You are working on a client with muscle pain and very tender trigger points (TPs). As you dig into the muscle with manual therapy or massage, the client is jumping and complaining about the pain. What do you do? Choices:
1. Keep digging, you think, no pain, no gain.
2. Stop digging and work on another area.
3. Apply ice to mitigate the sensitivity.
4. Start exercise since they cannot tolerate the manual therapy.
5. Tell them to take some medication before the next visit so it doesn’t hurt so much.
6. Press your thumb into the trigger point and hold it for awhile. They will be so happy when you release it they will feel better.
There is an alternative: positional release. If the pain is related to trigger points, simply pushing more may cause undue discomfort. Ischemic compression is often beneficial to reduce the painful sensitivity of those TPs; however, it is painful to press on them. Applying pressure may mitigate the pain afterwards by “gating” the pain. (Melzack and Wall’s theory) It may also stimulate A fibers to override the C fibers carrying pain messages. Is there a way to reduce the tenderness without causing more pain? Yes, if the pain is related to a reflex dysfunction. If the muscle spindle bias is elevated, they muscle is more sensitive to stretch, and the muscle may tense even when it is not in a stretch. using positional release (also known as Strain-Counterstrain) may reduce or even eliminate the tenderness and abnormal tension in the muscle by resetting the spindle threshold (the bias) to a more normal level of sensitivity. In most positional releases, the muscle attachments are approximated to remove all tension, and the position is held for about 90 seconds. Not too long to wait to make a difference! Educise offers courses in positional release and integrated neuromuscular re-education to address the abnormal tension and pain associated with TPs. There is ample evidence to prove it works, too!
