Muscle Mug Shot: the trapezius

The first muscle mug shot simply had to be about the trapezius. Why? Because that is the one muscle people instinctively point to accompanied by the words ‘I’ve got this pain right here, could you quickly fix it?’ when they hear I’m a remedial massage therapist. But as one of my favorite villains said:

What can I say? I’m an evil, evil person.

Anyway. The trapezius, or how I choose to remember it: the ‘ballerina muscle’! A big, hard working muscle with lots of different actions. But to understand the actions, you need to know where the muscle attaches and what it looks like. So, I present to you: the trapezius mug shot!

Trapezius front view

Trapezius side view

 

 

 

 

 

 

 

As you can see, the left and right trapezius combined sort of looks like a trapezium – in a Dali clock kind of way. It is the most superficial muscle of the shoulder and back. The trapezius consists of an upper, middle and lower part, and each part has different attachments and actions which I will list below.

Just to clarify: there are two types of attachment sites, the origin and the insertion. The origin of a muscle is usually the attachment site that doesn’t move when the muscle contracts, the insertion the site that does. The actions are the movements a muscle can produce.

For the upper part of the trapezius:

Arm lifted, head and neck rotated and extended: a perfect example of the trapezius’ actions

• Origin: occipital bone (= base of the skull), ligamentum nuchae and spinous process of C7
• Insertion: lateral (= away from the body’s midline) third of clavicle (= collar bone)
•  Actions:
  • When one side contracts and the head/neck is fixed: pulls the shoulder up by pulling the collar bone up, prevents lowering of the shoulder when carrying a weight, upwardly rotates the shoulder blade by pulling the collar bone up (which is needed for example when you lift your arm overhead)
  • When one side contracts and the shoulder is fixed: laterally flexes the head and neck to the same side, rotates the head and neck to the opposite side
  • When both sides contract and the shoulder is fixed: extends the head and neck
• You use it when: shrugging your shoulders, wearing a backpack, lifting your arm up above your head, moving your head

For the middle part:

• Origin: spinous processes of T1-T5
• Insertion: medial (= towards the body’s midline) part of acromion and top of spine of scapula (= shoulder blade)
• Actions: adducts (= retracts) the shoulder blade and stabilises the shoulder blade when it gets upwardly rotated by other muscles
• You use it when: squeezing your shoulder blades together, boxing

For the lower part:

• Origin: spinous processes of T6-T12
• Insertion: medial end of spine of scapula
• Actions: pulls the shoulder blade down and stabilises the shoulder blade when it gets upwardly rotated by other muscles
• You use it when: pulling the shoulder blades down, using the hands to get up from a chair

This absolutely amazing video shows the trapezius in action. The text is in French, but you can see the muscle working:

The trapezius is often involved in headaches, neck and shoulder pain. It can also refer pain between the shoulder blades or into the jaw and even the teeth. The most common trigger points (cross) and referral patterns (blue and red) look like this:

 

 

 

 

That’s it, folks! Our very first muscle mug shot. In this one I explained a few terms, so the next article will be more concise.

References:

Chris Jarmey’s The Concise Book of Muscles (2008)

Travell & Simons’ Myofascial Pain and Dysfunction: The Trigger Point Manual VOLUME 1. Upper Half of Body (second edition)

NSW School of Massage’s AMT Notes (2012)

Images:

https://commons.wikimedia.org

http://abbottcenter.com/bostonpaintherapy/?p=1492

To the point: trigger points

For many of us, trigger points are like politics. We don’t understand what the hell is going on half of the time, but the resulting situation can cause us quite a lot of grief if it doesn’t get stopped through massage (the trigger point, that is). That is why this time I decided to zoom in on trigger points and give you a more in-depth profile about the little buggers. In my first article, I explained the definition of a general trigger point. There are different types of trigger points however, which I will explore here.

One important concept to understand is the difference between active and latent trigger points. Active trigger points spontaneously cause local and often also referred pain. ‘Spontaneously’ means that they cause pain when the muscle is at rest (more serious) or working (less serious). When you put pressure on them, they produce the same kind of pain. Active trigger points mess with the muscle’s mojo: they weaken it and reduce its flexibility by causing tension and by preventing it from stretching fully. They can even provoke symptoms such as sweating.

A slightly creepy picture to show you that the triceps relaxes when the biceps contracts

On top of that, they can do some unholy business with other muscles like triggering a muscle spasm or interfering with the coordination between muscles. An example of the latter: if your biceps has a trigger point in it and you want to contract it, your triceps has to relax in order to make that happen. The trigger point in your biceps interferes with the coordination between the two, which results in contraction of both muscles.

The only difference between active and latent trigger points is that latent ones are just ‘there’, without causing pain. Only under pressure they hurt locally and can refer pain. You can compare active trigger points to bosses who bully you: they always cause (emotional) pain and tension, make you feel weak and make you sweat. Latent trigger points are more like regular bosses: usually cause tension, make you feel weak and sweat but it’s only when they are under pressure that they will hurt you (emotionally). Latent trigger points are much more common than active trigger points, so when you come to Worthing for a sports massage I’ll probably find at least one tender spot! Yes, my clients love me.

Scientists assume that latent trigger points develop first, and then turn into active ones. But what triggers them in the first place, and what can ‘activate’ a latent trigger point? Everything that generates a latent trigger point, can also turn it into an active one and aggravate the situation. Usually it is the result of muscle overload: you abused your muscle in some way.

Trigger points love these exercises!

Muscle overload can be acute, sustained and repetitive. Doing excessive or unusual exercise, such as running a marathon without properly training for it, often results in acute overload. Acute overload mainly happens when the muscle has to contract too strongly or when it is lengthening while contracting at the same time, like your biceps do when you are slowly lowering a weight. Sustained overload means that you keep your muscles contracted for a long time. This is often posture related (hunching over your phone) but can also be the result of work activities (holding your arms up when painting a ceiling) or stress (pulling your shoulders up when stressed). Repetitive overload means you are repeatedly using the same muscles in the same way for long periods of time, a bit like Charlie in this video.

There are many other things that can leave your muscles knotted. Remember that marathon you didn’t actually train for? If you need an excuse for not doing it, this is a good recipe: leave your leg muscles in a shortened position for a long time. Better yet, contract the muscle while it is shortened. Doing that can get you some serious trigger point lovin’, as I discovered myself when the right side of my lower back started hurting after I sat with my right hip elevated for a few hours (don’t ask). It took me quite some trigger pointing to get out of that pickle. And finally: nerve compression or acute trauma such as a blow to the muscle, whiplash etc. will also result in trigger points.

Indirect triggers are other existing trigger points, diseases, joint problems and stress. There are also elements that don’t necessarily cause trigger points but ‘keep them alive’ or make them worse such as cold and insomnia, which I will leave for another time. With enough rest and without those elements, an active trigger point can spontaneously go back to being a latent trigger point. Great, no more worries? No, because it can always be reactivated and it can still cause pain when you put pressure on it (for example when you lie on it). It will also mess with the muscle in other ways, such as by weakening it.

No matter what you do, you will probably develop some latent or even active trigger points here and there. Getting a sports massage regularly is a great way to get rid of them before they can bother you.

To be continued.

References:

Mense & Gerwin’s Muscle Pain: Diagnosis and Treatment (2010)

Travell & Simons’ Myofascial Pain and Dysfunction: The Trigger Point Manual VOLUME 1. Upper Half of Body (second edition)

Muscles are drama queens: they complain about everything. True or false?

To answer the question: both true and false. Yes, I tricked you. No, I’m not playing with your feelings. Well… Maybe. Muscles can be literally and metaphorically a pain in the bum, but they don’t do that just because they can. There are interesting mechanisms behind muscle pain, which we will explore in this post.

Sometimes it’s easy to see why a muscle isn’t a happy chap:

Spear in quads = pain. Simple! Unfortunately (?), these are not the problems clients visit me for. They visit me because they have sore wrists and tingling fingers and the doctor told them they should relax their hands and take a bunch of pills and they did that but still don’t feel better and now they are worried they might have carpal tunnel and have to quit their job and live on the streets. So… that escalated quickly!

There are many, more obscure reasons why muscles hurt. The easiest way to explore this subject is to categorize the causes by the type of pain. Muscle pain can be local, projected, referred and central.

Muscle pain is considered to be local if the muscle is painful because of a problem in or with the muscle itself, like in our friend Ace’s situation. Other local causes of pain are local trigger points, spasms/cramps, RSI (overuse) and DOMS (after-exercise-soreness). Since I take my job as seriously as getting the right type of mayonnaise for my fries (I will always be a Belgian!), I will explore all of these causes properly in the future. Promised.

Cross-section of spinal cord with nerve roots

Projected muscle pain is pain caused by compression or inflammation of the dorsal root of a spinal nerve. It can also occur when a spinal nerve is compressed or inflamed anywhere along its path.

The dorsal root of a spinal nerve comes out of the back of the spinal cord and converges with the ventral root to make up a spinal nerve. The dorsal root carries sensory (sensation: pain and temperature) information, the ventral root carries motor (movement) information. So, spinal nerves are a bit like the never ending facebook updates of health obsessed individuals: they always carry both motor and sensory information (‘Today I ran a million miles and it felt amazing!’).

When a dorsal root or spinal nerve gets damaged, a pain message gets sent to the spinal cord. This message travels via the same nerve fibers that send pain messages from the nerve ending to the spinal cord. Because the brain can’t distinguish between the two sensations, it interprets the ‘Auch! There is damage somewhere along this nerve’s path’ as ‘Auch! There is damage at the end of the path’. This means that when for example your sciatic nerve is compressed under a hyperactive muscle in the hip area, you can feel pain in your hammies, calf and foot (= the nerve’s pathway).

Muscles are very generous with their pain. Trigger points in one muscle can cause referred pain in another muscle. For example: a trigger point in the side of your neck can cause your forearm muscles to hurt. The same thing happens when a muscle is damaged, it can refer pain to another, undamaged muscle. And just to make it extra confusing: referred pain can occur together with pain at the original location of muscle damage OR by itself!

A theory as to why this happens is that pain messages from the damaged muscle or trigger point enter the spinal cord and then get ‘rerouted’ to another nerve cell. This then leads to the brain interpreting the pain as originating in the area that this other nerve cell is connected to.

Just so you know: joint problems, internal organ problems and bursitis (inflammation of fluid-filled sacs that cushion tendons, joints and bones) can also refer pain to muscles. Even though this is certainly interesting info, I feel like this would take us a bit too far in our quest to understand muscle pain.

Finally, central pain is pain that has its origin in the central nervous system, meaning the brain or the spinal cord. A very easy example would be phantom pain, in which the central nervous system ‘remembers’ the pain of a limb that is no longer there.

This post was just a short introduction to muscle pain. I mainly wanted to explain why muscle pain is much more complicated than usually expected. To be continued.

References:

Mense & Gerwin’s Muscle Pain: Diagnosis and Treatment

Mense & Gerwin’s Muscle Pain: Understanding the Mechanisms

Trigger points: what a pain

Trigger points, also known as ‘knots’. So you thought your muscles were fine, until you came in for a sports massage and we found this exquisitely painful spot in your muscle? It happens to the best of us. But what are trigger points? Where do they come from? How come, much like teenagers, they are often accompanied by others AND give in to pressure? Let’s take a closer look.

The concept of myofascial trigger points as we know them today is based on Dr. Travell’s research. She described trigger points decades ago and is regarded as the ‘mother of myofascial trigger points’. I can imagine more pleasant children. But interesting, they definitely are. Trigger points are described as:

A hyperirritable spot in skeletal muscle that is associated with a hypersensitive palpable nodule in a taut band. The spot is painful on compression and can give rise to characteristic referred pain, referred tenderness, motor dysfunction and autonomic phenomena.

Say what? To break it down, a trigger point:

• is an easily irritated spot in the muscles that you can control (as opposed to the muscles you can’t control such as heart muscle and internal organ muscles).
• feels like a pea in a very tight hammock.
• hurts like hell when you put pressure on it but can be painful without said pressure.
• can be the cause of pain in a completely different area in the body. Think: trigger point in the glutes (‘bum muscles’) can be felt in the calf.
• can mess with the muscle’s mojo by causing muscle weakness and loss of control over the muscle. It can also decrease the amount of time a muscle can effectively work for without rest, because muscles with trigger points are hyper sensitive, slower to relax between work periods, tired to start with and they tire out more easily. Trigger points can also provoke spasms in other muscles. A client of mine got a spasm in one of his neck muscles, for the exact amount of time that I triggerpointed his shoulder muscle. Crazy stuff.
• and can even have an influence on the control center that unconsciously regulates ‘bodily functions’. As in: trigger points can cause abnormal sweating, excessive salivation (drooling) etc. No burrito needed.

So trigger points can be pretty annoying. But why is there a trigger point to start with? The leading theory about what happens when a trigger point pops up is: it is simply a chronic contraction of part of one or more muscle fibers.

When part of a muscle fiber contracts it gets ‘bigger’ (for example: Popeye’s biceps). Because it stays contracted, the ‘knot’ starts to compress local blood vessels, which in turn means that nutrients and oxygen have a hard time getting to the region. This results in an energy crisis.

When an energy crisis occurs, cells release substances that make the area extra sensitive, and make you feel pain. Thank you, body. This is how a trigger point is born. When you put pressure on a trigger point (as we do in sports massage), you break this cycle and the contraction releases.

It is generally accepted that there are a few ‘trigger point triggers’. Situations that cause trigger points directly are overuse, overload of the muscle, nerve problems and direct trauma, like a blow to the leg. Indirect causes are other trigger points, certain diseases, joint problems and stress. So basically: if you’re alive, you’ll probably have a few trigger points here and there.

So there you have it, a simple introduction as to the what, how and why of trigger points. To be continued.

Reference:

Travell & Simons’ Myofascial Pain and Dysfunction: The Trigger Point Manual VOLUME 1. Upper Half of Body (second edition)