Learn Spray and Stretch

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By Jeffrey A. Lutz, CMTPT

The Right Approach
Trigger point pain can be alleviated by spray and stretch techniques

The efficient treatment of trigger points (TrPs) requires a thorough understanding of the signs, symptoms and pain patterns, and then applying several important skills and devices. When you encounter TrPs, you must decide how to approach treatment. It’s important to know that many perpetuating factors may exist and they should be addressed to allow a better chance for resolution. These mechanical, nutritional or systemic factors can be anything that sustains the formation and existence of TrPs. For this reason, it’s important to work with a physician familiar with myofascial pain and TrPs. For mechanical factors, look into workstation ergonomics, sporting activities and sleep positions for poor body mechanics that can place undue stress on the musculoskeletal system.

Once a history and evaluation are complete, you can begin treatment. The idea is to deactivate the TrP through mechanical disruption of the nodule and restore range of motion (ROM) to affected muscles. Use deactivation techniques based on the patient’s presentation of symptoms and current pain. Conservative treatments include direct compression or active myofascial release techniques, followed by moist heat and stretching.

Another technique is called the spray and stretch technique. This method works by spraying a stream of vapocoolant spray over the skin from the muscle origin over the TrP to the insertion and over the referred pain zone, while passively stretching the targeted muscle. The spray bombards the central nervous system with cold to block the reflex muscle spasm and allow a full stretch. Stretch the muscle by taking up slack, which appears as the spray is passed over the muscle; it’s evident even as the spray contacts the distal point of pain referral.

This approach has several benefits. For instance, there’s less discomfort for the patient and it reduces strain on the manual therapist. The technique may also be used in conjunction with other manual therapies, including TrP dry needling techniques (TDN), to reduce muscle spasms and increase ROM. When used with TDN, many patients report the experience of cold to be soothing after the needling procedure.

After treating with a vapocoolant, a patient’s tissues should be re-warmed with a moist heating pack. Then, take the treated muscles through three full ROM cycles, from fully contracted to fully lengthened, to retrain the muscle. Also, instruct patients about stretching techniques and at-home TrP care with a self treatment tool.

By following this basic protocol, many patients can achieve noticeable results and you’ll be able to expand your clinical experience with pain treatment.

For more information on trigger point therapy, go to www.pressurepositive.com
Jeffrey A. Lutz is a myofascial trigger point therapist at The Pain Treatment & Wellness Center, with offices in Greensburg and Pittsburgh, PA. He can be reached at jeff@musclepainhelp.com or www.learnsprayandstretch.org.