Advanced Manual Techniques Using TRIGGER-& ACCUPRESSURE POINTS For Immediate Relief of MUSCULAR PAIN, TENSION, & DYSFUNCTION VOLUME I UPPER EXTREMITIES BY TORBJORN M. HANSON, A.c., MANUAL THERAPIST © T. HANSON 2012 TORBJORN HANSON, A.c. Kinesiologist & Muscle Therapist Torbjorn has 28 years of clinical experience in manual therapy for pain or dysfunction in muscles, tendons, ligaments and joints. He holds a degree from Sweden in Acupuncture and Physio Therapy, and has specialized in Trigger Point Therapy, Acupressure, Kinesiology and Sports Medicine. For 5 years he wrote a column and answered reader questions on sports injuries in B&K Sports Magazine, Scandinavia’s largest fitness publication. In 1994 Torbjorn founded Sports Performance Therapy Center, with a vision to bring together diversified therapies that would get patients Better, Faster. This state of the art physical therapy clinic is located inside Club Sport of Pleasanton, 184,000 square foot athletic club. He is also the founder of POSTU-Rx, a computer software program developed to prescribe custom made exercises, to stretch short muscles, and to strengthen elongated muscles. This program brings a new concept to sports medicine. His extensive work with professional and recreational athletes has led to the development of HandsOn Muscle Therapy. A cutting edge approach to Injury Rehabilitation and Prevention as well as Performance Enhancement. Torjorn has been teaching his techniques to therapists and physicians throughout Europe. His hands-on work is followed by a long record of success and gives instant relief and functional improvement in muscles/joint pain syndrome and sports injuries. His unique use of manual muscle testing provides feedback that assures specific therapy for each individual and every injury. HansOn Muscle Therapy H.M.T. is an advanced manual technique using trigger and acupressure points for immediate relief of muscular pain, tension and dysfunction. H.M.T. is a diversified system that integrates Feedback from postural evaluation, range of motion assessment and specific muscle testing to pinpoint areas of myofascial tension. Muscular Imbalance Sprains, strains or micro tearing due to overuse or trauma of certain muscles leads to an accumulation of tension, i.e. muscle shortening and adhesions. Anytime there is muscle shortening, and subsequent muscle lengthening of the antagonistic muscles, there is a MUSCULAR IMBALANCE. In other words, the body is out of ALIGNMENT. The core theory in H.M.T. is that muscular imbalance is the cause of injuries and decreased performance. Muscle shortening causes: Decreased range of motion Postural imbalances Change joint positions with decreased joint space Decreased vascular circulation Inhibition of lymphatic drainage Decreased strength Friction, pressure, compression and excessive pulling over time leads to dysfunction, inflammation and pain. This pain is caused by soft tissue damage or nerve entrapment and ultimately leads to neuropathy, joint pathology and joint degeneration. Reading Body Feedback H.M.T. uses postural and range of motion assessments together with manual testing of individual muscles, the recognition of referred pain patterns, and acupressure meridian distribution to determine primary muscles with the most accumulated tension. 1 Circuit Breakers Accumulation of tension in muscles, fascia and tendons manifest as hypersensitive myofascial reflex points know as trigger points or acupressure points. Those reflex points act as circuit breakers and when overloaded with excessive tension can give rise to local or referred pain. Trigger or acupressure points are activated directly by acute overload, overwork, fatigue or direct trauma to the muscle they are located in. Those reflex points can also be activated indirectly by other reflex points, visceral disease, joint dysfunction, or emotional distress. Once a reflex point is activated, repeated muscular stress of a lesser degree can activate pain in the reference zone, especially when the muscle becomes fatigued. Research shows that a change in electrical resistance (3) and temperature (4) can be measured at the dermal location of a reflex point. This can be confirmed with ohm meters and thermograms. “Getting to the Point” There are approximately 700 acupressure points on the human body and all skeletal muscles can develop multiple trigger points. The acupressure points have definite anatomical locations while the trigger point locations are not fixed. The proper point to select for therapy is not always located at the site of pain, but rather at the site of maximal accumulated tension. Due to the number of points possibly related too an injury, the therapeutic skill lies in the ability to select the right point(s) for each specific injury. H.M.T. teaches the relationship between different reflex points, referred pain patterns and acupuncture meridian distribution. H.M.T. utilizes patient muscle feedback by the unique use of indicator muscle testing in how to select the primary point(s) for each individual condition. This muscle feedback takes away the “guesswork” or the “hit or miss” approach in the selection of appropriate reflex points for a specific condition. Re-setting The Circuit/Releasing the Tension Once a primary reflex point has been localized, it should be released of its excessive tension with deep friction massage. Deep intermittent digital pressure to a reflex point in a specific direction causes a form of “depolarization”. Digital pressure on a primary reflex point will elicit local and/or referred pain. Complete release of tension with digital pressure to a reflex point will cause all elicit pain to completely disappear. 2 Proper release of tension in a reflex point will immediately abolish readings of changed electrical resistance. Inactivation of the reflex point allows associated muscle(s) to return to proper tone and hence restore muscular balance. Releasing tension to acupressure or trigger points in shortened muscles is very effective in reducing joint pressure and restoring range of motion. Lasting results will be achieved in eliminating local or referred pain caused by muscle shortening. This also improves vascularity and lymphatic drainage which stimulates the body’s natural self-curative abilities. Due to somatovisceral effects, a release of a hypersensitive myofascial reflex point can improve tension related visceral ailments and provide emotional release. Some theories suggest that digital pressure applied to acupressure points may also stimulate the nervous system to release neuro-hormones (such as endorphins). Research has documented that this is the case with acupressure (5). This would explain the analgesic effect often experienced with the release of an acupressure point. The analgesic effect is generally short lasting in cases of joint or nerve pathology. In other cases however, endorphin release may break the pain cycle and promote lasting or permanent relief. References: (1) Travell J. Bigelow NH: Referred somatic pain does not follow a simple “segmental” pattern. Fed Proc 5:106, 1046. (2) Travell J. & Simons D: Myofascial pain and dysfunction. The trigger point manual, upper extremities. Vol. 1, pg. 15, 1983. (3) Sola AE and Williams RL: Myofascial pain syndromes. Neurol 6:91-95, 1956. (4) Fisher AA: Thermography and pain. Arch Phys Med Rehabil 62:542, 1981. (5) Mayer FJ, Price DD, Barber J, et al: Acupuncture analgesia: Evidence for activation of pain inhibitory system as a mechanism of action. In advances in pain research and therapy, edited by J.J. Bonica, D. Albe-fessard, Vol 1 Raven press, New York 1976 (pp. 751-754). 3 Objective #1 A) Find and relieve muscular tension B) Immediate pain relief C) Restore normal range of motion, posture and strength. Muscular tension will cause muscular imbalance with uneven wear and tear to muscles, tendons and ligaments thus causing tissue damage with pain and inflammation. Muscular tension will cause a blockage of circulation with a relative oxygen deprivation as well as inhibited drainage of lymphatic waste products thus becoming the cause of muscle contraction, spasm, inflammation, pain and swelling. Excessive muscle tension can trap and pinch nerves thereby causing radiating pain patterns and neuropathy. Muscular tension results in muscular imbalance with altered posture. This misalignment will alter joint position and space, thus causing joint pathology and eventual joint degeneration. Muscular tension results in muscular imbalance with inhibited range of motion, decreased function, strength and endurance. 4 Objective #2 A) Find the underlying cause of muscular tension B) Educate to prevent recurrence of symptoms Physical cause: Direct trauma - Impact - Sudden uncontrolled body movement = Immediate tissue damage and tension. Microtrauma - Repetitive movement patterns - Improper movement patterns - Poor posture - Poor sleeping position - Improper pedal foundation = Accumulative structural stress causing tension and eventual tissue damage. Mental / Emotional cause: - ongoing mental / emotional stress - past unresolved mental / emotional stress = Accumulative emotional stress causing chronic muscular tension and eventual tissue damage. Nutritional / Chemical cause: - Nutritional deficiencies - Dehydration - Toxic conditions = Lymphatic congestion and muscular tension Environmental cause: - Allergies = Lymphatic congestion with muscular tension. 5 Hanson Muscle Therapy HMT Synopsis Posture and Range of motion evaluation is used together with manual testing of individual muscles and recognition of referred pain patterns to localize muscles with accumulated tension. Indicator muscle testing is used as feedback to pinpoint the exact location of active trigger points and acupoints in muscles with accumulated tension. Digital intermittent friction massage is used to relieve tension and inactivate those points. HansOn Muscle Therapy will: A) Relieve pain and tension immediately. B) Restore muscular balance and joint integrity. C) Improve vascularity and lymphatic drainage to injured tissue which will initiate healing. 6 How to LOCALIZE MUSCLES with ACCUMULATED TENSION Evaluate posture of pain area Use form A:1-3 for Anterior, Posterior and Lateral view Posture Evaluation. Reference; “Postu-Rx Manual for Muscle Imbalance” or DVD to establish standard for normal posture. Each postural imbalance indicates which muscles are tense / shortened or elongated. Evaluate range of motion of the joints proximal to the pain area. Use form B:1 for the upper extremities, form B:2 for lower extremities and spine to establish standard for normal range of motion. Reference; “Postu-Rx Manual for Muscular Imbalance” or DVD to establish standards for normal range of motion. Each range of motion imbalance indicates which muscles are tens / shortened or elongated. Perform manual muscle testing of muscles in pain area Use form C:1, for testing upper extremity muscles #1-35 or form C:2 for lower extremity and spine muscles #36-72. Each muscle will test either normal, hypotonic/weak/elongated, or hypertonic/tense/shortened. Reference; HMT Manual Muscle Testing manual I (upper extremity, muscles # 1- 35), and II (lower extremity and spine, muscles #36-72). “Muscle Testing and Function” by Kendall or “Applied Kinesiology, Synopsis” by Walther, can also be used. Ask the Patient where the pain is felt and fill in the appropriate pain zones Use form D:1, For the patient to indicate pain patterns on anterior, posterior or lateral illustration. 7 How to prioritize which muscle to treat first Postural Evaluation, Range of Motion Assessment, Manual Muscle Testing, Referred Pain Patterns and Acu-Meridians is what determines which muscles have an accumulation of tension and harbor active trigger points or AcuPoints. Use the Priority sheet (Form E) to determine which muscle(s) are indicated the most. Example I: A patient presents with a right shoulder promlem. Postural Exam: Anterior view show a medially rotated right arm. See exam form A-1 on page #11 This indicares that the muscles that medially rotate the arms are relatively shorter (more contracted) than the muscies that laterally rotate the arms. This also indicates that the muscles that laterally rotate the arms are relatively elongated compared to the muscles that medially rotate the arms. Shortened muscles Elongated muscles Medial rotators of arm Lateral rotators of arm #8 Pectoralis Major Clavicular #16 Infraspinatus #9 Pectoralis Major Sternal #17 Teres Minor #10 Latissimus Dorsi #20 Deltoid Posterior #12 Teres Major #14 Subscapularis #18 Deltoid Anterior Posterior view shows and elevated right scapula. See exam form A-2 on page #12 This indicates that the muscles that elevate the scapula are shortened and the muscles that depress the scapula are elongated Shortened muscles Elongated muscles #1 Trapezius Upper #3 Trapezius Lower #5 Levator Scapulae (#10 Latissimus Dorsi) #6 Rhomboids #7 Pectoralis Minor 8
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