Treatment technique

To palpate the tissues, move the pads of the fingers or thumb superficially over the tissues and search carefully for any areas that feel harder and less pliable than normal. These will be areas of increased tension, thickening, fibrotic adhesions or nodules. Continue moving deeper into the tissues with increased pressure to locate the exact site of the problem. When abnormalities are identified, the area should first of all be warmed with general manipulations such as effleurage and kneading and then treated with the deeper stroking movements. The treatment is completed with more effleurage.

Strokes may be long or short, depending on the size of the area. Short strokes are used for small areas of tension but longer strokes are used on larger areas. Strokes may be applied with the fingers, the thumb, and sometimes with the elbow when deeper pressure is required.

When the thumb is used contact is made with the lateral border of the ball of the thumb while the fingers rest lightly on the part. For greater pressure, both thumbs may be used, positioned one behind the other with the fingers of both hands resting on the part. Alternatively, the pads of the fingers may be used: on small areas contact is made with

Figure 9.1

Neuromuscular stroking on erector spinae.

Figure 9.2 Neuromuscular stroking on gastrocnemius.

Figure 9.3 Neuromuscular stroking to trapezius and the rhomboids.

the middle finger supported by the index and ring fingers but on larger areas the three fingers may make contact reinforced by the same fingers of the other hand.

Stroke over the area in all directions to stretch the tissues and loosen any adhesions. Then stroke in the direction of the muscle fibres until the tissues yield or give slightly: this will elongate and realign the tissues. Repeat several times until any pain is reduced and the area feels softer and more pliable. Effleurage the area to complete the treatment. This stroking technique can also be used to treat fibrotic and fatty nodules.

Trigger points are small, hard areas of extreme irritability, usually located within a muscle but can also be found in the fascia. They are tender and painful: the degree of pain can vary from mild discomfort to excruciating pain. When palpated they feel like short, thick, tight bands of contracted fibres, which produce a 'twitch' when stroked. The muscles in which trigger points are located may be tense and shortened, their elasticity is limited and they are unable to extend to their normal length. Pain is usually produced when the muscles contract or are stretched or manipulated.

Trigger points may be described as latent or active.

Latent trigger points are painful only when direct pressure is applied.

Active trigger points are tender, radiate pain, and may also refer pain to another area known as the target zone, or target area. This occurs because the trigger point and the target zone are innervated by the same spinal nerve or are linked by the autonomic system.

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