Trigger Points: What Are They?

Massage Therapy is a very confusing field now. Not being covered under insurance leaves the door wide open to what falls under the heading. A given massage therapist practices anything from spa relaxation to physical therapy type work.

To clarify what I do, the type of massage therapy modality I specialize in is “Neuromuscular Therapy” or “Trigger Point Myotherapy.”

What’s a Trigger Point & Why Work It?

“Trigger points” (TrPs) are tender points in soft tissue that radiate or refer pain to distant areas. These are found all over the human body usually in the belly of a muscle. Once formed, they radiate pain out from the belly similar to a wrinkle in a sheet or a ripple on the water, this is the referred pain felt. Trigger points are produced by muscle stress, such as overwork, repetitive motion, or sudden excessive stretch.

There are four types of trigger points:

  1. Active TrP – one that is spontaneously producing referred pain.
  2. Latent TrP – one that produces pain when pressure is applied during palpation.
  3. Primary TrP – one that is caused by muscle stress.
  4. Satellite TrP – one that is produced secondarily by a primary trigger point.

How Do They Go Away?

Trigger points generally stay inside the muscle until manipulated away. Get rid of them today with medical massage therapy in Des Moines Iowa.Trigger points generally stay inside the muscle until manipulated away. In layman’s terms, when a muscle is over-stressed it feels compromised and immediately protects itself. This tightening process forms TrPs within the muscle. Muscles are very stubborn and don’t forget experiences easily, hence the term “muscle memory”. Muscles will hold on to this protection until a manual process occurs which tells the brain to send a signal to the muscle that it’s safe to relax and return to a normal resting length. This is what I do.

Pressure is placed directly into a tight or sensitive trigger point area, which often causes radiating pain, and held until the tenderness disappears. This process repeats running along the rippled path of the TrPs. There is a delicate balance between applying enough pressure to release it and applying so much pressure that the TrP worsens. Releasing the points encourages increased circulation to the area allowing the underlying tissue to soften. This is the point when clients say, “I didn’t even know that hurt until you found it! How did you know that was there?”

What Is Neuromuscular Therapy?

Neuromuscular Therapy is also called Trigger Point Myotherapy. This technique alters the length muscles to teach them how to operate correctly. Muscles are manipulated back into the shape originally intended. Less is more during this treatment session to avoid bruising and soreness. This type of therapy consists of alternating levels of concentrated pressure on the areas of muscle spasm to release the lactic acid from the muscle, resulting in increased blood flow and oxygen. Fascia is also stretched to keep the body loose. If the shell of the body is loose, the muscles can loosen and relax back into their natural form.

Causes of Trigger Points

The common cause of trigger points results from various forms of trauma, ranging from a direct injury, excessive stretching, heavy lifting and twisting, or even emotional stress. These sensitive regions will often activate pain in referring areas. Once we eliminate the trigger point, massage aids in removing the waste products and restore circulation to the area.

Some trigger points will be more severe than others and patience is the key factor during the session. Less severe TrPs will release almost immediatley. More severe ones need worked longer. The reason the experience is so worth it, however, is that there is an immediate relief as soon as the TrP dissipates. There’s no waiting 3-5 days to see if the session was a success. You know right away.

Some severe trigger points can reform after a session. I always recommend icing the area worked after a session. The ice will increase circulation to the area and decrease inflammation, minimizing the odds of the TrP reforming.

Carmen Satre, LMT, CMMT, CMLDT, OMTDr. Janet Travell is the person most often associated with trigger point therapy. She’s quoted as saying, “Active trigger points cause pain. Normal muscles do not contain trigger points. Individuals of either gender and of any age can develop trigger points.” Simple enough. Another great reminder that you don’t have to live with the pain. Come in and get those stinkers gone so you can feel good in your skin again.

See you on the table!

Thoracic Outlet Syndrome

Thoracic Outlet Syndrome (TOS) is a painful medical issue with painful medical procedures, but certain techniques of massage can bring pain relief, reduce inflammation, and decrease healing time. There is much controversy among physicians and diagnosing this syndrome is very difficult. It is often confused with carpal tunnel syndrome, brachial plexus syndrome, rotator cuff syndrome, and bursitis.

What Is the Thoracic Outlet?

Massage therapy is highly effective in treating thoracic outlet syndrome.The term “thoracic outlet” refers to the entire area defined by scalenes and the first rib, or to the passage between the anterior and middle scalenes. On their way to the arm, the axillary (subclavian) artery and brachial plexus pass between these two muscles, then between the first rib and the clavicle. They can become entrapped at some point in this area by tightness in the anterior and middle scalenes. It is sometimes difficult to distinguish pain referred by the scalenes from pain resulting from entrapment of the brachial plexus.

How Do I Know if I Have Thoracic Outlet Syndrome?

TOS is impingement of the brachial plexus nerve bundle and the blood vessels going to and from the arm. As a reminder, a syndrome is a collection of specific symptoms that is not a true pathological condition.

Symptoms include:

  • Edema
  • Numbness
  • Tingling sensations
  • Weakness of the upper limbs
  • Paresthesia (pins and needles)
  • Shooting pain
  • Feeling of fullness
  • Possible discoloration in the area due to diminished circulation

To diagnose this problem, a doctor or therapist will have you move your neck and shoulders in specific directions, which may result in a nerve entrapment or pinching sensation. They will also ask you to lift your hands above your head and open and close them for a few minutes. If you feel pain, numbness, or heaviness, you may have this disorder.

What Causes TOS?

Massage therapy is highly effective in treating thoracic outlet syndrome.There are various causes that produce symptoms of pressure on structures such as nerves (in the brachial plexus) and blood vessels that exit from the thorax (posterior to the clavicle) to enter the limbs:

  • Cervical or rib misalignment
  • Tight muscles
  • Spasm of neck muscles (scalenes) or other muscles such as the pectoralis minor lying close to the structures passing through the outlet
  • Atrophied muscles, muscle degeneration
  • Herniated intervertebral disk
  • Spondylosis (a bone spur at the nerve root)
  • Whiplash
  • Postural changes during pregnancy
  • Any activity that causes enlargement (weight lifting or weight gain) or movement (exercise or injuries) of the muscles in this area

So Can Massage Help?

Massage IS indicated for TOS if muscle tightness or spasm causes the impingement. If there are any causes other than muscular tension, massage is contraindicated for that local problem area.

Massage helps by:

  • Relaxing the area
  • Increasing circulation
  • Reducing inflammation
  • Speeding up the healing time

Massage therapy is highly effective in treating thoracic outlet syndrome.During a session, focus is on the muscles of the neck, shoulders, arms, and upper back. The upper chest and arm area is also a focus. Overall treatment for TOS includes specialized exercise routines, massage therapy techniques, possible physical therapy, and in some severe cases, surgery.

If symptoms do not diminish with massage, impingement may be due to another cause and such clients should be referred to their healthcare professional to get a diagnosis and treatment plan. While the condition is present, avoid being in prolonged positions with the shoulders and arms, such as sleeping on arms, changing desk orientations to increase ergonomics, and so on.

Again, you don’t have to live with the pain. Choose to start the healing process today.

See you on the table!


Introduction to Massage Therapy, second edition, Mary Beth Braun, BA, MT, NCTMB & Stephanie J. Simonson, BS, MT

The Massage Connection: Anatomy & Physiology, second edition, Kalyani Premkumar, MBBS, MD, MSc (Med Ed), CMT, PhD

Thoracic Outlet Syndrome & Massage,

Skin Brushing

Skin brushing is the daily jump-start to your lymphatic system.Awhile back a client recommended I look into skin brushing. The first thing I thought was, “That’s all I need, another process in my life!” I heard great things about skin brushing but didn’t think it necessary to add to my already busy schedule. Then another client recommended it – I began to take the hint. My rule of thumb is if more than one person recommends something it’s worth checking out. So I jumped online to order reasonable brush to try this long-held procedure (dating back to the athletes in Greece).

I’ve been skin brushing DAILY for 44 days now and yup – definitely hooked! I skin brush every morning before showering (yes, you skin brush on dry skin) and from day one have found it an immediately invigorating experience. It’s as if every part of my body truly wakes up for the day and is ready to take on anything. It seems like something just for the ladies but is extremely effective for men as well.

What Exactly Is Skin Brushing?

Skin brushing is the daily jump-start to your lymphatic system! Remember from the Massage Biology 101 entry that this system is our body-guard. It does the following to keep us going in our lives:

  • Strengthens the immune system overall
  • Increases the number of natural killer cells and their activity
  • Relieves stress
  • Waste removal for our circulatory system
  • Eliminates toxins
  • Improves blood circulation and removes sweat (great for athletes)
  • Diminishes spider veins over time

What’s this mean and why am I writing about it? We can get over the bad stuff quicker and with more energy: colds, viruses, flu, Candida, cancers, etc. This is a fantastic self-care routine to aid regular massage. As massage flushes the lymphatic system as well, daily skin brushing will keep the body clean going into the appointment, which means even more effective massage sessions with quicker benefits!

Skin brushing is so easy it’s a bit embarrassing I haven’t been doing this and promoting it from the beginning of my massage career. It fits easily into the daily routine and only takes 5-10 minutes before a shower to do.

Ok, But Why Skin Brushing?

Our skin is the largest organ in our bodies. We overlook it as a rule but it’s actually responsible for 15% of our toxin elimination. Skin brushing removes the top layer of our skin, the dead cells, to encourage new cells to grow. By unclogging pores, toxins are eliminated with more efficiency. What else does skin brushing do for us:

  • Improves lymph drainage
  • Releases toxins
  • Encourages new cell renewal
  • Promotes tighter skin
  • Boosts circulation
  • Exfoliates
  • Reduces cellulite

Choosing A Brush

Skin brushing is the daily jump-start to your lymphatic system!The type of brush used does make a big difference, and it doesn’t have to be pricey. Natural bristles are a must as synthetic bristles scratch and contain toxic chemicals, which defeats the purpose of skin brushing. The bristles should be fairly stiff as firmer bristles with have a greater effect on your circulation. I purchased the Yerba Prima Tampico Skin Brush off Amazon. Buy-in is only $10 and it does a great job. It has a removable handle which makes for easier access around the body. There are more expensive ones for serious “brushers” and one day I may graduate up to the big leagues. But for now, this one treats me well.

How To Do It

There is a very specific routine for skin brushing. To help boost the lymphatic system a rigid order and natural flow need to occur. For the beginning routine I use feel free to email me and I’ll send it your way. Remember, every bit helps in getting us all feeling good in our skin again.

See you on the table!

Why Stretch?

Stretching daily after massage sessions keeps muscles in a constant state of their natural resting length, happy and healthy.I am a nag about people’s daily stretching routine. More times than not I learn that people have good intentions to include stretching in their day but “don’t get around to it.” We are all guilty of this! But why is stretching so important? There is a science to it.

What Exactly Does Stretching Do?

Stretching your muscles on a regular basis can improve the range of motion and flexibility. Keeping muscles at a proper length takes unnecessary tension off tendons, which lessens damage and helps recover from injury. Stretching also allows for more muscle tone; muscle will be larger in volume without becoming bulky.

Stretching allows the body’s muscles to gently loosen. Increased flexibility of the neck, shoulders, and upper back improve respiratory function. Keeping upper and lower legs as well as the glutes stretched prevents plantar fasciitis and loose fluid movement in the lower back.

Without stretching, the body becomes stiff and tight. Stretching helps to push fluids and oxygenated blood throughout the entire body, increasing range of motion and improving posture. Remember, stretching is not relaxation (although that is a natural side effect); stretching is elongation!

Even if you do not have a regular exercise routine, stretching daily has many benefits. As our bodies age our muscles tighten and we lose some of the range of motion that we once enjoyed. Stretching can reverse these signs of aging by continuing to allow you to do the tasks that you expect. It doesn’t take a large time commitment, and the benefits far outweigh the effort. Start small and work your way into more stretches.

So What’s Stretching Have To Do With Massage?

Stretching is very important following a massage session. During the massage I am removing/releasing trigger points, or areas of built-up tension, within the muscles. Tension builds by: repetitive movements, gravity, moving around within our environment with a compromised gait pattern, exercising without stretching, the list goes on. Muscles kneaded and worked during the massage remove trigger points. When this happens, the brain sends a signal to the muscles to return to their natural resting states. The body does not feel tight any longer and fluids and chemicals flow freely inside the body.

So the person leaves the massage and returns to their daily life, right? Exactly, and then two weeks later they’re back in the same situation of pain and tightness. Stretching daily after massage sessions keeps muscles in a constant state of their natural resting length, happy and healthy!

The other important result of daily stretching in regards to massage sessions is Less Pain! An inflexible and tight body experiences a more painful session with slower progress. Better muscle tone + increased flexibility = less painful massage sessions. This is now when the person receives regular monthly massage sessions as maintenance to enjoy a “well-aging” body vs. someone who can’t seem to “kick the pain,” having massage sessions only last them a week or two. Make sense?

Ok, Then What Is the Proper Way To Stretch?

  • Strengthen Then Stretch – I come from a ballet conditioning background, ballet being the most efficient way to strengthen the human body, and learned immediately that the fastest and healthiest result of balanced muscle tone is to first strengthen the muscle, then stretch it. Football players and professional athletes can attest to this – yes, they’re doing secret ballet conditioning, shhh! DO NOT STRETCH A COLD MUSCLE! This causes injury, tears, and frustration as flexibility is not found. Walk first, do a few movements first, then stretch. I stretch multiple times during the workout to constantly elongate the muscles. When you do this, you will not be sore the next day after workouts! The key to knowing when your body has achieved a healthy state of strength and flexibility is when you can get out of bed in the morning and immediately reach the same level of flexibility you have after a workout, be it touching your knees, ankles, or toes.
  • Form, Form, Form – every stretch performed must have proper form to avoid injury and hyper-flexion. If you are unsure of proper form, look it up on the internet or have me demo the stretch for you.
  • Stretching daily after massage sessions keeps muscles in a constant state of their natural resting length, happy and healthy.Protect the Lower Back – for any stretch done standing it is crucial to keep knees slightly bent and pelvis tilted forward to protect the lower back. Otherwise, as you’re getting a wonderful stretch in the target muscle, you compromise the lower back and scratch your head why your back feels like it’s “ready to go out” a few days later.
  • BREATHE – it is a natural reaction to hold in our breath when we feel tension. This is the opposite of what the muscles need. While holding each stretch, breathe deeply! The science to this breathing mechanism is the pump. As we breathe deeply during our stretches, oxygen is physically being pumped into the muscles, allowing our bodies to extend, relax, and as a result, gain flexibility.

I do believe there are good stretches and bad stretches for the body. For more information, talk with me during your next session. I will help you choose the right stretches for your troubled area and create a customized protocol for you.

See you on the table!

What About Grandma?

Geriatric massage is about helping the person age better.

My beautiful grandmother resting from her hike in southern Germany.

Geriatric massage. What is it? Not many people talk about it but it is a rising demand in our society. The baby boomers are entering their most crucial stage of life in a healthcare sector trying to keep up. Put simply, geriatrics is the study of health impairments that happen because of changes within the body. Simple, right? Not so fast.

Seniors tend to fall into three basic groups:

  1. Robust – typical middle-aged clients free from serious health impairments leading healthy and physically active lives.
  2. Age Appropriate – those suffering from age related illnesses, such as diabetes, arthritis, Parkinson’s disease, and heart disease. Geriatric massage naturally improves circulation of lymphatic fluid and blood.
  3. Frail – seniors in this group look and feel fragile to the touch. They tend to fall and suffer from broken hips, deep bruising, and effects from being on a cocktail of medication. Massage work focuses on helping a weakened body maintain, or sometimes regain, functions essential for general well-being. In fact, this is a massage goal for any age group. This means that despite the many cautions to which massage is subject, there are very few true contraindications. Sessions are shorter in length for this population, usually 30 minutes.

I think about geriatric massage in this way: it is not so much about “fixing” issues as it is about helping the person “age better.” Massage increases comfort, decreases aches and pains, relieves highly annoying issues such as restless leg syndrome and keeps muscles long and loose. Not only does this help the overall body internally, touch also keeps people connected. The aging process is not fun in any way, it’s hard work, and tends to increase internal feelings of alienation and isolation as once proud people are examined, poked, and prodded at will.

My lovely grandma, pictured above, has since passed. She was a proud German woman with a ornery personality who was fiercely flirtatious and danced into the night. She was not a “touch” person. At the end of her time here her body ached as it was shutting down. She would have me massage her legs for great lengths of time, the only thing that helped her calm down inside and relax. Those were amazing bonding moments for us. Massage not only connected us on a deep level, it helped ease her into her passing. That’s powerful!

The senior community is a group near and dear to my heart. I enjoy working with them both in my place and on-site. Some struggle with mobility and it’s my pleasure to work with them where they are at, be it in a retirement home, their own house, or a hospice setting. Truly, every person benefits from massage, from babies in vitro to end-of-life adults.

See you on the table!