanced, but when we overload it with one or more of the above, it causes changes to the recipe, resulting in a drop in PH (becoming more acidic) and reduces the oxygen supply. This leads to the development of TP’s.

How do we treat a trigger point?

Your desire to change must be greater than your desire to stay the same. 

The following treatments for trigger points will help settle them down, but if we provide the same environment they will return.

  • Trigger point release – sustained manual pressure applied to the trigger point causes increased blood flow to remove toxins from the area, interrupts the pattern of pain and spasm and encourages the production of natural pain relieving endorphin’s.
  • Trigger point dry needling – There is a growing evidence base for trigger point dry needling. The needling causes local twitch responses which are a central nervous system reflex. This helps disrupt the pain feedback loop but also reset the acidic biochemical “soup” the muscle is sitting in, back to its normal levels.
  • Myofascial release – the surrounding tight myofascial tissue that feeds into and over the trigger points could also be restricted, causing further exacerbation of the area. Using this technique will give some length back to these structures and can alleviate the trigger point.

Once the hands on therapy has been applied it is not the end of treatment. The muscles with the TP’s will need to be stretched to help prevent their return. Postural correction and stability exercises for surrounding muscles may need to be followed. Changes ergonomically may need to be enforced to prevent falling back into poor habits. Also looking at ways of alleviating stress through improved sleep, meditation, breathing techniques and increase of general exercise.

All of these factors will need to be considered to provide long lasting benefit and avoid their return.

  1. Travell & Simon (1999). Myofascial Pain and Dysfunction: The Trigger Point Manual
  2. Shah et al (2008) Uncovering the biochemical milieu of myofascial trigger points using in vivo microdialysis: An application of muscle pain concepts to myofascial pain syndrome. Journal of Bodywork and Movement Therapies
  3. Simons, (2008), New Views of Myofascial Trigger Points: Etiology and Diagnosis, Archives of Physical Medicine and Rehabilitation