Trigger Point Therapy for Myofascial Pain by L.M.T. L.Ac. Donna Finando Read Free Book Online

directions when there is no awareness of where the muscles attach. An awareness of fiber direction in both superficial and underlying musculature is necessary to evolve the skill of differentiating muscular layers. In addition, it is important to have a working knowledge of other structures that might be within the region being palpated, such as lymph nodes in the anterior and posterior triangles of the neck and in the femoral triangle.
    Attentive practice will provide you with the skill that is desired—and that is truly required—to understand the dysfunctions causing pain and discomfort to your patients. Skilled hands not only can ascertain the muscle or muscles that are involved, but as you follow constricted muscle fibers through their course you can arrive at an image of the habitual physical postures your patient assumes that could be the source of the myofascial problem. For example, in palpating his neck and shoulders you may “see” with your hands that the left side is considerably more relaxed than the right: the right sternocleidomastoid is contracted, the right trapezius is contracted, and the right levator scapulae is contracted. What posture could this person be taking to produce this muscular configuration? He might possibly be sitting in front of a computer with the monitor off to the left instead of directly in front of him. Perhaps he elevates his right shoulder in directing his cursor around the computer screen. Maybe his television at home sits to the left of his favorite chair. At least you have a mental image, an initial clue, a place from which to question your patient to find out what his habitual activities might be. Knowing the muscular action, knowing the postural habits and feeling the muscular configurations, allows you to do effective detective work. You are then able to help your patient change his habits in order to alleviate perpetuating factors giving rise to his difficulties. This discernment is essential to helping the patient rectify the muscular problem.
    To palpate most effectively, the following basic principles should be embraced and practiced:
    1.   Clearly image the area to be palpated.
    2.   Soften and relax your fingers, hands, and arms in order to make full, firm contact with the area under palpation.
    3.   As you palpate, use as broad a surface area of your hand as possible. Palpation, as a method of gathering information, is far more effective if practiced using the palmar surfaces of the hands rather than the tips of the fingers. In using a broad hand you cover more “ground” and can thus evolve a clearer mental image of the area under palpation.
    4.   Identify pertinent bony structures in the region.
    5.   Palpate each muscle in at least two directions:
    â€¢Â Â along the muscle fiber, from its proximal to its distal attachment, to locate the muscle and identify its size and shape; and
    â€¢Â Â across the muscle fibers, to isolate areas of constriction, taut bands, and trigger points.
    6.   Limit pressure to the point of muscle resistance. When you feel the muscle providing some resistance to pressure, keep your contact at that level of pressure. Deep, excessive pressure that causes some pain will produce an automatic tightening of the body and will prevent you from clearly identifying underlying structures; pressure that is too light will not allow you to contact the muscle properly, and a great deal of information will be overlooked as a result.
    7.   Palpate each muscle bilaterally to provide direct comparison. Remember that bilateral musculature should optimally be equally soft and supple and have the same shape and form. By comparing sides you can easily note areas of constriction that may exist in one side and not the other.
    In summary, palpation is an essential diagnostic and treatment tool that requires attentive practice, an ability to clearly visualize