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!

TMJ Disorder – Do You Have It?

Countless people suffer from chronic pain stemming from TMJ Disorder. The symptoms are nagging and constant. But TMJ Disorder is a condition easily confused with muscle tightness in the jaw. Fortunately there is lasting relief from both types of pain with massage therapy. So what’s the difference between the two and how does someone know which they have?

What Is TMJ?

Massage therapy mixed with stretching and exercise frees the jaw of TMJD pain and discomfort.TMJ stands for the temporomandibular joint. Easy rule of thumb: everyone has TMJ, but not everyone has TMJ Disorder. TMJ is the hinge joint that connects the lower jaw (mandible) to the temporal bone of the skull, in front of each ear. These joints are flexible and allow the jaw to move smoothly up and down and side to side, allowing us to chew, talk, yawn, etc. The muscles attached and around the joint control the position and movement of the jaw.

What’s TMJ Disorder and Its Symptoms?

Temporomandibular joint disorder (TMD for short, thankfully) occurs as a result of problems in the joint (and disc) where the jawbone meets the skull. One of the common symptoms is clicking, popping, or grating sounds in the jaw joint when talking or chewing. Pain could be involved but not necessarily. Other symptoms include:

  • Pain or tenderness in the face, jaw joint, neck and shoulders. Pain could also occur in or around the ear when chewing, talking, or opening the mouth wide.
  • Inability to open the mouth wide.
  • Jaw becoming “stuck” or “locked” in either the open or closed-mouth positions.
  • A feeling as if the upper and lower teeth are not fitting together properly.
  • Swelling on the side of the face.
  • Possible toothache, headache, neck ache, dizziness, earache, hearing problems, upper shoulder pain, and tinnitus (ringing in the ears).

How is TMD Diagnosed?

There are many other conditions causing similar symptoms to TMD, therefore it is very important to have a dentist conduct a careful examination of the entire area. The dentist will look for specific limitations in range of motion or jaw locking as well as a wearing away of the joint. X-rays may be involved as well as CT scans or MRI.

What Causes TMD?

There are many causes of TMD such as injury causing whiplash, jaw abnormalities, and poor posture. Other causes include:

  • Constant teeth grinding or clenching, which puts pressure on the TMJ.
  • Dislocation of the soft cushion or disc between the ball and socket of the joint.
  • Osteoarthritis or rheumatoid arthritis in the TMJ.
  • Stress resulting in a constant tightening of the facial and jaw muscles.

What’s the Fix?

Some medical professionals may recommend surgery and orthodontics to correct the problem, however more natural solutions are long-lasting and much less invasive and expensive. The National Institute of Dental and Craniofacial Research recommends gentle stretching and relaxation exercises to increase jaw movement. Massage therapy mixed with stretching and exercise of the muscles involved significantly loosen up the entire area, freeing the jaw of pain and discomfort. After only one or two sessions people find such relief that many have put away their mouth guards and report a better quality of life.

What If It’s Only Muscle Tightness?

Massage therapy mixed with stretching and exercise frees the jaw of pain and discomfort.Outside of TMJ issues, the main muscles involved in everyday jaw tightness or discomfort are the masseter muscles. The masseter muscle is the primary chewing muscle. With regular talking, chewing, and stress these muscles develop “knots” (or adhesions) and trigger points just like any other muscle in the body. Most people don’t realize these muscles play a part in headaches, neck aches, and shoulder tension. After flattening out adhesions and removing trigger points the muscle loosens and returns to its natural resting length. It’s so fun to loosen these during a session and hear people say, “Wow I didn’t realize how tight I was in there. I feel so much better!”

I work on both conditions of muscle tightness and TMD daily with high success. With a specific combination of modalities for each, the jaw area immediately loosens up, decreasing stress and tension in the head and neck. After a session, I offer daily exercises and stretches for the jaw to keep the area from tightening.

Another wonderful sigh of relief that you don’t have to live with the pain, even if it’s only nagging. Feel good in your skin again today.

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,

Neck & Shoulder Pain: Why Won’t It Go Away?

Massage provides relief for first rib fixation syndrome.There are those of you suffering from chronic pain or spasms in your neck, shoulder(s), or mid-back. You’re beyond frustration. You’ve tried several healthcare providers, including chiropractors and physical therapists, all issuing different treatment plans but nothing has helped. You’ve even tried massage but that provided nothing more than temporary relaxation. X-rays and MRI results are normal. What is going on and why can’t you find relief? The answer could be First Rib Fixation Syndrome. A lot of people haven’t heard of this and don’t realize they have it.

What Is First Rib Fixation Syndrome?

Doctors tend to overlook this syndrome as part of their first examination and diagnosis. It’s easy to miss, which is too bad because an elevated first rib can cause a plethora of symptoms and complications, leaving someone to suffer unnecessarily for years. This syndrome can be a long-held issue developed over time. Common causes include bad posture, long hours at the desk, over exercising, moving heavy objects, having a physical job, or possibly sustaining an injury.

Massage provides relief for Upper Crossed Syndrome symptoms.Over time, a muscular imbalance occurs known as The Upper Crossed Syndrome which elevates the first rib. When this happens, shoulder muscles (the subscapularis and infraspinatus) load up with trigger points, resulting in weakness and pain. With muscles now compromised, the shoulder is unable to move normally. People then tend to compensate for the pain by rounding the shoulders forward and jutting the head out further from the neck. The neck muscles (scalenes, serratus anterior, and sternocleidomastoid) overcompensate and develop more active trigger points. Referred pain from these new trigger points manifests as what may seem like random, erratic symptoms. Since these muscles attach to the first rib, even more elevation occurs. The trapezius muscle in the back then goes into immediate self-protection mode, resulting in tightness and spasm. This has a tendency to compress the brachial plexus and subclavian artery to eventually throw the person into a possible state of Thoracic Outlet Syndrome. Vicious, isn’t it?!

Sleeping habits play a large part in the development and treatment of this syndrome. Elevated first ribs typically occur in stomach sleepers. Some sleep with one arm tucked under their head, or sleep with minimal or multiple pillows. These now compromised muscles work extra hard if the person spends long hours working in front of computers using a mouse or has an intense job with repetitive movements. Changes in sleep style post treatment speed recovery and help prevent trigger points from reforming.

Also, all athletes should be evaluated as an elevated first rib is common in that type of lifestyle, particularly tennis players and weight lifters.


  • Shoulder pain
  • Neck pain
  • A heavy hurting feeling or throbbing in the arm
  • Dull achy pain and tightness in upper back and shoulders
  • Headaches
  • Trapezius spasm
  • Radiculopathy (a neuropathy)
  • Jaw pain
  • Mid-back pain
  • Paraesthesia (tingling, prickling, or burning)
  • Chest & sternal pain

Treatment: Can It Go Away?

Massage therapy provides relief for thoracic outlet syndrome, first rib fixation syndrome, and frozen shoulder.So what do I do that’s different than others? When someone presents a certain set of physical complaints that resemble this syndrome, I palpate effected areas for tenderness, spasm, and edema. A person will automatically jump or pull away when an elevated first rib is touched. Through various soft tissue mobilization techniques (MFR, PNF, ART, TPT, Gua Sha, Massage Cupping) active and latent trigger points in almost all of the muscles listed above are manipulated until pain ceases. This can take as little as one treatment for someone to experience immediate relief but can take up to a handful of sessions for more aggressive cases (those with repetitive work related movements that reform trigger points). These sessions are different than “typical” massages as the entire time can be spent on removing and breaking up the trigger points. This is aggressive and intense so I am sure to only work within the person’s tolerance level.

If this sounds familiar, please contact me. I also strongly recommend visiting your chiropractor for them to adjust the first rib(s) back in place. Again, this is a great example of the kind of pain you don’t have to live with. Let’s knock it out so you can feel good in your skin again.

See you on the table!

Massage Biology 101: The Science of Touch

Massage positively affects all systems in the body. The remarkable fact about regular massage is it slows down the aging process universally.I’m often asked what systems within the human body massage therapy effects. It’s a fantastic question as massage positively affects ALL systems in the body. The remarkable fact about regular massage is it slows down the aging process universally. Of course aging still occurs, but the human body ages better with regular massage than without. Below is an overview of how massage affects each system within our bodies.

The Integumentary (Skin) System & Massage

The importance of touch as an avenue for healing of the mind and body cannot be underestimated. The internal state of mind directly affects the surface of the skin, evidenced by blushing when embarrassed or turning pale when frightened. Because the skin is the largest sensor that informs the mind about the external environment, it is conceivable for techniques used on the skin to affect the mind and internal organs in various ways. This system includes skin, hair, glands, and nails. It’s purpose is to protect our bodies from environmental hazards and maintain our core body temperature. Secondarily, it helps manufacture vitamin D and eliminates waste products (via sweat, etc.).

Massage benefits the integumentary system in the following ways:

  • Skin becomes more soft and supple
  • Skin becomes more resilient, flexible, and elastic with recurrent massage
  • Massage removes dry, scaly skin – exfoliates
  • Breaks down scar tissue to free up trapped nerves, blood vessels, and lymphatics
  • Increases blood and lymph flow
  • Removes toxins
  • Quickens the healing process of injured tissue
  • Reduces pain perceived by the brain
  • Reduces stress, anxiety, and pain and increases immune function, all which relaxes the skin

The Skeletal System & Massage

Well purposed massage has the following benefits to our skeletal system.Our skeletal system is made of bones, bone marrow, and joints. As the supporting framework for the rest of our body, it protects important organs, acts as a lever by providing areas for muscle attachments, and allows movement in various planes (joints). It also manufactures blood cells, stores fat, and is our main reservoir for minerals like calcium and phosphorus. Anyone who has experienced a deep tissue massage so firm it feels as if the bones themselves are being massaged knows that is not a pleasant experience. However, well purposed massage has the following benefits to our skeletal system:

  • Facilitates breakage of cross linkages and increases range of motion.
  • Benefits those suffering from joint-related disorders such as arthritis by reducing stiffness and swelling,
  • increasing blood flow, relieves pain and muscle spasm, and mobilizes fibrous tissue
  • Decreases pain in some types of lower back issues and increases range of motion
  • May lessen the fibrosis that usually develops after injury

The Muscular System & Massage

The muscular system (muscles, ligaments, and tendons) is responsible, obviously, for any form of movement both inside our bodies and in our external environment. Secondarily, it produces heat and helps maintain our body temperature. Although massage is beneficial in treating many musculoskeletal problems, such as tendonitis, sprain, tenosynovitis, and low back pain, listed below are the five main benefits of massage:

  • Reduces swelling
  • Increases blood flow
  • Relieves pain and muscle spasm
  • Mobilizes fibrous tissue
  • Improves muscle action and induces a state of general relaxation

The Nervous System & Massage

Massage therapists are perhaps the most skilled technicians when it comes to treating neuromuscular issues.Massage therapists are perhaps the most skilled technicians when it comes to treating neuromuscular issues. Muscles and nerves have such an intimate symbiotic relationship they both go hand-in-hand (pun intended) when it comes to massage and bodywork. The brain, spinal cord, nerves, and supporting tissue coordinate the activities of all our body systems and work in the shadows undetected by us consciously, until something goes wrong. The beneficial effects of bodywork on the nervous system is undisputed, but are too complex and difficult to explain, with many aspects still a mystery. Changes throughout the nervous system could be reflex effects, such as:

  • Relaxation of muscle
  • Vasodilation
  • Changes in blood flow
  • Psychological effects – changes in mind, emotions, or behavior
  • Psychoneuroimmunologic effects – altering hormone levels and immune functions as the mind is affected
  • Sleep patterns are positively changed
  • Reduced pain by interrupting the pain-spasm-pain cycle
  • Reduces pressure on nerves by initiating a relaxation of local muscles, increasing blood flow, and removing
  • chemicals that stimulate pain receptors
  • Releases Endorphins – our natural painkillers

The Endocrine System & Massage

Our endocrine system is becoming more of a focus in our society as hormones are becoming more and more unbalanced, thyroid issues emerge, and battles rage with diabetes. Our pituitary, thyroid, parathyroid, adrenal glands, and parts of the pancreas, ovaries, and testes release and transport hormones. Massage has indirect effects on this system through the nervous system:

  • Relieves stress in many ways
  • Relaxes tense muscles
  • Reduces the activity of the sympathetic nerves and the fight-or-flight reaction that occurs with stress
  • Directly affects the hypothalamus-pituitary-adrenal cortex axis and stimulates immune responses and healing

The Reproductive System & Massage

By now you’re seeing how massage positively changes all areas inside our bodies, including keeping our general reproductive system healthy. In Reflexology, there are specific points to help flush out the organs involved to keep things regulated. Massage in this area is focusing more and more on pre-natal, labor, and soon after childbirth work.

  • Decreases anxiety and levels of stress hormones during pregnancy
  • Less complications during labor and postnatally in women who have regular massage during pregnancy
  • Relieves the painful 3rd trimester rib pain that can occur
  • Massage during labor decreases anxiety and pain, reduces tim of labor and hospital stay, and lowers incidence of depression postnatally
  • Preterm infants gain more weight and are calmer
  • Newborns who receive massage are also calmer and show greater weight gain and more optimal cognitive and motor development later

The Cardiovascular System & Massage

Massage has a significant effect on the cardiovascular system.Our heart, blood vessels, and blood keep us alive, after all “life is in the blood,” according to Leviticus. Massage has a significant effect on this system:

  • Produces vasodilation in tissue and speeds the removal of toxins that cause aches and pains
  • Improves circulation and availability of oxygen and nutrients to the area
  • Enhances recovery after intense exercise or injury
  • Slows down heart rate
  • Decreases blood pressure and hypertension

The Lymphatic System & Massage

Our immune system is our natural body-guard. With regular global transportation it’s increasingly important to keep our body-guard strong and untouchable. Massage boosts the various functions of the immune system by:

  • Relieving stress – Science is now finding stress is literally a walking time bomb ready to explode within our bodies
  • Increases the number of natural killer cells and their activity
  • Strengthens the immune system overall
  • Significantly improves immune function in HIV-positive people and other immune-related disorders

The Respiratory System & Massage

Massage helps bring the overworked respiratory system relief.Our nose, nasal cavity, pharynx, larynx, trachea, bronchial tubes, and lungs work hard every second of our lives to bring in oxygen and release carbon dioxide. Massage helps bring this overworked system relief by:

  • Slowing respiratory rate through inhibiting the sympathetic system
  • Benefits clients with breathing difficulties
  • Relieves aches and pains originating from respiratory muscles
  • Increases vital capacity and lung function by relaxing tight respiratory muscles and stretching fascia
  • Massage techniques break up postural drainage and further mobilize secretions in lungs
  • Calms asthma symptoms

The Digestive System & Massage

One wouldn’t think massage changes this system in any way but it’s true. Even the digestive system benefits through massage.

  • Promotes regular bowel movements
  • Reduces the incidence of incontinence and decreases the use of enemas
  • Relieves intestinal colic, biliary colic, and flatulence
  • Promotes secretion and digestion of food
  • Benefits disorders such as anorexia and bulimia by reducing anxiety, improving mood, and decreasing stress hormones

The Urinary System & Massage

Closely partnered with the digestive system, massage helps the urinary system in the following ways:

  • Increases urine production
  • Aids the movement of fluid from the interstitial compartment into systemic circulation
  • Decreases edema
  • Reduces pain originating from urinary tract

See you on the table!

The Massage Connection: Anatomy & Physiology, second edition, Kalyani Premkumar