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Diane -> Re: manual therapy for trigger points (November 25, 2001 6:53:00 AM)
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Hello adhi_pt,
Can your patient lie prone with the arm off the edge of the table at a 90 degree angle? If your patient has at least that much range you might try this technique:
With one hand, gently grasp the skin/deltoid/shoulder soft tissue, and bring it into internal rotation for several seconds. Go slow and feel the tissue responding. Don't do anything else yet.
When the tissue feels quiet, take your patient's arm with the other hand and move it into "abduction" (out from the hanging position) just a little way, and ask them to do a very light contraction toward their original position (inward) while you prevent them from moving.( Meanwhile you are still monitering their deltoid (or whatever) tissue with the other hand.)
Ask them to hold for several seconds, then relax. Take their arm out to a second position. If you feel their deltoid move a bit that's too far, go back a notch... repeat. Repeat again. (Three times)
Take their deltoid tissue into external rotation and repeat the sequence. You can repeat the whole thing again, into shoulder flexion this time, or extension if you want... or whatever you can dream up... the point of this is to get bloodflow happening all around/ underneath/ in between all the various tissues that happen to live in the shoulder area, circumflex nerve being one of them.
This is a global approach to trigger point reduction. If you want to be specific you could find the trigger,(patient seated) lift the arm up sideways/forward to 100 degrees or so, finetune rotation and feel for the trigger to melt, hold for a couple minutes and lower the arm slowly (to avoid restimulating that which you just elegantly treated and eliminated...) let the patient rest a few seconds, shrug a couple times (to slide the layers over each other) then try the movement actively.
Good luck in either case.
Diane
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