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(NOT SO) TENDER LOVING CARE

When your muscles feel tight, what’s the most natural thing to do? If you said stretch, you’re right, and also wrong. Paradoxically, stretching an already tight muscle can cause reactive tension as the muscle tries to protect itself, and since taut muscles already put pressure on their attachments, stretching can actually damage the tendon and joint. What is needed is to identify the real cause of muscle irritation and treat it properly.

You’ve probably heard of trigger points. The term was coined by Dr. Janet Travell, M.D. to describe small contraction knots in muscle and surrounding tissue (collectively termed myofascia). Trigger points can feel like a partly cooked piece of macaroni buried deep beneath the skin. They are often caused by overuse and/or overexertion, as in the case of the athlete attempting to run farther or faster, and who among us doesn’t fit that description? As you can guess, myofascial irritation is astoundingly common, implicated to some degree in iliotibial band syndrome, plantar fasciitis, and other running-related conditions. What’s more, trigger points are notorious for referring pain to distant body parts - for example, pain in the quadriceps muscles often radiates to the knee – which can make them very difficult to treat. That is, unless you know where to look. Use the following head-to-toe guide, and with your own fingers and perhaps a trusty massage tool or two, you’ll find myofascial release to be fun and satisfying. Prepare to be pain free!

Foot Pain/Plantar Fasciitis
Together the two muscles of the calf (soleus and gastrocnemius) have the power to lift the entire weight of your body, which certainly comes in handy when  hurdling rocks, climbing hills, and controlling descents. But these dense muscles, if irritated, can do as much harm as good. Signs of calf trouble are felt in the feet, specifically in the long arch of the foot. The plantar fascia, as this area is called, is actually the tendon formed by the union of the two muscles. Massage these muscles with your opposite knee or with a tool like The Stick. Use deep, stroking massage rather than static pressure, massaging with short, repeated strokes in one direction.

Runner’s Knee
While arthritis and tendonitis are common diagnoses in the setting of knee pain, often it is the muscles of the thigh that require attention. Runner’s knee, or pain around or behind the kneecap, is most commonly caused by the oval bulge of muscle on the inside of the thigh just above the knee, known as the vastus medialis, one of the four quadriceps muscles. For this muscle, paired thumbs work well for massage. Be sure to give attention to the other quadriceps muscles running along your thigh between your knee and your hip, as you will likely find other hot spots as well.

Hip Pain
Pain and other symptoms of the hip are likely due to the combined effects of more than one muscle. A big culprit is the piriformis, the largest of six short hip rotator muscles located between your tailbone and thigh bone. A shortened piriformis can compress the sciatic nerve and radiate pain down the back of your leg and into the sole of the foot. To locate the piriformis, feel it contract as you rotate your leg outward while lying on your opposite side, and search the area between the top of your hip bone (greater trochanter) and your sit bone (ischial tuberosity). Massage the piriformis with a tennis ball or a lacrosse ball, either on the floor or against the wall.

Lower Back
Back pain always has a myofascial component. What’s surprising is that if you look for muscle tension in your lower back, you may never find the real cause of pain. It is actually the gluteus medius which heads the list of the many muscles associated with low back pain. One of the three buttocks muscles, the gluteus medius primarily functions as a pelvis stabilizer. Each time you lift your leg to take a step, the muscle on the opposite side contracts to keep your hip from sagging. Dead butt syndrome commonly affects runners and is a sign of weak glutes. You can feel the gluteus medius just above your greater trochanter and slightly to the rear. Try a lacrosse ball against a wall and use short, rolling strokes.

Head and Neck
Most of the time neck pain is referred from trigger points in the upper back and shoulders rather than in the neck itself.  Pay careful attention to the trapezius, the flat, four-cornered “shrug” muscle located along your upper back, since the traps are the most common musculoskeletal cause of headaches and neck pains. Leaning against a ball on the wall is especially effective for massaging this area. Come back to problem areas three to six times per day.

Be aware that longstanding trigger points often lead to irritation in adjacent muscles, so don’t limit your massage efforts to focal points: spread out. You’ll know you’ve found a “hot spot” because trigger points are always painful when pressed. Oddly enough, pain level depends more on the degree of trigger point irritability than on the size of the muscle, as trigger points in some of the tiniest muscles can be downright debilitating. The pain that comes from massaging a trigger point should be of the pleasant variety, the kind you can relax into, but not so tender as to put you to sleep. Aim for a pain level of seven on a scale of one to ten, and limit massage to roughly ten strokes per trigger point. If you get no relief from massage, you may be working the wrong spot.

Of course, not all cases of pain have muscle irritation as the main cause. If sore muscles are accompanied by redness, swelling, or joint deformity, pay a visit to a sports medicine physician. And for a more comprehensive list of muscles and their pain patterns, pick up a copy of Clair Davies’ The Trigger Point Therapy Workbook.

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