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Q & A #1 Tail Bone Pain

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Hey, Robert, I have a problem that you might be able to help with, given your therapeutic expertise. (in all actuality, I suffer from a variety of physical problems, as you may or may not be aware of, so by way of caveat here let me just state plainly that I am not seeking “medical” advice).

It appears that I have some sort of autoimmune condition which is affecting my soft tissue and joints; basically I’m quick to injury and slow to heal, and no one can figure out why. At this point, I don’t even care anymore; I’ve taken matters into my own hands and am focusing mind-body-soul on my recovery, which means proper diet, proper exercise, sleeping, and a positive attitude, yadda yadda yadda… My wrists and ankles have it the worst, but I’m slowly building up long-atrophied muscle mass and getting very weak tendons acclimated to daily activity. It’s been a very long and grueling process, but I am seeing slow progress.

Here is the specific problem I’m having right now in my rehab. After about two years of being sidelined by a pretty persistent achilles strain, I’ve been able to work my way up to walking a good mile three times a week. However, I recently began to notice that my glutes were not firing correctly, and this was causing undue strain on my lower back. I quickly realized I could not even hinge properly at the hips in order to do a proper deadlift, etc. And the reason seemed to be that my hamstrings were just insanely tight. So for the past month or so I’ve been working on building up my glutes, making sure that they are firing properly when I walk, etc. And also I’ve been attempting to stretch out my hamstrings. However, almost as soon as I began this workout plan, I mysteriously developed this severe tail bone pain that will simply not go away! I never hit my tailbone or injured it in anyway (that I know of), but it hurts unbearably if I sit on it wrong, and even sometimes when I’m just walking. I can’t make heads or tails of it, except that it is undeniably worse on the days after I stretch out my hamstrings.

Have you ever came across anything like this? Are there any specific stretches or techniques that might help to alleviate this pain? I realize that without an examination there’s probably very little that you could tell me definitively about what is going on here, but maybe you could point me in the right direction. You see, in my experience doctors are not very much help with this sort of thing, and every time I go to a physical therapist they just make things worse with their over-zealous recommendations; they just don’t seem to have the tools to deal with a patient in my reduced state of physical fitness.

Respectfully,
Anonymous

Dear Anonymous,

You’re correct in not seeking medical advice from a massage therapist but based on the info you gave me, we can try some things out and see if it helps. I’ve had a 12 year career helping people with odd pain no one else seemed to understand so I’ll walk you through a few things that may help.

My guess based on what you describe is that you’re having some sort of trigger point dysfunction in your glutes. Most people are Very tight around their sacrum which makes up the S or the Sacroiliac joint. The musculature on most people I work with is taught, tense and gets very little stretching. This muscular tension alone will cause pain in the low back around the legs, possibly down the legs and so on. With the information you’ve given me you could have latent issues that wake up from regular exercise etc. In addition, muscles on one side of your sacrum may be tighter than say the left and imbalance your hips as you’re trying to open things up.

In short, I think everything you’re doing is great! I’ll give you a few things to try out and we’ll see if this helps.

Hamstrings are rough to deal with and I recommend you stretch your hamstrings as I show in this video. Remember to keep the leg bent, whether standing in a forward bend or sitting in a chair. This puts pressure on the hamstrings but protects your low back. Slow and steady is the way to go.

I think the other best thing for your glutes, other than what we’ve already covered, is to find a tennis ball and lay down on it. Put the tennis ball smack dab in your glutes and you can press on anything fleshy. You’ll be anywhere from the greater trochanter of your femur to right along the sacrum. Don’t put pressure directly on the tailbone! As long as you’re in flesh, you’re fine. The intensity should be something that you can breathe into through your nose. If you find it hard to breathe, if it’s too much pressure back off or maybe fold a towel over the tennis ball. You’re looking for tender spots that you can use the tennis ball to massage slowly. Try this for 5 minutes a day and see if there’s any improvement. The chart below shows some of the referred pain we’re talking about.

Trigger Point Pain in the Gluteus Maximus

Make sure to work both sides, if one is more tender work that side a little more but do both to find out.

I hope this information helps. Get back to me when you’ve done this so we can update. If that doesn’t we’ll move on to something else until you get some relief.

Carpal Tunnel Syndrome

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I hear of carpal tunnel syndrome so often I grow sick of it. Computer workers constantly complain of pain in their hands and wrists. I think I used to have it. Syndromes in western medicine are complicated because they’re usually a list of symptoms that are given a name. In my case, I work as a massage therapist and I use my hands, all day. A few years into my practice and before I used Thai massage it was just too much pressure on my carpals and wrists.

In that position I do what everyone does, I go to the doctor and they look at my quizzically. I was told to work less and use naproxen sodium. If you’re anything like me you have Huge fear and anxiety about your ability to keep working to pay bills. It’s no fun to realize you type at a computer all day and are now going to have to figure something else out.

That carpal tunnel I had? I didn’t. Essentially I had trigger points in my forearms that were causing pain in my hand. Deal with the trigger points and slowly but surely hand pain, what hand pain? I’ve been working for 11 years with no signs of slowing down. That incident was 8 years ago. The video above shows the work I do on my wife periodically for her continuous use of her hands at a computer and from knitting.

If you’re having issues with carpal tunnel you should Come In and See Me. I can figure out within ten minutes if I’m going to be able to help you. As I tell people, I do not diagnose, I do not treat conditions but…what if I we can make your symptoms go away?

Myofascial Pain Trigger Points pt.9 Anterior Scalene

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For such small muscles the scalenes cause a huge amount of pain in a large range of the body. When clients come in I often check the anterior scalene if they have issue with any of the following: arm pain, hand pain, thoracic outlet syndrome, headaches, migraines, chest pain and carpal tunnel syndrome. Being able to work on and release the scalenes effectively is an important part of any bodyworker’s tool chest.

You place gentle broad finger pressure on the muscle and hold. Have whoever you’re working on breathe and see if the muscle begins to give way. The upper portion often refers pain into the head the lower half down into the chest and arm. If you do not tell the client this notice that they’ll start moving their hand on the side you’re working as they feel the sensation.

The carotid artery is nearby and is fine, just don’t press into it if you feel the pulse underneath. When it doubt don’t. Take your time, breathe, go slow and use your hands effectively. Try working it on yourself and see how tight the muscle is.

Myofascial Pain Trigger Points pt.8 Coracobrachialis

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I’ve had pain in my arm for so long I’ve almost forgotten what it feels like to not have pain. I’d worked trigger points in subscapularis, infraspinatus and subclavius but still had some lingering pain. I was completely blown away when I found coracobrachialis.

My arm rotation, I’m happy to announce, is much greater and it’s improving slowly with ease, care and work. It feels nice to have my arm back after ten or more years.

When you work on the trigger point go slow. The area feels exquisitely tender and as I mention in the video be sure to use the pad of your thumb. No stress in the hands is needed and coracobrachialis is fortunately easy to access. Pull the elbow down into your side and you’ll feel the muscle pop up, relax the arm then press gently. Start in the middle of the arm then move slowly, purposefully into the armpit near the coracoid process.

Infraspinatus

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Myofascial pain trigger points from infraspinatus are some of the worst I’ve ever seen in bodywork practice. Having had problems with the area myself, clients aren’t usually very happy when I find problems with theirs. It’s one of the most painful things I’ll work on anyone.

Infraspinatus helps control rotation of the head of the humerus or upper arm. It’s part of the rotator cuff that reaches around the shoulder joint. Releasing this area gives someone a much wider range of motion in the shoulder joint and if you have arm or shoulder pain I highly recommend trying this to see if it helps.

Myofascial Pain Trigger Points

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Myofascial pain and trigger points from flexor carpi ulnaris should be the next spot you look at after working with flexor carpi radialis. The referred pain caused by trigger points here will be similar to flexor carpi radialis but in my experience the pain runs down towards the underside of the outer hand and to the middle to pinky fingers. If you believe you’re having carpal tunnel syndrome, check this area.

I find the forearm extensors to be the first stop in dealing with carpal tunnel syndrome but I recommend looking at these two trigger points in addition. Spending time at a computer is something most of us will continue for a long time so regular maintenance is a must. When you work the trigger point, go slow, it can be tender. You’ll find it exquisitely painful then hang out, breath and see if it releases.

Myofascial Pain Trigger Points

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Pain due to carpal tunnel syndrome and myofascial pain from trigger points is all too common. In our previous blog posts we went over chest and shoulder girdle pain and we’re slowly working out way down the arm. This is pt. 4 and the muscle I want to cover is flexor carpi radialis.

Trigger points in this muscle will send pain down the hand near the wrist. It’s an easy to reach spot and if you spend your time at a keyboard doing computer work try this out. Even if you’ve no debilitating issues it will probably be tight as mine is, from doing manual labor. Use slow continuous pressure from your implement of choice. I show using finger pressure then a steady elbow in the video.

Flexor carpi radialis is a good starting point for forearm and hand pain. Check out the anatomy of the muscle and also keep in mind that you may compress and remove blood supply to the hand temporarily. This flush of fresh blood is a good thing and to be encouraged, we’re cleaning you out from the inside out.

If you can use a tool like your elbow or a small knob feel free to be creative. Any small amount of work you do is cumulative. Good luck and keep carpal tunnel syndrome at bay.

Myofascial Pain Trigger Points

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Myofascial pain trigger points in infraspinatus are a problematic area to work on. They’re hard to reach but this video shows an easy way to access and treat these yourself. Infraspinatus is one of the muscles that make up the rotator cuff. This muscle in particular is an extremely common dysfunction I see in my bodywork practice. Due to its function in moving the upper arm around it means that it’s used when people lift their arms out in front of them. This happens in such common activities as driving, using a computer or many manual labor tasks like hanging sheet rock.

Keeping muscles in the rotator cuff relaxed seems to be good in preventing long term injury or a torn rotator cuff. When you think about tightening a guitar string to the point that it snaps, that is what can happen to a tight infraspinatus. Releasing chronic contractions and trigger points in the area go a long way to helping ease this tension and set things back in good working order.

Remember to go slow, breathe through your nose and relax onto a golf ball or tennis ball when you do this. Take your time and also keep in mind that the area can be extremely tender to the touch. Feel free to fold a rag or towel over your tool of choice to soften the pressure. The area is muscular, not bony and it takes time to get the superficial muscles to relax and allow a deeper tissue to be relaxed and released. Try it first for about 5 minutes, you can extend duration from there.

Myofascial Pain Trigger Points

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Myosfascial pain trigger points in pec. minor wreak havoc on clients just as subclavius does. Where subclavius locks the clavicle in place or pulls it medially, into the body, pec. minor pulls the shoulder blade down and forward. That slouched forward posture we all see so often usually has pec. minor involved. To complicate matters more women with breast tissue have increased pull on this area from gravity and often find pec. minor shortening over time.

To reach pec. minor you have to sink through pec. major. The muscles break into three bands that generally connect along the 3rd, 4th and 5th rib. There’s no harm if you miss it, even pec. major work is good. If you have trouble locating pec. minor slide your arm behind your back on the side you’re working and push your chest forward on that side, this should help you isolate the muscle fibers to work on. The area can be very tender, go slow.

Use your fingers, maybe two at a time to reinforce each other as you press. If it begins to hurt your fingers, switch fingers and take your time. Rome wasn’t built in a day. You build strength in your fingers and hands over time but don’t jeopardize your hands to work on your pec. minor.

The trigger points can refer pain to the shoulder joint on the same side and down the arm into the fingers. Don’t be afraid if you feel this while pressing into pec. minor. Go slow, breathe, feel the tenderness and let it soften. In time the trigger points will vanish. When pec. minor lengthens you can breathe more easily, roll the shoulder blades back and your angel wings start to open. Your upper back and chest feel free again.

Myofascial Pain Trigger Points

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Myofascial pain trigger points come up regularly not only in clients but in my own body. The simple video below shows you how to work on a muscle called subclavius. I find many women with large breasts have problems with the area as well as people with severely rolled forward shoulders that cause a slouched posture.

You can hold pressure on the spot that causes referred pain down the arm. Hold until the referred pain subsides or your hands grow tired. Rome wasn’t built in a day, take your time. Play with the muscle, angle and move the clavicle around to find the sweet spot. Self care for trigger points is highly effective.

Trigger points treatment

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I’ve spent years mashing on myself and others trying to unlock the mysteries of the human body. After ten years I still feel I’ve only scratched the surface. Anything I’ve learned I pass on to clients and help others on their healing path.

Years ago while in massage school I developed horrible pain in my shoulder. I’m left handed and working at a large shipping company doing repetitive manual labor I developed severe pain that eventually made me quit and look for other work. Whatever happened at that job has sat with me in some form for the last ten years or so. While in school I realized that my teachers didn’t know what was going on and after leaving school I continued to work on myself and try to figure out how to get it to stop.

There was a low level ache that ran down my arm and never ceased. Months went by and I’d done things that others consider near torture to get it to stop. At a friends house one day I noticed a baseball bat in the corner. Being the explorer I am I lay the bat on the ground and layed down on the knob end where you hold the bat while working what I now know to be my rotator cuff, particularly infraspinatus.

Infraspinatus is one of the most commonly dysfunctional muscles in the human body. I didn’t know this at the time but as I lay on the bat and pressed into my rotator cuff I noticed horribly sharp pain. This felt good, in the way that deep, intense bodywork can feel but it took my breath away. I relaxed, moved my arm around, got as comfortable as I could and continued to breathe deeply. Finding a single solid spot that seemed the most tender I lay down and breathed for nearly 30 minutes.

At the end I was near tears. The sensation was so deep there was nothing else for a time. The stimulation was so core I could explore nothing else. I finally sat up and noticed that my shoulder pain was gone. My rotator cuff was apparently causing the issue I felt. It was sore but the shoulder pain I felt has never returned. Months of agony, gone in 30 minutes. At the time I was unsure what caused this and am only now starting to put the pieces together.

Trigger points treatment is profoundly healing work. The more I explore, the more I’m amazed. I’ll be shooting videos soon to show you how to treat trigger points and how to do self care for trigger points.

Forearms and Hands pt.2

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Hand pain is something I find fairly frequently as a massage therapist and also something I have to be cautious about from my own practice involving those same structures. Many times I see hand and finger tingling, numbness and pain in various forms coming from the forearm extensors of clients.

In my clinical experience the points that you’re working are primarily at the elbow end of extensor carpi radialis, extensor carpi ulnaris and brachioradialis. Those are big words but don’t let them scare you, people just use them when they’re trying to seem smart. If you watch the video and use these techniques you’ll hit all three points with ease.

If you use these techniques on someone go slow and be purposeful. You can hold a point to get a release or you can roll through it towards the elbow which is also intense. It can feel odd to someone to press in one area and feel it elsewhere so reassure the person you’re working on that you’re not doing damage so long as the sensation is intense but no pain is experienced. To me that means that you don’t contract muscles and pull away out of fear of further harm.

Trigger points can be extremely tender. For people with chronic issues these can be real healers. I wouldn’t doubt there are people who’ve given up their favorite activities, knitting, spinning or playing musical instruments when they didn’t need to. Working as a massage therapist for ten years I use these on myself regularly, it’s allowed me to keep going without fear that I would harm myself.

Good luck and feel free to share your experiences.