Posts tagged ‘repetitive strain injury’

Important muscles involved in hand, wrist & arm pain – Part 1

There are many intricate muscles and soft tissue structures in the hand, wrist and arm which can cause various types of pain, numbness sensations, weakness, pins and needles or electric shock type of sensations when they become constricted, tight or dehydrated through physical over use or misuse, bad posture, accidents, old injuries (such as high velocity neck impact or whiplash) and deep scar tissue, and/or combined with unremitting emotional stress.

2 muscles which I’d like to draw the reader’s particular special attention to in this article are the scalenes and pectroalis minor muscles.  These are 2 very important and relevant muscles which massage therapists who have been through advanced trainings in say for example clinical massage techniques will know how to treat efficiently and very specifically.  Both of these muscles are very much neglected in most general relaxation massage work.  The scalenes muscles are located in the base of the lower neck and attach to the first and second ribs, whilst the pectoralis minor muscles covers the 2nd, 3rd and 4th rib in the region of the front upper chest.  Both muscles although located respectively in the neck and upper shoulder region are often highly relevant in hand, wrist and arm pain pathologies, one of the main reasons behind this is that the brachial nerve plexus and its subsequent other  sub branching nerves serving the arm passes directly underneath both of these muscles so any tightness in either of these muscles is going to have a direct physical effect on creating nerve related aggravation in these regions.

[Trigger Point Pain Referral Pattern for Scalenes Muscle Group]

[Trigger Point Pain Referral Pattern for Pectoralis Minor Muscle]

Signs of nerve related impingement or over simulation can include pins and needles, intermittent shooting pains over a certain region (such as down the arm), electric shock type sensations, or areas of numbness.  Nerve impingement caused by the scalenes or pectoralis minor muscles can also cause the muscles and proprioception to misfire so causing symptoms of weakness or spasm in the arm, hand or wrist.  Symptoms of carpel tunnel or other repetitive strain injury type side effects can also be triggered or caused by soft tissue tension in these apparently unrelated areas further up and away from the hand, wrist and lower arm (but which you now know after having read this article and viewing the related videos are very much related).

Tightness in the scalenes muscles can cause tingling all the way down to the thumb and first fingers of the hand, whilst pectoralis minor tension cause refer tingling all the way down to the ring finger and little finger.  Constriction of the blood supply serving the arm from a tight pectoralis minor muscle can also cause feelings of coldness or lack of circulation to the fingers.

Habitual shallow breathing, particularly whereby the type of breathing only involves the use of the upper chest (rather than full deep belly breaths) is another potential cause of chronic tightness in the scalenes muscles.  Stress management through gradual build up practice of proper relaxing deep breathing is the perfect antidote.  Notice when you’re stressed or shallow breathing, be gentle and kind to yourself, congratulate yourself for noticing and just start by receiving 3 deep breaths in and out and build up that number over time, the idea is that over time it builds up to more of an unconscious habit rather than a conscious effort.

As with all these topic, there’s always so much that could be written or linked to, this is just what I could cobble together off the top of my head and without turning this into a fully blown dissertation as well as given the fact that I would like to go to bed in a moment (!!), but if you want to know more or have any suggestions I would be glad to receive your feedback as always and compile a part 2 or further subsequent parts as a follow on to this particular article as the demand unfolds.

Be well! 🙂


Visit the ISCA Therapies website:


19 January, 2011 at 00:13 3 comments

Are trigger points the answer to your unresolved soft tissue pain?

Almost immediately after I had completed my initial basic training in massage, I happened to come across across a series courses for already qualified therapists such as myself, the courses were modular and taught remedial soft tissue techniques and skills to profoundly affect soft tissue pain conditions for the better in clients. This new information opened up a whole new range of clients for me whom I’d never have thought of working with before and changed the course of my practice. Trigger point therapy along with myofascial release are the joint top 2 remedial techniques that appear to have the most profound affect on clients I have worked with, especially ones who have been around the houses already to see conventional health professionals and other alternative therapists without much of a result.

Trigger points are basically a single point of very tight knots in the fibres and fascia (connective tissue) of a muscle which causes pain to be felt as result, these knots can vary in size from a pea to a grain of sand. An appropriately experienced remedial therapist will normally be able to detect these knots through palpation or touch alone, but often will also require verbal feedback from the client in order to confirm whether a sore spot is being pressed upon. Trigger points can be caused by repetitive overuse, over strain, stress, injury, accident or trauma. These knots impede the flow of fresh blood to the area where the knots are, this constriction also means that metabolic waste and toxins which are normally flushed away back into the circulatory system cannot escape so there ends up being a build up in this confined area which is what causes the pain. Trigger points may need to have pressure applied to them in order for the pain pattern to become activated or the trigger point may be in such a state that it is always actively causing the pain regardless. The muscle knots that form a trigger point site do not tend to respond to standard kneading type massage movements, they require precisely aimed static pressure, pressure which shouldn’t be too hard either as this will just make the muscle go into further contracture and hardening. I usually apply up to 12 seconds of constant static pressure on a trigger point, within that time frame the client should be experiencing levels of pain no greater than a 7 out of 10 (and much less is fine), before that time is up I would expect the client to perceive a change in the quality of pain, either getting less or changing say from a sharp pain to dull ache and this would be a sign for me to cease pressing. I could also choose to follow the movement of the tissues as they begin to ease and release, so combining a myofascial release technique (more on myofasical release in an upcoming article).

The most distinctive attribute of most trigger points is their ability to refer pain, so that pain appears to be experienced at a remote and apparently unrelated location to that of where the trigger point actually physically is. Not only are most trigger points able to set-up pain referral conditions, but all these pain referral patterns have been proved by research to be consistently reproducible and predictable. Books and charts have therefore been produced showing typical trigger point locations on a diagram of a muscle along with the expected pain referral pattern(s).

There has been plenty of scientific and medical research conducted into the efficacy of trigger points, but despite this it is still not part of any of the qualifying training that a conventional medical doctor would go through, so therefore most would be ignorant of this phenomenon. Dr Janet Travell who was also president John F Kennedy’s personal physician, was one of the main pioneering figures behind research into the theory and practical implications of trigger points.

Here are so common examples:

Reoccurring headaches where the pain is usually felt in the same predictable areas on the skull every time are usually caused by trigger points in the muscles either side on the side of the neck.

Sciatica and the characteristic shooting pains down the back of leg is often caused by trigger points in the gluteal region muscles and the resulting nerve entrapment that occurs of the sciatic nerve (usually the piriformis muscle deep in the mid region of the buttocks).  Can also cause lower back pain issues.

Shin splints are usually usually caused by trigger points in the (tibalis anterior) muscle on the outside front part of the lower leg just a few inches below the knee.

Tingling or numbness sensations in the fingers often accompanied by RSI (repetitive strain injury), carpel tunnel or thoracic outlet syndrome type symptoms are usually caused by nerve fibres (of the brachial nerve plexus) being entrapped by tight muscles containing trigger points, namely the muscles at the base of the neck (scalenes) and the muscles in the chest area either side on the front of the rib cage just a bit below the collar bone (pectoralis minor).

This website I came across whilst researching this article gives an excellent extract from a book about trigger points, but provides an even fuller commentary than here if you are interested in reading more, so I’d point you there for further reading as it’s really very good and saves me from trying to re-invent the wheel here so to speak:

And to see pictorial diagrams and a very comprehensive listing of pain related symptoms that can be related to trigger points in a certain muscle, have a look at this highly informative website:

Here are 2 books that I use myself during client consultation sessions and come highly recommended as well if you are interested in looking into self treatment (click on the images for more details):

Trigger Point Therapy for Myofascial Pain – Fernando & Fernando:

The Trigger Point Therapy Workbook – Davis & Davis:

Thera cane: an essential self treatment tool (comes with instructions)

14 February, 2010 at 01:27 10 comments

Henry Tang – Therapeutic & Advanced Clinical Massage Practitioner (Crows Nest, Sydney, Australia)

Click image above to visit Spaces of Possibilities Wellness Centre, Crows Nest, Sydney, Australia.

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