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Bryan Cobb- Advanced Remedial Massage Therapist
Precision Touch Massage Therapy, Winnipeg MB
204 688 1777

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Trigger Point Page

A self help guide to addressing a common source of muscle pain

I suggest to all my health and fitness clients and athletes that they learn how to do trigger point (TP) massage on themselves and those who do it attest to better recovery, performance, and fewer repetitive strain injuries. I do trigger point work on my own muscles a little bit every day and see a therapist when needed.

This is me using the Theracane massage tool to work out a trigger point in my hamstring. There's a little nib about the width of a thumb (not seen) on the tool that's pressing into a TP.

I'll leave the explanation of what trigger points are and how to treat them to the expert, Bryan Cobb ARMT. Bryan is the massage therapist for the Woodcock Cycle Works cycling team.

In my opinion most massage therapy modalities are bunk. Merely fluff and buff. If someone tells you your "energy fields" are out of balance and offers to put hot rocks on you to fix the problem, chances are they have rocks in their head.

Crystals, meridian energy, essential oils; They fall under the category of pseudo science with nothing more than anecdotal gibberish to explain them.

Trigger point therapy shares no common background with these bogus massage methods. Trigger point therapy was born out of clinical observation and scientific research by physicians.

Have muscle pain? If it's from trigger points, the pain can be eliminated in most cases.

Cris LaBossiere

Bryan Cobb's Articles:

What the heck is a Trigger Point? A trigger point is a painful knot in muscle tissue that can refer pain to other areas of the body. You have probably felt the characteristic achy pain and stiffness that trigger points produce, at some time in your life.

Adductors: The forgotten muscles The Adductors play a very important role in movement and stabilization of the leg and pelvis. Problems that arise from injury or overuse can be severe, even crippling. Care of the Adductors is as important as care of the Quads and Hamstrings.

Trigger Points and the Cyclist

What are the first muscles that you think of when you think about Cycling? Probably the Quads and Hamstrings (front and back of the legs respectively). But Cycling uses a wide variety of muscles to produce force and motion, balance and coordination, including the gluts, the abs, and the psoas. When any of these muscles develops Trigger Points, it can decrease performance and lead to injury.

I would like to talk about some of the common areas that can cause problems in Cycling, what the problems are, and how Trigger Point Therapy can help improve your performance.

Quads


The most obvious area a Cyclist will develop Trigger Points is the Quadriceps muscle group. These muscles produce a large amount of force during peddling. Trigger Points in any of these muscles will definitely impact on your performance.


Trigger Points can develop anywhere in this group. They can refer pain either up the leg to the hip or down the leg to the knee. For example, Trigger Points in the Vastus Lateralis muscle produce a strong deep pain into the knee. Trigger Points in the Vastus Medialis can actually cause the knee to give out randomly when walking. Pain can also be felt in the hip, as well as deep in the belly of the muscle itself.


Trigger Points in the Quads can cause weakness in that muscle, as well as a feeling of fatigue and stiffness. This stiffness can cause your pelvis to tilt anteriorly (forward and down), which causes your low back to have an excessive arch (Hyper-lordosis). This, in turn, leads to a tight and painful low back as well as tight hamstrings.


Hamstrings

Hamstrings flex the knee and extend the hip. Trigger points in the Hamstrings will make it difficult to fully extend the knee and flex at the hip. Trigger Points will cause pain to be felt anywhere from the back of the knee to the base of the buttock. Trigger Points in either the Medial or Lateral Hamstrings can cause the Tibia (big, low leg bone) to rotate either laterally or medially (inward or outward), respectively. This leads to poor mechanics and force distribution in the knee joint. It will also cause the patella (knee cap) to track (move) improperly in the joint.

Areas that you might not think of immediately include the Gluts, Abs, and Psoas.

Gluteus Minimus

The Gluteus Minimus is a small muscle in your hip. It helps to flex the hip and stabilize the pelvis during walking and standing. Trigger Points develop in this muscle along with the Quads group, specifically the Vastus Lateralis. Trigger Points in the Gluts will, of course, cause pain. It will also lead to the propagation of more Trigger Points in the Vastus Lateralis.

Gluteus Medeus

The Gluteus Medeus also stabilizes the pelvis and helps to medially rotate the Femur (thigh bone). Trigger Points can cause propagation of Trigger Points down the outside of the leg, due to its referral pattern down the leg, to the knee. If Trigger Points develop in this muscle, it could cause other Trigger Points to develop in the Gluteus Maximus (buttock). It can also maintain Trigger Points in the Quads or cause them to redevelop after they have been treated.

Abs

Another overlooked muscle for Cyclists is the Rectus Abdominus muscle, also known as the "six-pack". This muscle is constantly contracting to stabilize your core while cycling, and it is usually forced to do so in a pre-shortened position, hunched over the handlebars. Trigger Points in the Abs can cause a wide variety of symptoms, including nausea, indigestion, difficulty breathing, abdominal pain, back pain, and can even mimic some forms of visceral disease.

Psoas

Deep to the Abdominal muscles is another muscle forced to do its work in a contracted position: the Psoas. The Psoas muscle group is a major hip flexor (the Up portion of a peddle stroke), so it is highly active during cycling. But, due to the body position on a bike (especially a road bike) the Psoas do not get a chance to lengthen all the way. Trigger Points in this muscle can cause an anteriorly rotated pelvis, groin pain, leg pain and low back pain. If this muscle is weakened by chronic Trigger Points, then reaching full power on a bike is impossible.


Adductors Group


Another muscle group that is often neglected by the Cyclist - and that can cause a large amount of dysfunction- is the Adductor Group. The adductor muscle group consists of the Adductor Longus, Adductor Brevis, Adductor Magnus, the Gracilis, and the Pectineus. These muscles are found on the inside of the thigh and are often referred to as the groin. They have attachment points from the pubic bone and the inside of the Femur (large leg bone). Their primary task is to adduct the femur, that is, they pull the leg in toward the midline of the body.

This muscle group works hard in Cyclists to keep the knees from flaring outward during pedalling. Cyclists often forget to train this muscle adequately, causing poor mechanics and the aforementioned knee flare. This biomechanical error in the peddle stroke will cause chronic shortening of the Gluteus Minimus and the Lateral Rotators of the hip, as well as the Vastus Lateralis. All of which will develop Trigger Points. This problem can propogate all the way down the outside of the leg, including the calf muscles (Gastronemius and Soleus). Also, due to the overload of the Adductors, you can develop Trigger Points in this muscle group, as well, which will cause pain on the inside of the knee, the groin, and anywhere along the inside of the thigh.


The Adductor Group is very important to proper cycling mechanics. Strengthening of this muscles group is essential for Cyclists, especially if they are experiencing reoccuring Trigger Points in the Gluteus Minimus, the LateralRotators, or anywhere along the outside of the leg.


Maximizing Performance

To maximize your cycling performance, you need to cover all three bases: stretching, exercise, and Trigger Point Massage Therapy. A complete stretching program that covers the muscles of the legs, pelvis, and core is a must. These stretches should be performed after each training session to encourage the return of these muscles to their normal physiological length. A balanced functional resistance training program will help to build strength and endurance and help prevent Trigger Point development. However, to address those TP's you already have, and those that you will inevitably develop, Trigger Point Therapy is also a must for maximizing your performance.


Remember, Cycling involves more than just the Quads and Hams. For a Cyclist to achieve his or her full potential, as well as to manage pain, injury and fatigue, attention should be paid to all the muscles of the leg and pelvis, with special attention to the areas outlined in this article.


Bryan Cobb, Advanced Remedial Massage Therapist
Precision Touch Massage Therapy
688-1777

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For more information contact: clabossiere@rhinofitness.ca

This page was last updated on December 10, 2009