We're about to let you in on a little secret that we've been using with great results for several months now. It's absolutely revolutionizing the way in which trigger points and muscular pain in general can be treated. The secret is the revitalization of a technique that quite frankly isn't performed much anymore. That's about to change...
First off, let's have a little review of what trigger points are. Trigger points are tender and irritable spots located in muscles and tendons, that when activated, refer painful sensations (including aching, throbbing, burning and even itching) to distant areas of the body.
The hundreds of known trigger points are beyond the scope of this article but can be found in resources such as the monumental texts by Travell and Simons: [...] The Trigger Point Manuals: Volumes 1 & 2 (which cover the upper and lower body respectively).
The most frequently used techniques to diminish trigger point activity include the following:
- Trigger point pressure release (also known as "ischemic compression")
- Chilling techniques (including ice, and spray and stretch)
- Dry or wet needling (acupuncture or trigger point injection)
- Muscle energy stretching techniques
- Superficial Moist heat (as from a hot pack)
- And a host of other techniques way beyond the scope of this article.
One of the authors (Keats) a massage therapist specializing in Neuromuscular Therapy, primarily uses the trigger point pressure release method as it has been shown in scientific research to be one of the most effective methods for deactivating noxious trigger points. However, performing this type of therapeutic modality requires a thorough knowledge of anatomy and a high level of palpatory skill in order to locate the trigger points.
Enter Spray And Stretch
Next to trigger point pressure release, the next most effective means (according to research) associated with trigger points is a technique called Spray and Stretch.
**(See the following research article in you are interested: Hong C-Z Chen Y-C Pon C Yu J, 1993 Immediate effects of various physical medicine modalities on pain threshold of an active myofascial trigger point. Journal Of Musculoskeletal Pain 1 (2).)
The Spray And Stretch method utilizes a cold chemical sprayed in sweeping passes on the skin overlying a painful muscle which is subsequently stretched to its pain free limit. The technique is VERY effective at reducing and deactivating acute trigger points.
The problem with the original technique, which was developed primarily by the late Dr. Janet Travell, is that it requires ethyl chloride or Fluori-Methane. Both of these substances, which are technically known as vapocoolants, require a medical license or a prescription to obtain making them unavailable to the general public.
Additionally, ethyl chloride can irritate the skin and is often too cold when applied to it. It is potentially toxic if inhaled and is also flammable and explosive. Fluori-Methane was a step in the right direction since it's non-flammable, non-toxic and does not pose significant risk of skin irritation. It is however damaging to the ozone layer due to its make up of two fluorocarbons: trichloromonofluoromethane (try saying that 10 times fast!) and dichlorodifluoromethane.
| What Are Fluorocarbons?
Any of the organic compounds in which all of the hydrogen atoms attached to a carbon atom have been replaced by fluorine; also referred to as a perfluorocarbon. Fluorocarbons are usually gases or liquids at room temperature, depending on the number of carbon atoms in the molecule. A major use of gaseous fluorocarbons is in radiation-induced etching processes for the microelectronics industry; the most common one is tetrafluoromethane.
Liquid fluorocarbons possess a unique combination of properties that has led to their use as inert fluids for cooling of electronic devices and soldering. Solubility of gases in fluorocarbons has also been used to advantage. For example, they have been used in biological cultures requiring oxygen, and as liquid barrier filters for purifying air. See also Halogenated hydrocarbon.
"fluorocarbon." McGraw-Hill Encyclopedia of Science and Technology. The McGraw-Hill Companies, Inc., 2005. Answers.com 19 Sep. 2007. www.answers.com/topic/fluorocarbon
Now you might be asking at this point, "How the heck do vapocoolants de-activate trigger points in the first place?" It's a great question. According to Travell and Simons, vapocoolants work by causing a sudden drop in skin temperature which causes a barrage of sensory impulses to enter the spinal cord. These impulses have an inhibitory effect on local pain and actually cause the muscles under the sprayed area to relax and accept a subsequent stretch.
This stretch may actually break the "contracture knot" that is speculated to exist in most trigger points. This is crucial for trigger point deactivation because under normal circumstances, the muscles which house active trigger points will be painful while under stretch.
The pain activates the sympathetic nervous system (aka the "fight or flight" part of the nervous system,) which creates a reflex contraction of the involved muscle(s), thus limiting the potential range of motion.
| The "Fight Or Flight" Reaction.
The set of processes that occur in the body when it is confronted with some form of physical or mental stress. For example, if a person is faced with danger (as from a vicious animal about to attack), the nervous system signals for adrenaline and other hormones to be released into the blood.
These hormones prepare the body either to confront the attacking animal or to flee to safety (thus, "fight or flight"). Changes in the body include increased heart rate, dilated pupils of the eye (to improve vision), and increased supply of blood to the muscles (to prepare the body for action).
To make a long story short, when using the spray and stretch technique, the "stretch" part is the action while the spray is the "distraction." The extreme cold serves as a source of "proprioceptive confusion" of sorts which then allows better muscle excursion and extensibility.
Since trigger points form for various reasons, one should always ask whether removal of any given trigger point(s) is the wisest choice. Current thoughts by some of the leading experts on trigger points include the theory that trigger points may actually serve as low-energy tension-producers that might be used to splint an unstable joint or assist in the maintenance of a frequently assumed occupational or sporting posture.
In other words, some trigger points could be serving as a functional "crutch" of sorts. Removal or deactivation of the trigger point might remove this crutch. With that said, many active trigger points can and should be deactivated in most relatively healthy fitness enthusiasts because they can be a real pain the butt; literally!
Enter The Spray And Stretch Technique!
A product Developed by Gebauer Company, Instant Ice is leading the way in a line of new skin refrigerants (vapocoolants) that are completely non-flammable and non-toxic; and you don't need a prescription.
Just because anyone can order it though doesn't mean it's not potentially harmful. If sprayed for longer than it takes to turn the skin white, it may actually freeze the skin leading to skin damage! The spray is not to be used by diabetics or anyone with any kind of sensory nerve damage or neuropathy and should not be inhaled, or sprayed near the eyes or mucous membranes.
To perform the Spray and Stretch technique as taught by Travell and Simon is WAY beyond the scope of this article and requires hands on training and extensive knowledge of common trigger point location and referral zones. However, with basic knowledge of anatomy and muscular attachments sites, a modified Spray and Stretch technique is fairly simple. In fact, it's so easy a caveman could do it!
How To Use The Spray And Stretch Technique
- Place the body part in questions (with skin exposed) in a very mild stretch to start. Too great a stretch may irritate the trigger point and activate a quasi-stretch reflex. Make sure the person receiving the treatment is warm and their body is supported posturally as to avoid unnecessary postural strain.
- Have your training partner, friend or significant other spray the Instant Ice from one attachment of the muscle(s) towards the other. Very important: the stream should be spayed from a distance of 12 to 18 inches for maximum coldness and effect on the nervous system.
The closer the can is to the body the warmer it is when it hits the skin while the farther away (up until 18 inches) the colder it will feel. Beyond 18 inches you lose your aim/precision and get no further benefit of coldness. Additionally, Travell and Simons report that applying the stream from an angle of 30 degrees (as compared to the surface you're applying it to) works best.
- After spraying 3-5 streams parallel to each other (each stream traversing a slight lateral or medial course to the previous one), you should gently stretch the muscle to its pain free limit.
Hold this stretch for up to 30 seconds or so making sure the person is breathing slowly and deeply (preferably with their diaphragm muscle). The stretch will help to keep the offending trigger points from coming back as fast. Of course if you go do the activities or assume the offensive static postures that caused the trigger points to activate in the first place they'll probably return quickly.
- After performing the above steps, you should apply moist heat for up to 10 minutes to promote healthy blood flow and further relax any shortened tissues left in the treated muscle. A second dose of the spray and stretch can then be performed for further gains if desired.
[ Q ] When Should One Perform The Spray & Stretch Technique?
This technique can be applied in a number of settings. We prefer to use it post-workout or on an off/recovery day prior to range of motion or "mobility" work. It could be used pre-workout or in between sets for muscles that are not directly involved in force production if they are painful. Ideally though, it not used prior to maximum dynamic or explosive activities.
[ Q ] Where Can I Get More Information On How To Perform The Technique For More Muscle Groups?
First off, get the classic Trigger Point texts by Travell and Simons that were mentioned earlier in the article. These have techniques for all the muscles of the body. We also welcome and will field your questions and comments to this article.
About The Authors:
Charles Staley, B.Sc., MSS: His colleagues call him an iconoclast... a visionary... a rule-breaker. His clients call him "The Secret Weapon" for his ability to see what other coaches miss. Charles calls himself a "geek" who struggled in Phys Ed throughout school. Whatever you call him, Charles' methods are ahead of their time and quickly produce serious results. His counter-intuitive approach and self-effacing demeanor have lead to appearances on NBC's The TODAY Show and The CBS Early Show.
Keats Snideman, B.S. CSCS, LMT, NMT currently serves as Technical Content Director for Staley Training Systems. As a competitive sub-masters sprinter (100 & 200m dashes), Keats specializes in the enhancement of athletic fitness and has a proven track record for getting his clients, stronger, faster, and leaner. He has coached and provided treatment to a variety of clients, including athletes from the NFL, NBA, MLBA, USA Track & Field as well as athletes from both the collegiate and high school levels. He may be reached at email@example.com or through his websites at www.keatssnideman.com and www.nmtbykeats.com.
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