With CRPS, the pain usually begins by radiating from the site of injury. As time goes by, the pain can spread to incorporate a larger area, and even spread to the opposite limb. Some people end up with constant full-body pain. My pain is limited to my right leg, but sometimes I have flares during which the pain takes over all my body. I have found trigger point therapy helpful in treating the radiating pain that goes up my leg, as well as many other sorenesses and muscle spasms I have due to the fact that I spend a lot of time lying down. I also find that I get tense muscles when I’m having higher pain–after a bad night, I can wake up stiff as a brick!
Trigger point therapy was initially developed by Dr. Janet Travell, who first described trigger points in 1942. Since then, it has fared well in scientific research, and trigger points have been found to be located in the same place in the human body from person to person. However, it is still considered, much like all massage, as a fringe therapy by most of the western medical community, and only a small subset of massage practitioners are trained in trigger point massage. However, with the use of a few tools (some that can be assembled from items that you may find in your house), people who suffer from problems with their trigger points (and there are few people who have zero active trigger points in their bodies, just like there are few people who have zero aches and pains) can do trigger point self-massage very effectively.
So first, what is a trigger point? Imagine a band of muscle. (Previous experience in massage or even preparing meat dishes is helpful here.) A band of muscle is a whole bunch of muscle fiber cells, surrounded by a thin wrapping called the fascia that kind of holds them together and keeps them separated from the rest of the body. The easiest way to picture this is in a muscle like the calf muscle, where the fibers run all in the same direction up and down your leg, A trigger point involves only one or a couple of muscle fibers–they’re extremely small, and some people’s fingers are not sensitive enough to be able to feel them. Trigger points are usually located in the center of the fiber, and are a tiny lump of contraction that causes swelling and pulls on the rest of the muscle.
Trigger points are tricky, because they don’t cause pain where they are. Often trigger points are located very close to nerves, which get pushed on by the little lump of trigger point. This causes pain to be felt in an area served by this nerve–usually a bigger area that can be a ways away in the body. This is called referred pain. To work on trigger points, you first have to find them, and to find them, you have to be familiar with the referred pain pattern of the trigger point.
I have three books that I find extremely useful for helping me find my active trigger points: The Trigger Point Therapy Workbook by Clair Davies (my favorite) and Trigger Point Self-Care Manual by Donna Finando both have great images and descriptions of the areas of referred pain that help you figure out where the trigger point is, as well as many tips and tricks for working out the knots yourself. Basic Clinical Massage Therapy by James Clay and David Pounds has the best pictures for visualizing muscles in the body and how to manipulate them for massage that I’ve ever seen.
There are more than one method out there of working on trigger points, but the one I was taught involves pressing down on the trigger point strongly and steadily. This pressure will often temporarily intensify the referred pain, and can cause muscle spasms as well as local pain as well. The beneficiary/victim of the trigger point massage should breathe in slowly and deeply, and then breathe out with a sigh of conscious relaxation of the whole body, especially the area being worked on. This breath should be repeated about three times, and then the pressure should be released. (It’s important not to press for too long, as that can cause bruising, which leads to swelling and can worsen the problem, or at least prevent it from being worked on effectively for a few days.) The trigger point should be massaged (or, if that is too painful, the area immediately surrounding the trigger point) for 15-30 seconds following the direct pressure, to move fluids that have been built up due to the swelling out of the area, getting any toxins or waste products out of there. Stubborn trigger points may need to be worked on multiple times per day for several days to get them to really release, which means that to really take care of them you need to be able to work on them yourself. For really stubborn trigger points, some doctors will inject the trigger point with medication for the pain and to help it relax, but I’ve never had this done.
The books listed above desribe several tools you can make at home to help work on trigger points. My favorite of these is just a ball in a sock. Hang the sock from the top over your shoulder and lean against the wall–the ball will help find and press the trigger points in your shoulders. There are a couple purpose-made tools that I personally find indispensable for working on my trigger points. The first is called the Backnobber II (the original one is all one piece, while this one snaps together so it can be stuck in a bag or a desk drawer), which looks like a big S with knobs at both ends. It’s great for problems I have with my hips and latissimus dorsi. The second is called the Indexknobber, and is a hand grip with a ball that sticks out to replace your index finger, which can get pretty sore from pressing those trigger points. I often use that one on my lower leg muscles and sometimes my forearms as well. They’re both made by The Pressure Positive Company and are personal favorites.