Excerpts from The Trigger Point Therapy Workbook by Clair Davies, NCTMB
Arthritis, ligament injury, and deterioration of joint cartilage are the most usual medical explanations for hip and knee pain. X-rays and other tests often seem to substantiate such diagnoses. But even in the absence of objective evidence, joint pain itself is assumed to be proof that the joint is in trouble. As a consequence, hip and knee replacement surgery is commonplace and heavily promoted (Travell and Simons 1992, 221, 263-264, 300-302).
In reality, pain in hip and knee joints is often nothing more than referred pain from trigger points in the muscles of the thigh; such pain can be every bit as intense and debilitating as pain from a damaged joint. Even when a hip or knee joint has suffered a genuine injury, trigger points in associated muscles nearly always contribute a major part of the pain. Treatment of joint trauma should always include treatment of trigger points in all nearby muscles. Look for trigger points first when you have pain in a hip or knee. You can take care of trigger points yourself.
Trigger points in the tensor fasciae latae (TFL) muscle cause pain in the hip joint just in front of the greater trochanter. There can be two sites for trigger points, one in front immediately below the hip bone, and another an inch or so to the outside. Occasionally, pain may extend down the outer thigh as far as the knee. You may also have a deep ache behind your hip, between the sit bone on that side and greater trochanter. The muscle shortening that is sponsored by trigger points makes it difficult to straighten the hip. You may need to walk slowly because of the restriction in the hip. You tend to stand with both your hip and knee partly flexed. Pain from trigger points in the TFL may be mistaken for bursitis of the hip. It may also be wrongly blamed on a thinning of the hip joint cartilage (1992, 217-221).
To locate the belly of the TFL by isolated contraction, first find the greater trochanter, the bony knob on the side of your hip. Place a finger right in front of the trochanter and shift your weight from leg to leg. The muscle will alternately bulge and soften. Simply turning your knee or foot inward also makes the muscle contract, as does raising your leg to the side. Supported fingers don't work well for deep massage of the TFL because the leverage is poor. The Thera Cane is excellent however, or you can stroke the muscle deeply with a tennis ball.
Be aware that tightness in the iliotibial band on the outside of the thigh is due to tightness in the TFL and gluteus maximus muscles, due of course to trigger points. Apparent tenderness in the iliotibial band is more likely coming from trigger points in the underlying vastus lateralis, which is part of the quadriceps. [see below]
The sartorius is the longest muscle in the body. The word comes from the Latin for "tailor." In olden times, tailors often sat in a cross-legged position to do their work. Strong action of the sartorius muscles is needed to get the legs into this posture. The sartorius attaches to the hip bone then descends, crossing the thigh toward the inner side, and attaches again to the tibia on the inner side of the knee. This arrangement allows the sartorius to participate in raising the leg forward and turning the knee outward. A soccer kick requires strong contraction of the sartorius.
This long muscle is interrupted in several places by strips of connective tissue that break the long muscle fibers into short ones. Each section of muscle has its own belly, creating the possibility of trigger points anywhere along the muscle's entire length.
Sartorius trigger points don't send active pain to the knees but they can make the inner knees so hypersensitive to pressure that it's uncomfortable to lie on your side with your knees together. This sensitivity can lead to the mistaken assumption that you have something wrong with your knee joints (1992, 229; Lange 1931, 49).
Compression of sensory nerves by a tight sartorius muscle can also cause superficial burning pain, numbness, itching, and tingling in the skin of the front and outer thigh. This is not referred pain but rather a direct effect on a nerve. These symptoms are often labeled "meralgia paresthetica," which is a fancy way of saying that you have numbness and pain in your leg. [Just work the trigger points in the sartorius muscle for relief.]
The quadriceps muscles are the largest, heaviest, and most powerful muscles in the body. Quadriceps trigger points are the primary source of knee pain. A case of jumper's or runner's knee is ordinarily nothing more serious than referred pain from the quadriceps. Growing pains in the legs and knees of children can usually be traced to trigger points in their quadriceps muscles. Quadriceps trigger points may also cause the phantom knee pain felt by amputees who no longer have their knees. Restless leg syndrome, a serious annoyance to its victims and a mystery to their doctors, can be traced to trigger points in quadriceps muscles. Knots in the quadriceps can also cause a locked knee, a trick knee, or a buckling hip (1992, 249-253, 263).
Pain and weakness from quadriceps trigger points are easily mistaken for tendinitis, bursitis, or arthritis of the knee, or for evidence of damaged ligaments or meniscus cartilage. Treatment is unlikely to succeed when the problem is wrongly assumed to be in the joint simply because it's the site of the pain (1992, 248-265). Knee pain can be extremely debilitating and yet unimaginably easy to get rid of when you understand what's really going on.
Four muscles actually make up the quadriceps muscles and they are the rectus femoris, vastus intermedius, vastus medialis, and vastus lateralis. The rectus femoris is superior (on top of) to the underlying vastus intermedius and is the only muscle of the four quadriceps muscles to work at both the hip and knee joints (the other three only work at the knee). The vastus medialis runs on the inner thigh side of the rectus femoris and the vastus lateralis on the outer thigh side.
The most common trigger point in the rectus femoris muscle refers pain deep inside the knee; this pain is usually described as feeling like it's under the kneecap. A second trigger point is sometimes found just above the knee. This trigger point causes a deep ache above the knee, local to the trigger point. Both these trigger points make the knees stiff and weak. They also contribute to restless leg syndrome. Interestingly, tightness in the muscle, in maintaining tension on the patellar ligament, inhibits the knee-jerk response to the doctor's taps with a percussion hammer (1992, 249-250, 267).
Pain from trigger points in the vastus intermedius is characteristically felt in the midthigh, spreading and radiating down from the trigger point, occasionally as far as the knee. Pain increases when you walk, and increases dramatically when you climb stairs. You may have trouble straightening your knee when you stand up after sitting for a long while. Stiffness in the knee may cause you to limp. Vastus intermedius trigger points combined with those in the upper gastrocnemius of the calf can make your knee weak enough to buckle without warning.
Problems caused by vastus medialis trigger points commonly affect runners. Trigger points in the vastus medialis send pain to the inner thigh and to the knee. The knee pain usually focuses in the lower half of the knee a bit to the inside. Vastus medialis trigger points typically make the knee weak; a buckling knee, in fact, is their signature. Knee pain and weakness caused by vastus medialis trigger points are frequently mistaken for signs of arthritis, ligament damage, and tendinitis.
Trigger points in the vastus lateralis can make the hip and outer thigh hurt, and they're an exceptionally common source of knee pain. Trigger points in the muscle's back edge can cause pain behind the knees and in the back of the hip (1992, 251-253).
Vastus lateralis trigger points are very common in children, even infants, and probably account for much of their unexplained thigh and hip pain. Healthy children--babies too--are continuously exercising and overexercising their leg muscles. "Growing pains" may be largely undiagnosed myofascial pain that would have a very simple remedy if it were only recognized (1992, 251-252).
Walking can be exceedingly painful with afflicted vastus lateralis muscles. Lying on your side can be very uncomfortable. Tension in the muscle can pull the kneecap to one side, locking it in place and preventing movement in the knee. A locked knee is usually due to a trigger point just above and to the outside of the kneecap. The normal position of the kneecap is maintained by balanced action of the vastus medialis and lateralis muscles. Trigger points in the vastus medialis can weaken its counterbalancing effect on the vastus lateralis and may be of central concern in treating a locked knee (1992, 251-252).
Pain from a pectineus trigger point occurs deep in the groin just below the crease where the leg joins the body. It may be felt as either a sharp pain or a deep ache, often seeming to be coming from the hip joint itself. Extreme extension of the thigh increases pain, but the leg's range of motion is otherwise unrestricted. Note that several other muscles may project pain to the groin, including psoas, gracilis, and the three adductor muscles (1992, 236-237).
Trigger points in the adductor longus are the most common cause of groin pain. Typically, it's felt deep in the hip joint. Occasionally, pain may extend down the inner thigh to the inner side of the knee, as far as the shin. Pain occurs during vigorous activity and is greater when you're carrying something. Adductor longus trigger points cause stiffness in the hip, tending to limit movement of the thigh in all directions and to restrict lateral rotation.
Pain from trigger points in the biceps femoris muscle is felt as a dull aching behind the knee. The pain tends to be toward the outer side of the back of the thigh rather than rather than centered, and sometimes concentrated around the head of the fibula. Discomfort from biceps femoris trigger points sometimes extends up the back of the thigh and down into the upper calf.
Trigger points in the popliteus muscle cause pain behind the knee when you straighten your leg. A shortened popliteus will prevent normal locking of the knee. The popliteus may not be suspected until trigger points in the biceps femoris have been deactivated. Knee pain caused by popliteus trigger points can be mistaken for tendinitis, torn ligaments, and damage to the meniscus or other knee joint tissues. While real physical damage to the knee is always a possibility, especially from accidents and in violent team sports, you shouldn't assume that knee pain automatically means knee surgery. The first step should always be to look for trigger points in the muscles that control the knee.
Foam rolling, even utilizing a basketball, tennis ball, and/or rubber ball are all excellent ways of working these tender trigger points. Thera Cane and the other tools discussed in this trigger point series are all great ways for eliminating your trigger point issues causing your knee and/or hip pain.
Now just a little something on buttocks pain. There are numerous trigger points and referral pain caused by the muscles in the buttocks (one was discussed in the Back Trigger Points post) including but not limited to piriformis muscle, sciatica, etc. These can causes problems not just in your low back but your hip, and entire leg with one example being: Trigger points in the gluteus minimus muscles cause pain down the back or the side of the thigh and the lower leg as far as the ankle. Tracking down the problem can be made difficult by pain from associated trigger points in the quadratus lumborum, gluteus medius, piriformis, tensor fasciae latae, vastus lateralis, peroneus longus, and hamstring muscles. Pain from gluteus minimus trigger points can be excruciating and constant. Numbness can occur anywhere in the referral areas. In addition to leg pain, there is often a diffuse tenderness in the buttocks (1992, 168-169; Zohn 1988, 212).
Even though I am posting excerpts from Mr. Davies' book The Trigger Point Therapy Workbook, I am by no means able to post every important facet on this subject and highly recommend you purchasing this book for your own reference...it is that good! Clair Davies' story is amazing as is his entire book. I am very grateful to his dedication and revelation of this subject matter!!!
For other posts of this series:
Trigger Points
Referred Pain,Trigger Point & Symptoms
Shoulder Trigger Points
Back Trigger Points
Trigger Points
Referred Pain,Trigger Point & Symptoms
Shoulder Trigger Points
Back Trigger Points
Arthritis, ligament injury, and deterioration of joint cartilage are the most usual medical explanations for hip and knee pain. X-rays and other tests often seem to substantiate such diagnoses. But even in the absence of objective evidence, joint pain itself is assumed to be proof that the joint is in trouble. As a consequence, hip and knee replacement surgery is commonplace and heavily promoted (Travell and Simons 1992, 221, 263-264, 300-302).
In reality, pain in hip and knee joints is often nothing more than referred pain from trigger points in the muscles of the thigh; such pain can be every bit as intense and debilitating as pain from a damaged joint. Even when a hip or knee joint has suffered a genuine injury, trigger points in associated muscles nearly always contribute a major part of the pain. Treatment of joint trauma should always include treatment of trigger points in all nearby muscles. Look for trigger points first when you have pain in a hip or knee. You can take care of trigger points yourself.
Trigger points in the tensor fasciae latae (TFL) muscle cause pain in the hip joint just in front of the greater trochanter. There can be two sites for trigger points, one in front immediately below the hip bone, and another an inch or so to the outside. Occasionally, pain may extend down the outer thigh as far as the knee. You may also have a deep ache behind your hip, between the sit bone on that side and greater trochanter. The muscle shortening that is sponsored by trigger points makes it difficult to straighten the hip. You may need to walk slowly because of the restriction in the hip. You tend to stand with both your hip and knee partly flexed. Pain from trigger points in the TFL may be mistaken for bursitis of the hip. It may also be wrongly blamed on a thinning of the hip joint cartilage (1992, 217-221).
To locate the belly of the TFL by isolated contraction, first find the greater trochanter, the bony knob on the side of your hip. Place a finger right in front of the trochanter and shift your weight from leg to leg. The muscle will alternately bulge and soften. Simply turning your knee or foot inward also makes the muscle contract, as does raising your leg to the side. Supported fingers don't work well for deep massage of the TFL because the leverage is poor. The Thera Cane is excellent however, or you can stroke the muscle deeply with a tennis ball.
Be aware that tightness in the iliotibial band on the outside of the thigh is due to tightness in the TFL and gluteus maximus muscles, due of course to trigger points. Apparent tenderness in the iliotibial band is more likely coming from trigger points in the underlying vastus lateralis, which is part of the quadriceps. [see below]
The sartorius is the longest muscle in the body. The word comes from the Latin for "tailor." In olden times, tailors often sat in a cross-legged position to do their work. Strong action of the sartorius muscles is needed to get the legs into this posture. The sartorius attaches to the hip bone then descends, crossing the thigh toward the inner side, and attaches again to the tibia on the inner side of the knee. This arrangement allows the sartorius to participate in raising the leg forward and turning the knee outward. A soccer kick requires strong contraction of the sartorius.
This long muscle is interrupted in several places by strips of connective tissue that break the long muscle fibers into short ones. Each section of muscle has its own belly, creating the possibility of trigger points anywhere along the muscle's entire length.
Sartorius trigger points don't send active pain to the knees but they can make the inner knees so hypersensitive to pressure that it's uncomfortable to lie on your side with your knees together. This sensitivity can lead to the mistaken assumption that you have something wrong with your knee joints (1992, 229; Lange 1931, 49).
Compression of sensory nerves by a tight sartorius muscle can also cause superficial burning pain, numbness, itching, and tingling in the skin of the front and outer thigh. This is not referred pain but rather a direct effect on a nerve. These symptoms are often labeled "meralgia paresthetica," which is a fancy way of saying that you have numbness and pain in your leg. [Just work the trigger points in the sartorius muscle for relief.]
The quadriceps muscles are the largest, heaviest, and most powerful muscles in the body. Quadriceps trigger points are the primary source of knee pain. A case of jumper's or runner's knee is ordinarily nothing more serious than referred pain from the quadriceps. Growing pains in the legs and knees of children can usually be traced to trigger points in their quadriceps muscles. Quadriceps trigger points may also cause the phantom knee pain felt by amputees who no longer have their knees. Restless leg syndrome, a serious annoyance to its victims and a mystery to their doctors, can be traced to trigger points in quadriceps muscles. Knots in the quadriceps can also cause a locked knee, a trick knee, or a buckling hip (1992, 249-253, 263).
Pain and weakness from quadriceps trigger points are easily mistaken for tendinitis, bursitis, or arthritis of the knee, or for evidence of damaged ligaments or meniscus cartilage. Treatment is unlikely to succeed when the problem is wrongly assumed to be in the joint simply because it's the site of the pain (1992, 248-265). Knee pain can be extremely debilitating and yet unimaginably easy to get rid of when you understand what's really going on.
Four muscles actually make up the quadriceps muscles and they are the rectus femoris, vastus intermedius, vastus medialis, and vastus lateralis. The rectus femoris is superior (on top of) to the underlying vastus intermedius and is the only muscle of the four quadriceps muscles to work at both the hip and knee joints (the other three only work at the knee). The vastus medialis runs on the inner thigh side of the rectus femoris and the vastus lateralis on the outer thigh side.
The most common trigger point in the rectus femoris muscle refers pain deep inside the knee; this pain is usually described as feeling like it's under the kneecap. A second trigger point is sometimes found just above the knee. This trigger point causes a deep ache above the knee, local to the trigger point. Both these trigger points make the knees stiff and weak. They also contribute to restless leg syndrome. Interestingly, tightness in the muscle, in maintaining tension on the patellar ligament, inhibits the knee-jerk response to the doctor's taps with a percussion hammer (1992, 249-250, 267).
Pain from trigger points in the vastus intermedius is characteristically felt in the midthigh, spreading and radiating down from the trigger point, occasionally as far as the knee. Pain increases when you walk, and increases dramatically when you climb stairs. You may have trouble straightening your knee when you stand up after sitting for a long while. Stiffness in the knee may cause you to limp. Vastus intermedius trigger points combined with those in the upper gastrocnemius of the calf can make your knee weak enough to buckle without warning.
Problems caused by vastus medialis trigger points commonly affect runners. Trigger points in the vastus medialis send pain to the inner thigh and to the knee. The knee pain usually focuses in the lower half of the knee a bit to the inside. Vastus medialis trigger points typically make the knee weak; a buckling knee, in fact, is their signature. Knee pain and weakness caused by vastus medialis trigger points are frequently mistaken for signs of arthritis, ligament damage, and tendinitis.
Trigger points in the vastus lateralis can make the hip and outer thigh hurt, and they're an exceptionally common source of knee pain. Trigger points in the muscle's back edge can cause pain behind the knees and in the back of the hip (1992, 251-253).
Vastus lateralis trigger points are very common in children, even infants, and probably account for much of their unexplained thigh and hip pain. Healthy children--babies too--are continuously exercising and overexercising their leg muscles. "Growing pains" may be largely undiagnosed myofascial pain that would have a very simple remedy if it were only recognized (1992, 251-252).
Walking can be exceedingly painful with afflicted vastus lateralis muscles. Lying on your side can be very uncomfortable. Tension in the muscle can pull the kneecap to one side, locking it in place and preventing movement in the knee. A locked knee is usually due to a trigger point just above and to the outside of the kneecap. The normal position of the kneecap is maintained by balanced action of the vastus medialis and lateralis muscles. Trigger points in the vastus medialis can weaken its counterbalancing effect on the vastus lateralis and may be of central concern in treating a locked knee (1992, 251-252).
Pain from a pectineus trigger point occurs deep in the groin just below the crease where the leg joins the body. It may be felt as either a sharp pain or a deep ache, often seeming to be coming from the hip joint itself. Extreme extension of the thigh increases pain, but the leg's range of motion is otherwise unrestricted. Note that several other muscles may project pain to the groin, including psoas, gracilis, and the three adductor muscles (1992, 236-237).
Trigger points in the adductor longus are the most common cause of groin pain. Typically, it's felt deep in the hip joint. Occasionally, pain may extend down the inner thigh to the inner side of the knee, as far as the shin. Pain occurs during vigorous activity and is greater when you're carrying something. Adductor longus trigger points cause stiffness in the hip, tending to limit movement of the thigh in all directions and to restrict lateral rotation.
Pain from trigger points in the biceps femoris muscle is felt as a dull aching behind the knee. The pain tends to be toward the outer side of the back of the thigh rather than rather than centered, and sometimes concentrated around the head of the fibula. Discomfort from biceps femoris trigger points sometimes extends up the back of the thigh and down into the upper calf.
Trigger points in the popliteus muscle cause pain behind the knee when you straighten your leg. A shortened popliteus will prevent normal locking of the knee. The popliteus may not be suspected until trigger points in the biceps femoris have been deactivated. Knee pain caused by popliteus trigger points can be mistaken for tendinitis, torn ligaments, and damage to the meniscus or other knee joint tissues. While real physical damage to the knee is always a possibility, especially from accidents and in violent team sports, you shouldn't assume that knee pain automatically means knee surgery. The first step should always be to look for trigger points in the muscles that control the knee.
Foam rolling, even utilizing a basketball, tennis ball, and/or rubber ball are all excellent ways of working these tender trigger points. Thera Cane and the other tools discussed in this trigger point series are all great ways for eliminating your trigger point issues causing your knee and/or hip pain.
Now just a little something on buttocks pain. There are numerous trigger points and referral pain caused by the muscles in the buttocks (one was discussed in the Back Trigger Points post) including but not limited to piriformis muscle, sciatica, etc. These can causes problems not just in your low back but your hip, and entire leg with one example being: Trigger points in the gluteus minimus muscles cause pain down the back or the side of the thigh and the lower leg as far as the ankle. Tracking down the problem can be made difficult by pain from associated trigger points in the quadratus lumborum, gluteus medius, piriformis, tensor fasciae latae, vastus lateralis, peroneus longus, and hamstring muscles. Pain from gluteus minimus trigger points can be excruciating and constant. Numbness can occur anywhere in the referral areas. In addition to leg pain, there is often a diffuse tenderness in the buttocks (1992, 168-169; Zohn 1988, 212).
Even though I am posting excerpts from Mr. Davies' book The Trigger Point Therapy Workbook, I am by no means able to post every important facet on this subject and highly recommend you purchasing this book for your own reference...it is that good! Clair Davies' story is amazing as is his entire book. I am very grateful to his dedication and revelation of this subject matter!!!
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