The use of therapeutic percussion/vibration to address pain and movement limitation has a long history, from manual percussion in traditional modalities like Thai or Shiatsu to more recent use of “massage guns” by manual therapists.
I began incorporating therapeutic percussion into our Hybrid Health Performance modality several years ago as an experiment to determine how it could augment our approach to trigger point therapy. Since that time, extensive clinical experience has shown me that properly used, vibration tools can powerfully augment trigger point work - but it demands a very different approach than the usual "vibrate where it hurts". The typical broadly applied, non-specific, “meat tenderizer” use of percussion in areas where the pain is felt may provide symptomatic relief for a time, but will not create lasting change. Tools aren’t magic – they are only as effective as the underlying understanding of the practitioner allows them to be. In this article, I'll cover some ways in which you can make therapeutic percussion far more specific and targeted, so that it becomes an effective technique for eliminating pain at the source. The first key is working the right muscles in the optimal order - easier to describe than it is to do. Proper analysis is one of the more difficult tasks facing trigger point therapists, and this lack of sophisticated analysis has limited the adoption of trigger point therapy in the past. More about this in a bit. The second major key is understanding how to use vibration to enhance neuroplasticity. Vibration tools are unrivaled in their ability to provide neurological distraction during movement, allowing taut fibers to normalize without the usual protective guarding that is triggered by techniques that mistakenly attempt to "break up adhesions" and cause too much discomfort. The HHP Treatment Cycle is an approach that I have developed and use with modifications on each individual muscle. It uses distraction, feedback, compression, vibration, scraping, cupping and movement to encourage the brain to allow muscles to move again without invoking the protective response. I have found that using vibration within the treatment cycle makes it hugely more effective. Finding The True Source Myofascial trigger points, not injury or disease, have been shown to be responsible for the majority of pain complaints in several formal and informal studies. Even in cases in which tissue damage or inflammation is present, trigger points are a useful target for treatment, due to their role in providing peripheral nociceptive input to the central nervous system, fostering upregulation and protective muscle splinting. Many practitioners make the mistake of identifying hard, taut bands in muscle as “scar tissue” or adhesions. In most cases, these areas are actually taut fibers containing trigger points. This is easy to verify in practice - scar tissue can’t be softened in minutes, but taut fibers can be released quickly via the use of appropriate techniques. Trigger point theory has shown us that it’s generally a mistake to “rub where it hurts” to have a lasting impact on pain, because the vast majority of muscles with trigger points refer pain to an area well removed from the location of the trigger point. For example, pain over the anterior deltoid is a very common complaint. While it’s tempting use a massage gun in the front of your shoulder where you feel the pain, you will probably find that the benefit is short-lived if that’s where you stop. There are 13 muscles that refer pain to the front of the shoulder, including local referral from the anterior deltoid itself. However, the deltoid, even in the presence of painful taut bands, is not the most likely origin of this sort of pain, which often occurs without any obvious stress or injury in the deltoid. The Hidden Referral Network So why then would the deltoid develop taut fibers and tenderness if it isn’t under unusual stress? To understand this, you have to be familiar with satellite referral. When a muscle’s fibers sit under the referral zone of another muscle, it can develop dysfunction itself, in a kind of chain reaction. This phenomenon was conceived and explored to an extent by Travell and Simons, but in their decades-long effort to establish the foundation of trigger point ideas they were never able to fully flesh it out. Sadly, in the most current 1-volume revision by other authors, satellite referral has been relegated to the dustbin, lumped in with other “associated muscles”. In my development of the Hybrid Health Performance modality, I have found that satellite referral plays a much greater role than its marginal coverage would suggest. Satellite referral chains occur consistently throughout the body, and set up a confusing, hidden network of causality that few practitioners are aware of. I have found satellite referral to be a reliable model that reveals the true source of many common pain patterns. In the anterior shoulder example, there are several commonly involved muscles that refer over the anterior deltoid and could set it up with taut fibers and tenderness. The scalenes, infraspinatus, clavicular pectoralis major and pectoralis minor are all frequent sources of inbound referral to the deltoid. The satellite referral chain often extends beyond a single step. For example, infraspinatus can itself be a target of satellite referral from low trapezius and serratus anterior, both important scapular stabilizers. The intersection of functional and satellite referral relationships is where the secrets lie in understanding the true origins of pain symptoms. How To Make Therapeutic Vibration Truly Effective Even the fanciest tools are only effective if they are supported by an informed analysis and used on the right muscles at the right time. Over the last 15 years, I have been developing Hybrid Health Advanced Muscle Therapy Protocols for all the major pain areas. These protocols each represent hundreds of hours of research to discover the key muscles contributing to each pain area, along with their interlocking patterns of satellite referral and functional relationships. Order of events is very important in designing treatments. It’s of little use to put a lot of time into full treatment of a muscle until some attention has been paid to the upstream muscles that might be feeding referral into it, and we must always ensure that we’re attending to its functional antagonists as well. This is nearly impossible to design on the fly during a session without some kind of framework. The HHP protocols present a suggested order of treatment based on numerous factors, including the best treatment positions for each muscle and its functional unit and what key muscles should be covered first. Most importantly, the HHP protocols include assessments and decision points that facilitate spending your time only in the most relevant areas, eliminating muscles that are less relevant. This is why our clients get results FAST! Most pain is referred by trigger points in muscles, although most medical professionals don’t understand this, and are misled by the “illusion of injury”. Remember, tools aren’t magic – they are only as effective as the underlying understanding of the practitioner allows them to be. Cheers to your healing, Vice
0 Comments
Leave a Reply. |
AuthorVice Lujan is a muscle and movement specialist in Bakersfield, CA. Vice specializes in reestablishing normal, pain-free range of motion of the body. Archives
May 2024
Categories
All
|