Myofascial trigger points

Imagine this: you feel a deep, spreading pain at your right shoulder. It feels better after a good night's rest, but as your day progresses, the knot-like feeling creeps up on you without invitation. The pain is sometimes very intense and sometimes moderate. And you note that sometimes it travels to different areas of your body.

These annoying little knots in our muscles and connective tissues are called myofascial trigger points. The "myo" part of the word means muscle and "fascial" refers to the elastic, connective tissue that runs throughout the body.

There are two basic types of trigger points: active and latent. Latent trigger points don't cause pain except when pressed. When latent trigger points become triggered and awakened by stress or injury, they become active. Active trigger points radiate (or refer) pain from muscle or fascia in a characteristic pattern. For example, trigger points in the shoulders often send pain and tension throughout the shoulders and up into the lower neck. Likewise, trigger points in your buttocks can refer pain down the leg just as in sciatica.

Two doctors, Dr. Janet Travell and Dr.
David Simons, revolutionized our understanding of trigger points. They mapped out the entire body and standardized a pain referral pattern for each muscle. Trigger points usually follow these maps, though some people have unusual pain patterns. In either case, deep breathing, stretching, applications of heat or cold, and massage can help.

A case in point

Travell and Simons say that the shoulders are the area most affected by trigger points. The levator scapula muscle connects your shoulder blade to your neck and is responsible for elevating your shoulder blade. It is especially prone to trigger points, and can refer pain to the neck, around the shoulders and down into the mid-back. Note the picture of the shoulders to the left. If you have pain in the shaded area, you may have trigger points (indicated by the X's) in the levator scapula.

To help relax this muscle, focus on the shoulder area. Breathe deeply and begin to let go of the tension with each exhale. Then inhale, shrug your shoulders up toward your ears, squeeze, and hold them to the count of three. Release them completely on the exhale. Repeat three to five times, then relax and breathe slowly and deeply.

Back to School Back Pain

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Ergonomics for children and grown-ups, too

Pediatricians, physical therapists, and massage therapists are seeing more young patients complaining of back and neck pain. The culprit is often overloaded backpacks.

Backpack weight
According to the American Chiropractic Association, backpack weight is contributing to pain earlier than in previous generations. By 4th or 5th grades, children are packing textbooks and instruments as well as cell phones, iPods and even lap tops.

Backpack guidelines
You can help your child strategize about how to prevent or recover from injury and pain from carrying too much weight.

1. Limit backpack weight to 15% of your child's weight. If your child weighs 75 pounds, the maximum backpack weight should be 10 pounds. If 125 pounds, your child should carry 18 pounds or less.

2. Use a backpack with wide straps, and wear it on both shoulders.

3. Only pack what is necessary. Maybe they don't need to carry all their books every day.

4. If they have a locker, they can leave the books they aren't using until needed. If they don't have one, could they get a second copy of textbooks to leave at home?

5. Some children use a pack on wheels.

Adults, too
Grown-ups, you may also be busily moving around -- from home to work to school or gym with a backpack, laptop case or messenger bag slung over your shoulder.

Use the guidelines above to prevent injury and pain as you go about your daily activities this fall.