Questionbefore i did ask you this question. your answer was great and further got me thinking. see below for new question.
latent tigger points
Question i am now a 38 year old male of good health except i have all kinds of problems or possibly pain causing areas of the back. i have read one of the medical classics trigger point manual travel and simmons. also i have read alot on posture and anatomy and function. i have observed several muscles of my back and hip that are short and tight and other the antagonist that is long weak and inhibited.
i am trying to stetch the tight muslces while also strenghtening the long weak muscles. but i am not exactly sure of the best techniques. it feels strange when i try to streghten my left gluteus medius inhibited muscle. any suggestions here? also what comes first (chicken or the egg) the long inhibted muscle or its antagonist short tight muscle?
also i have asked some doctors and they told me that it is impossible to remove latent triger points. i can find a very serious one of my rigth QL or illiucostas muslce around L2 that refers incredible amounts of pain too just above the crest of the illium.
thanking you in advance.
Answer Hi, Jii.
In my experience, both practical and schooling, I have never had a client with the symptoms you describe not be able to have a knowledgable therapist relieve those trigger points in the QLs, lower lumbars, gluteals, iliopsoas and so on. Many of my clients have been gentlement of around your age with the same type of problem. The only reasons that I know of that your physician might tell you that those trigger points can't be released would be either the physician is unfamiliar with trigger points or there has been a misunderstanding between the two of you as to what the cause is.
As for the chicken or the egg--who knows? Unless you have a specific injury that you know made one side weak or some such thing, it could be just about anything. I am surprised and delighted at your perusal of Travell, it's a great reference, as well as your attempts to decide where the problem lies via posture, etc analysis. It doesn't sound like the trigger points in your QLs and so on are latent, they are very much active at this point. But that is no matter. The QL indeed does refer a lot of pain when touched as well as when left alone, once it gets to a certain point. It has been my experience that if the QL is that painful then the gluteals and so on on the opposite side will need to be worked in order for there to be lasting relief. Try seeing a neuromuscular therapist (NMT), and/or someone who practices myofascial release. You can find therapists in your area via several sites--the AMTA: www.amtamassage.org and the ABMP's site--which I can never remember, but it comes up easily on searh engines. Ask how much schooling they have had with those methods, or if they are telling you that another method would be better, ask them to articulate why it would be.
At any rate, it sounds like you are on the right track. I wish you much luck and good health in the future. If there are questions you still have, I look forward to hearing from you, again. Take care.
Abby
slowly but surely i am putting all the pieces of the puzzle together. when you said that the It has been your experience that if the QL is that painful then the gluteals and so on on the opposite side will need to be worked in order for there to be lasting relief. read the next paragraph fully and you will understand why i mentioned this.
the QL or illiocostas on my right side at about L2 is where i can find a major trigger point that mimicks the almost same kind of pain that i do get. i also have a much less intense trigger points in the left side of the QL. i guess that it is caused when the QL acts unilaterally the antagonist is the opposite side. but getting back to the gluteals i definately have external hip snapping on the left side which is opposite of the major QL trigger point side. also when i stand on this left leg with the right leg completely off the ground especially when i close my eyes it becomes very difficult to hold for even 5 seconds. this is the gluteus medius being inhibited and long. and i also think that the hip snapping could be caused by this inhibited muscle and or the TFL / IT band being to short and tigtht. anyways would you hazzard to guess that this glutues medius being inhibted has been (caused or connected) to the trigger point in the QL? unfortunately i do live in thailand now and having searched for anyone knowledgable in myofascial pain treatment has not been located yet. also when you say gluteals need to be worked are you refering to all medius, minimumus, maximus? and please give exact isometric / isotonic / other excersizes that i should be doing?
thanking you in advance.
AnswerHello again, Jii.
One thing I didn't mention, that comes to me, now, is that you may have structural damage/irritation/dislocation, such as the sacroiliac joint (if you consider the pelvis, rear view,laying down or standing, you may notice one side higher than the other, or in the front view, at the "pointy part" of the pelvis, either side, one may be rotated forward or back. This would continue the aggrevation of the problems you are having and since you are having trouble locating a therapist--although I hear Thai massage can be very helpful, although I know little about it (might be worth a try)--you might consider seeing a chiropractor or a D.O. to see about structural distortions as well as muscular. As for which comes first-it's the chicken and egg question all over again. It does sound like you are at the point where attention to both stru ctural and muscular irritation should be considered. Your hip snapping--strictly from my point of view, having not seen nor been able to touch it--your gluteal hip rotators, medius, minimus, maximus, piriformis (piriformis is a real *itch, leading to sciatic type pain, much of the time) are pulling, thus (probably) causing the popping/snapping in your hip. The TFL/IT band is certainly involved, although it would be difficult for me to say if it is the primary concern, considering it's upper attachments. Trigger points in the TFL certainly could be adding to the problem. The IT band, in my experience, especially on the opposing side of the main QL problem, will be shortened, in that you may feel that your knee is unstable, with a pulling sensation in the medial portion as the IT/TFL pulls. I hesitate to give you any specific stretches until you have gotten a bit of relief from a professional, so please understand that these will be far more effective after that. Isometrics are better done with help, if you have someone?
Here goes: Lie on the floor, on your back flattened. Move your feet so that your knees are at an angle in front of you, with your feet near the gluteals (just as a reference point). Cross one leg over the other, still with the bottom knee in position, and let the top leg rest in a relaxed version of the bottom leg. Let the weight of the top leg push the bottom leg towards the opposite side-you should feel a stretch around your IT band, gluteals and possibly the LB if the tension is that bad. Hold for 15 seconds or so, and slowly come up and repeat on the other side. See if you have any results with that--but you really need to be under the care of a professional and be doing these exercises in the meantime. It's difficult to strengthen properly, or have stretches have a long term effect, if the cause is not dealt with as well. Another stretch: While lying on a higher surfacee, such as a bed, be close as possible to the edge (stablized) and slowly let the leg closest to the edge drop over the side-slowwwly-you don't want to hurt yourself--if done properly (and if the psoas is involved) you should feel a pulling sensation that will seem to come more from your stomach than your back, or around your groin/upper leg attachments. If you are really flexible, this next stretch is just one that I do, myself, find a surface about hip high, bring one leg up onto the surface with knee bent, and lean into it as much as you can without pain. If you are comfortable with it, slowly twist so that you feel the stretch in the gluteals/ITband and lower back (QL's, hopefully) and so on. Repeat on the other side, always. I hope these help a bit. Actual exercises at this point, I don't feel comfortable with giving, sorry. I will say that yoga (I love Bikram--hot yoga) did wonders for many clients of mine, and myself with lower back and leg issues. If you are still frustrated, feel free to write back and I will try to find out about the options for treatment I'm familiar with, in your area, although I will have to write a few people, so it might take a bit and I can't guarantee answers. Don't give up.
You sound to be on the right track and to me, that means you will find what you need to recover your health.
Abby
