Additional Compression Techniques

When it comes to doing massage the right way, there are two overriding issues: safety and effectiveness. You have to be able to do massage without straining and exhausting the muscles in your forearms and hands and you have to be able to do it in a way that will actually have an effect on a trigger point.

Nine principles of safe, effective, self-applied trigger point massage are listed below. These rules define the basic massage stroke that is used everywhere on the body. Massage of a given trigger point should be relatively brief, no more than 15-20 seconds. When you have done that much, stop and move on. That constitutes a treatment. It is not necessary to do more. Doing more may actually be counterproductive....

Impatience will tempt you to try to kill the trigger point, to rub it out. That is a normal impulse but it is not the best therapy. Never try to force a release. Trigger points release on their own when they get frequent daily treatment that follows the guidelines given below. You will be surprised at how well this simple routine works. Treatment failures are usually the result of being too aggressive or simply treating the wrong spot.

Massage Guidelines at a Glance

1. Use a tool if possible and save your hands.
2. Use deep stroking massage, not static pressure.
3. Massage with short, repeated strokes.
4. Do the massage stroke in one direction only.
5. Do the massage stroke slowly
6. Aim at a pain level of seven on a scale of one to ten.
7. Limit massage to six to twelve strokes per trigger point.
8. Work a trigger point six to twelve times per day.
9. If you get no relief, you may be working the wrong spot.

Established practice in therapeutic massage dictates that you press and hold trigger points for a specified number of seconds, or until they presumably “release”. This is known as ischemic compression. You literally squeeze the blood out of the tissue. The trouble with pressing and holding a trigger point is that it can become unnecessarily painful if the goal is to make it release. It also requires a sustained contraction of the shoulders, arms and hands of the person doing the therapy, which can become extremely tiring in a very short time. Massage Therapists who use ischemic compression as trigger point therapy very often have constant pain in their hands and arms. This is one of those serious ergonomic hazards causing such a large turnover in the profession. The burnout time for massage therapists averages about three years. As you can see, you must do massage safely or you will end up with more trouble than you started with. Fortunately there is safer and more effective way to deactivate trigger points.

Instead of the static pressure of ischemic compression, an alternative option is to make a series of strokes across the trigger point nodule. This also gets results quickly and with less irritation to the trigger point, less damage to your hands, and less risk of bruising the skin and muscle. In addition, some say a moving stroke, frequently repeated, elicits a greater change in a trigger point than static compression. Compressing the trigger point is the right idea, but a repeated “milking” action moves the blood and lymph fluid out more efficiently. The lymph contains the accumulated waste that has been generated by the continuously contracted muscle fibers. Picture how you rinse out a dirty cloth. Wetting it and wringing it out only once won’t get it clean no matter how hard and long you twist it. You need to run fresh water through it over and over until the water runs out of it clear. A similar process works best with a trigger point.

Another advantage of using the short, repeated stroke is that intermittent pain is easier to tolerate than continuous pain. Intermittent moving pressure allows you to go deeper and to evoke just a little more pain than you could stand if you just pressed a trigger point and held it. Work deeply and slowly, using very short strokes, and no more than one stroke per second. The massage stroke doesn’t need to be more than an inch and a half long. It only needs to move from one side of the trigger point to the other. Rather than sliding your fingers, or tool, across the skin, move with the skin with your fingers or tool. This will help free up the underlying fascia, the thin membrane that envelopes muscles and whose tightness is sometimes part of the problem Work deeply, mashing the trigger point against the underlying bone. Release at the end of the stroke, then go back to where you started, reset your fingers or tool and repeat. Each time you release the pressure, fresh blood immediately flows in, bringing a renewing charge of oxygen and nutrients. The trigger point has been deprived of these essential substances because pressure from the knotted up muscle fibers has been constricting the capillaries that supply them.

Although you’ll hear that you should always move the fluid towards the heart, it’s not a critical issue here, because so little fluid is being moved. Stroke in whatever direction feels best. If you do not make trigger point therapy as easy as you can, it will wear you out and you won’t want to do it.

Another benefit of the deep stroking massage is that it helps get the stretch back into the muscle fibers within the trigger point. Think of this as the microstretch, as opposed to the macrostretch of the whole muscle that you do with conventional stretching exercises. The microstretch is applied directly to the trigger point, right where it is needed. Done this way, there is little chance of overstretching the taut bands of muscle fibers that lead from each side of the trigger point to the muscle’s attachment at the bone. Abuse of this taut band risks irritating the trigger point and making it hold on tighter.

A gentle reminder is that trigger points hurt when compressed. You may be very reluctant to work them for fear of doing yourself harm or making your pain worse. You have to realize that pain created by massage is beneficial. The electrical impulses of moderate amounts of self-inflicted pain are therapeutic in that they disrupt the neurological feedback loop that maintains the trigger point. Rest assured that self-administered pain is usually self-limiting. Your natural defense mechanisms won’t allow you to inflict more pain on yourself than you can stand. It’s very unlikely you’ll do yourself real harm unless you try to massage too deeply with hard tools.

The above is an excerpt from Chapter Three in The Trigger Point Therapy Workbook, 2nd Edition, by Clair Davies, NCTMB.