Saturday, November 29, 2008

Saturday 11/29/08 - News

Hope everyone had a Happy Thanksgiving! Unfortunately the football wasn't so great this year with 3 blow out games! Oh well.

We have some very exciting stuff coming up from Optimum Sports Performance in the next few days. We are re-doing the website and we are also going to be adding on a free forum. There will be discussion boards on topics like Sports Performance Training, Youth Strength and Conditioning (so if you are a coach, parent or youth athlete, be sure to check in and ask questions!), General Health and Wellness, Nutrition, Posture and Injury Prevention. In addition, there is going to be a forum where you can keep a training log and get feedback and encouragement on your training program and there is a board for Strength Coaches and Trainers to discuss training ideas or brainstorm on programs for clients. We are also adding a "premium members" section to the forum for those that want individual online coaching (the fee is minimal).

It should be a really great discussion board and our main goal is to help people enhance their human performance, whether you are training for a competition or just looking to stay fit. Keep checking back here for updates on when we make the forum public (hopefully in the next few days).

We took all the pictures for my eBook and hopefully it will be ready to go out next weekend.

Since it is starting to cool down here in Pheonix, Optimum Sports Performance is going to be offering outdoor group training. It will be 4-5 people per group ($20 per person) and we will be out at the track or the park - depending on your location. I'll bring everything we need (medicine balls, bands, kettlebells, etc) and it should be a really great time. The training programs are going to be comprehensive and REAL training! Not like the 20-person boot camps you see around the greater phoenix area where they have people just running around doing nonsense. Our programs will have specific objectives for the training day and we want to make sure that you get the most out the session. Please shoot me an email for more details, dates and times.

Tell your friends too! A great way to kick off the holiday season, or get a jump start on your New Years goals is to grab some friends and do group training, and at $20 a session you wont find a better deal in the city (if you do, then chances are you are in a group of 20-30 people, which means the individual attention and the attention to detail is not going to be there).


Monday, November 24, 2008

Neuromuscular Therapy for the Cranium and Cervical Region

Another continuing education course in the books!

I spent this weekend at a workshop put on by the NMT Center. It was Neuromuscular Therapy (NMT) for the cranium and cervical region. It was awesome! Our teacher was Judith Delany, the head of the NMT Center and the co-author, along with Leon Chaitow, of Clinical Applications of Neuromuscular Techniques vol. 1 and vol. 2. It was a real treat. The first day she lectured about not only neuromuscular therapy, but also about inflammation and chronic illness and how leptin potentially plays into all of that. She really made it a point to drive home the fact that massage therapists (and therapists of all kinds really) need to think global about their clients/patients problems and not just think local and be so myopic. The following two days were a combination of anatomy lecture and hands on work for the cranium and cervical region. It was the first time I have ever worked on the muscles inside of the mouth and it was also the first time I have ever worked directly on the anterior portion of the cervical spine, done so by taking one hand and CAREFULLY displacing the esophagus, hyoid and thyroid cartilage towards the mid line of the body so that you can access the logus coli and longus capitis (intense stuff!). The work was challenging but something that I am really going to strive to be good at because (a) this work is extremely important and a lot of people NEED it and (b) not very many people are doing this work at all.

Overall, I would recommend this course to anyone in the field of massage therapy, chiropractic, physical therapy, osteopathy, medical doctors and dentists. Judith is an incredible teacher with a wealth of knowledge (on far more topics than just massage therapy) and a ton of experience. So far, I have take 2 out of the 4 NMT courses that the NMT center conducts (the other two being lower and upper extremity and then you can sit for the test to be certified) and I must say I am very impressed. These are some of the best workshops I have attended (and I have attended tons). If you are working in a clinical environment, do yourself a favor and check these workshops out. They are more than worth it.


Thursday, November 20, 2008

Thursday 11/20/08 – Notes

Since I will be in a workshop starting tomorrow and going through the entire weekend, I decided to do this weeks notes today.

Listen To Your Body...

It is trying to tell you something!

I was done at the Staley’s Bed and Barbell today to do some work on Phil’s shoulder, and Charles, Phil and I got into a conversation about pain and how it affects the things we do. Charles said he wished we had recorded the conversation because there was some good information coming out. Basically, listen to your body! Whether you are a runner, a lifter, an MMA guy or a weekend warrior, those aching and nagging pains are there for a reason. The worst phrase in the English language is “maybe it will go away.” Nothing just goes away. Pain has the ability to change the way we move, lift and perform every day activities. Unfortunately, this leads to more pain (usually somewhere else). If something hurts, try and find out why (or find someone who can at least give you an idea as to why it hurts) and give the muscle or joint or whatever is bothering you a break! Don’t try and train through it or hope that “this time it wont hurt as much.”

Paying Your Trainer

I was at the gym working today and I saw the usual trainers doing their usual nonsense. Honestly, with the economy in the dumps, let me help you save some money…If you are paying a trainer to watch you perform exercises on machines…STOP! I can’t think of a bigger waste of money (and time). Seriously, your trainer should be teaching you how to perform real exercises and should be competent enough to coach you through things like squats, deadlifts, push ups, bench press, rows, chin ups, and lunging or other single leg movements. I can’t believe that people are content with paying someone to basically “hang out” with them during their workout, because honestly, that is all your trainer is really doing if you are sitting on a machine and they are counting your reps for you.

Justifying Poor Exercise Programs

I got an email from a girl asking me what she was doing wrong. She had been trying to lose weight for the past 4 years by performing walking and various exercise DVDs (taebo, Jillian Michaels something or other, etc). I read through her email and told her that she should look into changing her program to more resistance training and do some intervals instead of the usual walking that she is doing. I typed out a few ideas for her as far as training and how to set things up. She then replied back “you don’t think those are good DVDs? I think they are good workouts!” She seemed upset with my answer, almost like she was angry because I didn’t validate what she was doing. I really don’t get it. You take the time to email me and ask my opinion. I take the time to answer you and then you want to fight with me about my answer. I emailed her back that I am not familiar with the DVDs, but that clearly what she is doing is not working, and has not been working for the past 4 years. If something is working for you, then stick with it. But if you have been trying to do the same thing for any significant amount of time (like 4 years) and nothing is happening, I think it is time to make a change.


I have been typing a lot lately to hopefully release my own E-Book very soon and I will get details more details out about it as quickly as I can.

I’ll be away from my computer for the next three days at a workshop, so don’t be upset if I don’t reply to your emails or questions right away. But, please keep them coming. I have been getting lots of great questions about working out and exercise lately!


Wednesday, November 19, 2008

Some Things Never Change

An article was published today on titled, “Ban on Fast Food TV Advertising Would Reduce Childhood Obesity Trends, Study Shows”.

Basically the study claimed that if we could ban fast food advertising during children and adolescent TV shows, the number of obese youth would begin to fall.

While I wouldn’t mind seeing the fast food advertising taken off the air (or just banned altogether as I find it to be total junk), “some things will never change”:

  • Even if you stop the advertising during television shows, kids still need to get up and move and get exercise and participate in activities that don’t involve playing video games and sitting there watching television.
  • Even if you took away fast food advertising and kids ate less fast food than in previous years, they still are going to be eating junk because no one is educating them on proper nutrition.
  • Their parents are not educating them on proper nutrition! Usually the parents are overweight/obese themselves. The plan needs to be family health plan with everyone on board, making an effort to live healthy, if you want to make it work.
  • Even if kids see these fast food commercials on television, guess who takes them to the restaurants (if you can even call them restaurants) and pays for the food…the parents!! How hard is it to say, “NO! We are eating a healthy meal at home tonight”?

The only way people are going to make a difference is by getting up and doing it themselves. No one can do your exercise for you and no one can eat your diet for you. You have to take control of your own life if you want to make a difference. All this stuff about banning fast food advertising during commercials and video game systems that have you standing up and moving your arms around or come with a “yoga” video game are silly. Turn the TV off, go outside and play. Be active.

I’d like to believe that we will some day change the trend of obesity in America and people will start to take pride in their health. Unfortunately, I just see people getting lazier and their kids following suit.


Friday, November 14, 2008

Friday 11/14/08 – Notes

1. Buying into the system is important. It doesn’t matter if you are training one client or a team of 20. The athletes (or clients), the coaches and the parents have to buy into what you are doing if you ever want to make some progress. I was talking with a friend who coach’s high school football and he proposed that the 12 and 13-year old boys start lifting this year to prepare for next year. This was met with some resentment from the other coaches, who felt that the 12-13 year old boys were “to young” to lift. This is nonsense! At 12-13 years old, those boys need to begin learning proper movement patterns and working on developing some base levels of strength and conditioning. My friends idea was to have those kids start learning body weight squats, lunges, push ups, and pull ups…the basics!! You don’t need to load them up with a whole bunch of weight at that age. You just need to allow them a platform to learn!

2. Being a strength coach doesn’t just take place in the gym. You need to get out and work with your athletes on the field, track or court. You need to observe practice and see what they do and HOW they do it. Knowing this will help you make modifications to your program, which can help improve the players’ abilities.

3. Speaking of being out of the weight room – I spent yesterday morning on the driving range with golf pro Tim Schrader of Kinetic Golf Systems. I had a great time talking to Tim about his ideas on the golf swing and making people not just better golfers, but better people! Tim is really into the power of the mind and visualizing everything. He took a little red basket and put it out about 30 yards on the driving range. Stared at it and visualized his shot and believed 100% that every time he hit the ball it would go into the basket. Every single shot he took was right around the basket and it was amazing when he was even sinking them. He then took it a step further and grabbed a left-handed club and did the same thing! It was awesome! He is a really passionate and dynamic guy and one of the first golf coaches I have spoken with who actually talks about the biomechanics of the swing and ground reaction force and things of that nature.

4. One more week to go and then I will be doing some more continuing education. I am taking another class in Neuromuscular Therapy (a type of soft tissue modality). This one is on the Cranium and Cervical region and it is put on by the NMT Center ( I am really excited! Hooray for education!!

5. Online coaching and consulting is available for anyone interested. I got some really great feed back from a high school football player that I helped out this year:

Patrick has been awesome directing me in the right way to go about training for football this season. I was at a loss for what to do to get ready in the off-season and he set up workouts that worked and were easy to understand. I can tell a great difference from the workouts he set up for me from the ones in previous years, that I just did by my own knowledge.

In my 4 seasons of football 2 out of 4 seasons I suffered injuries that basically ruined my season and this most recent season I can say without a doubt has been the best.

At the start of the season I could immediately see a difference - I was better conditioned than all of my teammates, I had greater strength and endurance, and was just overall way more prepared than anyone on the team. There are two more games left this season and I have been injury free and have dominated opponents with huge size advantages. With proper training I have gained injury prevention, strength, speed, and agility and I am at the best I have ever been thanks to Patrick.

It is really not a good idea to train without the help of someone else. Over-training is very easy to do and you can mess your body up and ruin your season. Instead, get help from someone that knows what they are talking about like Patrick. I did and knowing that I trained correctly and seeing the results on the field was a great feeling.

--Mark Cole-High school athlete

If interested, just shoot me an email:

Have a great weekend everyone!


Tuesday, November 11, 2008

Soft Tissue Self Care

I just stumbled upon the blog of Richard Poley, Feel Better Fast.

Pretty cool blog to check out, as it is all about selft soft tissue work and various ways to work out the "kinks" in your armour.

Check it out!


Monday, November 10, 2008

Warming Up For A Run

I was down at the Phoenix 10K this past weekend doing free stretching/sports massage for the runners. I got there very early to do some pre-event sports massage for some of the runners that I know. Basically the idea is to get the muscles warm, get the blood flowing and get the joints moving. This was especially important because it was kind of chilly that morning (it does get chilly in Phoenix!). Usually after about 10min. of work, I would have them get up and go do the rest of their warm ups (their “running stuff”).

I will say, I can’t believe the amount of people I saw out there still sitting around and static stretching everything (especially since it was cold). The whole idea of the warm up is to WARM UP. You need to increase circulation and do something that challenges the body to “wake up”, not relax (as static stretching does).

Warm ups should start with slower, more controlled movements and then move towards more dynamic movements which get the body ready for competition.

A warm up prior to a run may look something like this:

Ankle circles
Hip circles
Body weight squats
Forward lunges
Side lunges
Hand walkouts
Jumping jacks
Leg swings – forward and backward
Leg sings – side to side
Stride outs (50-60m of about 6-10 reps each building in intensity and focusing on perfect technique)

After the warm up, your body should feel nice and loose and your muscles should feel warm. You should then fuel up and be ready to go race!

Once the race is completed, then you should seek out some stretching and post even massage work to help the tissue recover from the work you just ask it to do.

Unfortunately, just about every person I worked on had some sort of problem! Back pain, knee pain, “sciatica”, and the list goes on and on. Very few people were actually healthy (in terms of tissue/joint health, not cardiovascular health, which obviously most were fine in that department). The other amazing thing about this is that most of these people just assumed that what they were experiencing was something that is going to happen every time they run and that they would just “live with it” if they wanted to continue running.

Needless to say, I had my work cut out for me. I was doing a lot of hands on work and a lot of education work: showing people what to stretch and how to stretch it and showing people how to use the foam roller and which muscles to use it on.

Self-care is critical in any sport. You need to make sure that the tissue is healthy so that it can do what you want it to do. Seek out professionals in the field that can help you educate you on this.

A new thing I am doing for runners is track work. I will come out to the track with you and we will do some technique work, some training and movement based work, and flexibility/mobility work to enhance the way that you perform. I’ll teach you exercises, we will talk about your overall program, and I will teach you some things you can do for soft tissue care and flexibility.

If you are interested, just shoot me an email!


Friday, November 7, 2008

Sports Massage

This article from 9/23/2008 was sent to me on sports massage. Pretty nice read. I am trying to get the full study that they quote in the article so that I can do a research review here. Usually studies in sports massage therapy are difficult for a variety of reasons. Anyway, hope you enjoy it.

If anyone is looking for this kind of work in the Phoenix area, don't hesitate to contact me!


Article Located Here

Study: Massage does help with muscle recovery

By Cynthia Billhartz Gregorian


Olympic swimmer Michael Phelps got a massage twice a day in Beijing. His teammate, Dara Torres, had two massage therapists on stand-by.

And a bunch of sedated rabbits in Ohio recently had massage performed on their legs after bouts of intense exercise.

Phelps, 23, made history by winning eight gold medals. Torres, 41, became the oldest swimmer to compete in an Olympic event and win a silver medal.

As for the rabbits? They might have proved scientifically what athletes and trainers have long believed: Massage really does help with muscle recovery.

According to a recent study published in Medicine & Science in Sports & Exercise, researchers at Ohio State University found that Swedish massage helped speed muscle recovery at the cellular level for rabbits who got mechanically intense exercise.

Athletes also use Swedish massage _ stroking, kneading and pressing soft tissue. Thomas Best, professor of family medicine at Ohio State University and senior author of the rabbit study, said it's too soon for clinical trials on humans. But he considers the rabbits a strong start toward confirming massage's benefits to athletes.

Best said he hopes further research "will dictate how much massage is needed, for how long and when it should be performed after exercise."

In the study, researchers used a mechanical device to create a motion similar to the way quadriceps in human thighs move when running downhill.

Afterward, some rabbits got Swedish massage, others did not but were rested. Scientists found that the muscles of the massaged rabbits had improved function, less swelling and fewer signs of inflammation than did muscles in non-massaged rabbits.


Those findings don't surprise Jim Anderson, athletic trainer for the St. Louis Rams. He remembers players getting massaged 25 years ago. More than half the players get massages now, he said. They hire their own massage therapists, who massage them the day after a game, Anderson said. Many follow up with another the day before a game to loosen their muscles, a process that relaxes them mentally.

"The way their bodies feel after a game, if something can alleviate that pain and soreness, they look at it as something good," Anderson said. "It gets fresh (oxygenated) blood in there, and getting fresh blood to an area helps speed recovery."

Muscles produce lactic acid during intense workouts, said Ethel Frese, a professor of physical therapy at St. Louis University and a cardiovascular and pulmonary specialist. The more intense the workout, the more lactic acid is produced. And the greater the accumulation of lactic acid, the more fatigued _ and painful _ the muscle becomes.

Lactic acid will dissipate on its own, but enhancing blood circulation helps get rid of it quicker. That helps relieve muscle cramps and spasms, she said.

Rams players make six- and often seven-figure salaries so they can afford massages whenever they want. College athletic programs and their athletes, on the other hand, usually can't afford such luxuries.

At Washington University, for instance, a chiropractic-massage therapist visits once a week, providing services to the all student athletes. But the time slots are limited.

Meanwhile Rick Larsen, head athletic trainer, and his team of therapists provide physical therapy, which might include massage of specific body parts, to injured athletes.

"We use it as an adjunct for other types of modalities that enhance the healing process, such as electronic muscle stimulation, heat, cold, ultrasound," Larsen said.

Swim coach Brad Shively estimates that if Washington U. has 300 athletes, a third of them could benefit greatly from massage at any given time.

"Massage makes a great difference," Shively said. "My swimmers use rollers on their legs and shoulders after intense workouts, and it's manual and self-applied, but it works."

At national competitions, he said, it's not unusual for swim teams _ Division I ones in particular _ to bring their own massage therapists.


Cynthia Riberio, vice president of the American Massage Therapy Association, says she has trained several thousand therapists specifically for sports massage. Today, there are more than 265,000 massage therapists nationwide and, of those, 40 percent provide sports massage. Massage therapists have become an established part of many athletes' training teams, which include doctors, chiropractors, psychologists and nutritionists.

Referrals are often made to massage therapists when, for example, athletes complain of sciatic pain that physicians and psychologists can't find an explanation for. Fatigued muscles can get so tight that they press on nerves, producing pain.

But Riberio has seen massage go beyond just helping with recovery from injuries and suggests using it during all phases of competition.

Before athletic events, a massage therapist can help athletes warm up by jostling and stretching the muscles and using circular friction and simple compression on specific body parts. This can continue, only more gently, during competition when the muscles are fatigued. And after an event, Swedish massage is best, Riberio said.

That's up for debate, says Mark Frank of St. Louis Rehabilitative and Sports Massage in Creve Coeur, Mo. He says there are about 200 approaches to massage and that he's had success with myofascial therapy which targets tissue rather than specific muscles.

Whatever the case, experts have long touted other means of reducing soreness and swelling after hard, prolonged exercise, such as icing overworked muscles, taking anti-inflammatory drugs like ibuprofen and properly cooling down. Cool-downs, during which activity is gradually decreased rather than abruptly stopping, prevents lactic acid from pooling in tired muscles.

Frese thinks massage also may do something else: promote the release of endorphins, a natural sedative that alleviates pain and produces a general sense of well-being. Massage is also more beneficial as athletes age, she said.

"The more fit you are, the less lactic acid you produce at a given workload and the faster you clear it," she said. "As you age, you're not as fit. You'll never be at 70 what you were at 20 and you do tend to lose flexibility."

Has anyone told Dara Torres?

Wednesday, November 5, 2008

Massage Case Study

It seems that there has been a lot of interest in my last entry on Trigger Points. I have gotten a lot of great feedback and questions (please keep the questions coming!) about how to work certain muscles or what to look for, etc.

Since people seem to be interested in soft tissue work, I decided to post up a case study that I have been doing on Phil, a powerlifter. The case study can be read at Charles Staley's website,

The direct link to the case study can be found here:

Phil's Journey From Lame to Fame

As always, please feel free to ask questions!


Monday, November 3, 2008

Trigger Point 101

Trigger Point 101

Training hard comes with a price. That price is usually some sort of nagging pain or injury that we typically just assume will be with us for the rest of our lives.

“Oh yea, it is just my bad shoulder. It always aches after I bench.”

“You know how that knee is. There is usually a dull pain in there all the time.”

Oftentimes, these injuries can be alleviated by some soft tissue work and stretching. There are a variety of different types of soft tissue work:

Active Release Techniques (ART)
Myofascial Release (MFR)
Neuromuscular Therapy (NMT)

And the list goes on and on. I believe that all types of soft tissue work have their place and what may be more important than seeking out a specific type of soft tissue work, is just getting SOMETHING done by a skilled therapist.

A term that gets thrown around by massage therapists, physical therapists, chiropractors and has recently been making its way into the strength and conditioning world, is the term “trigger point.” Since people seem to be talking about trigger points more and more, I decided to give you are run down of exactly what a trigger point is, why we should care about them, and what we can do about them.

What is a trigger point?

While some may tell you that trigger points are tender areas in the muscle, this is actually not entirely true! One key characteristic of trigger points is that they are tender to touch, however, every tender area is not a trigger point.

If an area of a muscle is just tender, but does not have the other characteristics of trigger points, then the area is just a “tender point”. These tender points are areas of congestion, where tissue may be ischemic (lacking blood flow), fibrotic, or there may be a lot of scar tissue matted down in the particular area of stress.

Trigger points are areas of taught, hyper-contracted bands/nodules within a muscle. They are tender to touch and have a predicted pain referral pattern. These hyper-contracted nodules within the muscle are palpable and will often feel like little peas or semi-cooked spaghetti. A visual example, would be this picture of some trigger points inside the Sterocleidomastoid:

As you can see, there are a few small contracted nodules, within the fibers that are at normal resting length.

The trigger points can be either active or latent.

A latent trigger point means that it only sends its pain referral pattern when you touch it. For example, if you take a tennis ball and place it between your scapula and your spine, you may push into a trigger point in the rhomboids, which will give you this radiating or dull ache all over the upper back area. If you didn’t push into that area with the trigger point, you would not know it was there. This is a latent trigger point. It only refers when you press into it.

An active trigger point is one, which is currently referring its myofascial pain response. A good example of this, is if you ever had a headache, and you pinched your upper traps, and in doing so were able to produce your symptoms (IE, the headache or that ache through the top of your head and behind your eyes), congratulations, you found an active trigger point!

Trigger points usually can be found in clusters. So, if you de-activate one (I’ll tell you how in a second), then you have to search out and try and de-activate the others within that muscle. This may take some time, and may be very intense, so you might want to do it over a few sessions.

Another thing to consider is that trigger points are not just located within the belly of the muscle. They can also be located in tendonus attachment of the muscle and, even some trigger point referral patterns have been documented ligaments - good examples of this would be the pain referral pattern for the sacrotuberous ligament, which refers a pain pattern down the back of the leg and into the calf (similar to what people may diagnose as or call sciatica) and the pain referral pattern for the iliolumbar ligament which is can be felt in the groin or pain on the outside of the hip (what some may diagnose as or refer to as trochanteric bursitis).

What Muscles Can Develop Trigger Points?

No man is safe!

Any muscle can develop a trigger point and there are several books documenting where these trigger point referral patterns are (Travell and Simons opus Myofascial Pain and Dysfuction: The Trigger Point Manual; Vol 1 (the upper extremity) and Vol. 2 (the lower extremity) are the most comprehensive and widely accepted books on the topic of trigger points).

A lot of times, trigger points can be found in muscles, which are antagonistic to muscles that are constantly contracted. An example of this would be the infraspinatus, always trying to exert an eccentric force on someone’s shoulder who sits at a desk all day, typing away in a chronically internally rotated position. After awhile, the infraspinatus gets tired and lengthens, however there are bands of that muscle, which stay contracted (trigger points!) to try and counteract the internal rotation force and overtime these bands can present their pain referral pattern. One of the pain referral patterns for the infraspinatus is to the front of the shoulder, where people will often say that they got a diagnosis of bicipital tendonitis or impingement. It is not uncommon for someone to come to see me with pain in the front of his or her shoulder (near or around the biciptal groove) and say that they think they have impingement. Upon inspecting their infraspinatus, I can find the trigger points and when I push into them, and ask how it feels and if they feel pain or sensation anywhere else, they comment that they feel the pain in the front of their shoulders and it is the same pain that they feel through out the day. On more than one occasion, I have de-activated trigger points in someone’s infraspinatus and they left totally pain free.

Trigger points can also be found in muscles that are under chronic contraction. A good example of this may be the upper traps or the sub occipital muscles (or even the pectoralis major from the above example! Another common example would be trigger points in the Psoas with people who are always in an anterior pelvic tilt). The upper traps or sub occipitals may develop trigger points from being over contracted all day as individuals sit at their desk with poor posture. Both of these muscles have pain referral patterns that go up into the head and behind or just above the eyes. It is no wonder that people who work desk jobs get such frequent headaches!!

So basically, any muscle can develop a trigger point for any number of reasons.

From Clinical Applications of Neuromuscular Techniques by Leon Chaitow and Judith Walker-Delaney (Vol 2, pg. 20):

Primary activating factors:

- Persistent muscular contraction, strain or overuse (emotional or physical cause)

- Trauma (local inflammatory reaction)

- Adverse environmental conditions (cold, heat, damp, draughts, etc)

- Prolonged immobility

- Febrile illness

- Systemic biochemical imbalance (e.g. hormonal, nutritional)

Secondary activating factors:

- Compensating synergist and antagonist muscles to those housing triggers may also develop triggers

- Satellite triggers evolve in referral zone (from key triggers or visceral disease referral, e.g., myocardial infarct)

- Infections

- Allergies (food and other)

- Nutritional deficiency (especially C, B-complex and iron)

- Hormonal imbalance (thyroid, in particular)

- Low oxygenation of tissues

The key is, knowing where to look and what to do when you find one!

Why Should We Care About Trigger Points?

The first and obvious reason to care about trigger points is BECAUSE THEY HURT! Basically, anything that hurts is going to alter the way that we move. This in turn, leads to other dysfunctions and problems and potentially more trigger point development.

Aside from altering the way that we move, when we are in pain, we psychologically don’t feel good! No one likes to be in pain or miss time playing their sport or training because they hurt.

Common clinical characteristics of trigger points are:

-There may be pain upon contraction – Again, no one likes to hurt. If it hurts to contract, we don’t want to contract.

-Pain during stretching of the muscle at certain ranges of motion – If it hurts to take a muscle through a certain range of motion, then we stop doing it or we limit that range of motion, leading to more problems.

- Muscle weakness – This is a big one!! If muscles are weak, then they can’t optimally do their job. An example of this is trigger points in the Psoas or the glute medius, making those muscles test weak, and causing other problems down the chain. This is also an important aspect, as we often times think of muscles that test weak as muscles that need to be strengthened. However, what happens when you try and strengthen a muscle (causing it to contract more) that has taught bands, which are already hyper-contracted? Not a whole lot, that’s what! You may end up just chasing your tail trying to help that person!

In short, we should care about trigger points because they can negatively affect our performance!

What Can We Do About Trigger Points?

So now that we know what trigger points are, how they develop and why we should care about them, most people are probably wondering, “HOW DO I GET RID OF THEM?”

The method of getting rid of trigger points isn’t that hard. You just have to know what muscles to check, how to access the muscle (not just how to find it, but knowing which direction the fibers run can be very helpful), and how to release the trigger point.

If you are rolling on a foam roller or tennis ball or if you are performing trigger point therapy on someone else, you are going to want to look for trigger points that refer to the area of the body that the person is complaining of pain. A great book that I recommend often is The Trigger Point Therapy Workbook: Your self-treatment guide for pain relief by Clair Davies. It is basically a “how to” book for finding trigger points and where there pain referral patterns are. Each chapter deals with a region of the body and the first page of each chapter has various places that people may feel pain (IE, anterior shoulder pain) and then the muscles and page numbers those muscles can be found on which refer pain to this area (IE, the muscles which can refer to the anterior shoulder are infraspinatus, anterior deltoid, scalenes, supraspinatus, pectoralis major, pectoralis minor, biceps, latissimus doris, coracobrachialis). It then tells you exactly how to work those muscles! It may be the best $20 you ever spend (assuming that you already purchased a foam roller).

Once you have found and confirmed your trigger point, you need to set up a barrier, which breaks apart the actin and myosin (the contractile proteins within the sarcomere) which are bound together due to the chronic contraction in the specific band of the muscle.

This barrier can be created with your fingers (as in the picture) or with any one of the self- care tools available today (e.g. foam roll, the stick, thera-cane, trigger point ball, tennis ball, etc). A lot of people like to take the foam roller and roll back and forth on it. This is okay, as it helps to address the fascia, improves circulation to the tissue and can help to break up adhesions. But, if you want to de-activate the trigger point, you need to stop on the tender area that is referring pain and hold your pressure until it begins to release and the pain starts to dissipate.

The amount of time that you hold the trigger point has been debated over the years, but it appears that approximately 8-12 seconds is the accepted amount of time. It is important to note that if you are pushing and it isn’t releasing, you may be giving it to much pressure and just blasting through superficial tissue and/or more superficial trigger points. Also, if the trigger point doesn’t release after a short period of time, you may want to mark the area (with a pen or something that will wash off) and work other areas of the muscle and come back to it, as trigger point therapy can get very intense and this intensity may not allow the trigger point to release right away. The real key is to give the trigger point just enough pressure to start to feel it release (and confirm that with a slight dissipation of the referral symptoms) and then start to go deeper and work through the next barrier.

How much pressure is enough?

A little bit goes a long way with this. In the past, it was suggested that you hold pressure the trigger point at the individuals’ pain tolerance of a 7-8/10 (10 being excruciating pain). It is now accepted that even a 7-8/10 may be to high to get a proper release, so authors and researchers suggest holding the trigger point at a level of a 5/10 until the individual experiences a decrease in symptoms, at which point you can either go deeper into the tissue (look for trigger points that are in deeper muscles) or move to another location and search for trigger points (the trigger point clusters that I referred to above).

It is important to know that this sustained compression is what will help to alleviate the trigger point. If you only hold for a short period of time, and don’t continue with the treatment, the shortened nodule within the muscle will return to its previous state and very little therapeutic benefit will be gained.

So, to review:

- Find the trigger point

- Hold pressure at a 5/10

- Wait for the tissue to release (you can feel it soften under your skin or, the person will begin to feel a decrease in the pain referral pattern)

- Once the tissue releases and the referral starts to dissipate, either go deeper into the tissue or move on and look for other trigger points in the cluster

Once the trigger points have been de-activated and “order has been restored to the muscle”, you can go ahead and roll the muscle out to promote some blood flow to the area, stretch the tissue (if it is a muscle which needs stretching) and strengthen the tissue.

Things To Consider

- Remember, not all tender areas are trigger points. They may be tender points where tissue is ischemic, scarred up, or fibrotic. This may require other forms of soft tissue therapy.

- Trigger points are not (usually not) the only problem. They are usually part of a bigger problem that has to do with other soft tissue dysfunctions. You should seek out a therapist who can work with you to determine what the underlying problems are.

- Self Care is important! Make sure you are foam rolling and working on your soft tissue. Make sure your training program is developed properly to limit tissue stress and overuse.

- Soft tissue work, foam rolling and proper strength exercises are essential in making sure that your tissue stays healthy and you stay pain free

- Be aware of your activities of daily living and your posture, so that you are not putting un-necessary stress on structures that don’t need it. So much of our pain and dysfunction comes back to how we operate on a daily basis. Altering activities of daily living, while difficult, are crucial in making lasting changes in your soft tissue.

- Just because you de-activate a trigger point, doesn’t mean that it can’t return!

- Always seek medical attention if you feel there is something more serious going on!


Simons D. Understanding Effective Treatments Of Myofascial Trigger Points. Journal of Bodywork and Movement Therapies. 2002. 6(2) 81-88.

Chaitow L, Walker-DeLany J. Clinical Application of Neuromuscular Techniques, Vol. 1: The Upper Body. Elsevier Limited. 2000.

Chaitow L, Walker-DeLany J. Clinical Application of Neuromuscular Techniques, Vol. 2: The Lower Body. Elsevier Limited. 2002.

Davies C. The Trigger Point Therapy Workbook: Your Self-Treatment Guide For Pain Relief. 2nd ed. New Harbinger Publications, Inc. 2004.

Archer P. Therapeutic Massage in Athletics. Lippincott, Williams & Wilkins. 2007.

Lecture notes from: Neuromuscular Therapy – American Version: Care of Soft Tissue Pain and Dysfunction. Judith Delany. International Academy of Neuromuscular Thearpies: NMT Training Center.

About the Author

Patrick Ward is the owner of Optimum Sports Performance LLC. He holds a Masters Degree in Exercise Science and is a Certified Strength and Conditioning Specialist with the NSCA and a Performance Enhancement Specialist with the NASM. He is certified in Active Release Techniques (ART) for the upper extremity and is a few weeks away from completing the necessary requirements to be licensed as a massage therapist in the state of Arizona (where he currently resides). He has worked with athletes and general population clients of all ages and abilities on both exercise programs and soft tissue therapies. He can be reached at

© Optimum Sports Performance LLC. 2008

Sunday, November 2, 2008

Why do I Get Hurt?

This article ran a few days ago in the New York Times. Why do some get hurt more than others? I bolded a few things in the article below.



New York Times - "Clues to Help Explain The Frequency of Injuries"

Clues to Help Explain the Frequency of Injuries

Published: October 29, 2008

The three women are all serious athletes, and they work together at a small research and development firm in New Jersey.

One had a single serious injury when she was a teenager doing gymnastics and skiing. One recently had a hairline crack in the tibia, a serious-overuse injury from running. And the third has had one injury after another for the last five years.

Which do you think is which:

¶Jennifer Davis, 38, runs almost every day, at least 10 miles, and wears her running shoes down to a nub. She has had surgery to remove half the meniscus in her left knee after she tore it exercising, and she is missing that piece of cartilage that stabilizes the joint.

¶Tara Martin, 30, is a triathlete who has competed in many triathlons including the Hawaii Ironman, which consists of a 2.4-mile swim, a 112-mile bike ride and a 26.2-mile run.

¶Birgit Unfried, 26, has been running competitively since high school. She also uses an elliptical cross-trainer, swims and takes spinning classes at her gym. She races in 5K and 10K events, never doing the long-distance training that is needed to run a marathon.

O.K., it’s a trick question.

Birgit has chronic injuries — either her knee hurts or she has excruciating shinsplints that keep her from running.

Jen, who is my workout partner, tore her meniscus, the cartilage that helps stabilize the knee, when she was a teenager. She had surgery at 15 and has not had a serious injury since.

And Tara, who is part of a running group that Jen and I belong to, had the hairline crack, a stress fracture, in 2006. The injury, which was devastating and which took three months to heal, occurred just when she was trying to increase her mileage for fall marathons.

And that leads to some of the most difficult problems in exercise science: Why do some people become injured even though, like Birgit, they try to do everything right while others, like Jen, who flout every rule, avoid injury? And how can the injury-prone protect themselves?

Exercise scientists say they have a few answers that can help with some common injuries. But all too often injuries remain a mystery and people may have to figure out how much exercise is too much for themselves and what sort of routines tend to produce injuries.

“We don’t have enough definitive evidence to say, ‘This causes an injury and even if you don’t have an injury you should change it,’ ” said Stephen Messier, who directs the biomechanics lab at Wake Forest University. Much of the work focuses on running injuries. But the same principles apply to swimming, tennis, bicycling or basketball.

“I think that there is a general quality of ‘heartiness’, or ‘robustness,’ that may influence who gets hurt and who doesn’t,” said Carl Foster, director of the human performance laboratory at the University of Wisconsin, La Crosse. “I’ve never seen any systematically collected data, and I’m not even sure what one would measure, but anyone who has worked with athletes for any time at all has seen that there are just some people who are fragile and some who aren’t.”

Sometimes injuries have a simple fix — like making sure your bicycle fits properly or improving your swimming stroke. More often, they do not. And people tend to get the same injury repeatedly.

“My guess is that it is probably your weak link, perhaps due to your structural malalignment,” said Irene Davis, the research director at the Drayer Physical Therapy Institute at the University of Delaware. “You probably have an innate predisposition for that injury.”

For example, people differ in the way their tissues, bones and ligaments respond to increased training, said Dr. Gordon Matheson, an exercise physiologist and orthopedic surgeon at Stanford University and a past editor of the journal Physician & Sportsmedicine.

“You might increase your running 10 percent a week but I might be only be able to handle 8 percent a week,” Dr. Matheson said.

Then there is muscle strength and endurance, which also can vary from person to person. If your muscles tire, more stress is placed on bones and tendons, which can lead to injury.

And there is the alignment of your skeleton. You might be fine running 30 miles a week, but increasing that to 40 miles means the likelihood of an injury also goes up.

In addition, Dr. Matheson said, some people “can handle distance but not pace.” He explained: “It’s a big jump from a 9-minute mile to an 8-minute mile, and shock absorption can decrease substantially making that move.”

But Dr. Davis’s recent research has identified a few biomechanical features of people who tend to get two common injuries — runner’s knee and stress fractures of the tibia — and showed that it’s possible to change peoples’ biomechanics. The investigators, though, have not yet confirmed those findings with rigorous studies.

Dr. Davis said that runners whose knees hurt tended to drop their hip with each step while, at the same time, their knees cave inward by an excessive amount. Using a computer monitor and cameras, she showed runners where their hips and knees were when they were running on a treadmill and where they should be. They learned to change their alignment and, according to Dr. Davis, they said their knee pain decreased.

Stress fractures of the tibia may have a very different cause, Dr. Davis said. Those who get it often have a characteristic gait, she said. The runners tend to strike the ground hard with their heel.

Dr. Davis’s solution is to train runners by having them run on treadmills that can measure the force of each step. The runners can see how hard their feet hit the treadmill.

That still leaves a lot of injuries that are largely unexplained. And that means that for some people, injuries may just be a fact of life.

Jen seems to get by unscathed. She ran the Baltimore marathon on Oct. 11, will run the New York City Marathon on Nov. 2, and will compete in a 50-mile race in Maryland a few weeks later.

Tara also ran in the Baltimore marathon, three weeks after competing in a triathlon in Maryland, and is training for a marathon in Harrisburg, Pa., on Nov. 9.

And Birgit is still in spinning classes and on the elliptical cross-trainer, hoping to run soon.

But that does not mean she can’t have fun.

Just ask Dr. Alan Garber, a professor of medicine at Stanford who has a daunting injury history and has learned to cope.

It began in the late 1970s when he was preparing for a marathon and got a stress fracture of his tibia. He sought help, changed his shoes, and thought he had solved his problem. Then, a few years ago, he started running the Silicon Valley Marathon but had to stop because he was in such pain. “I could barely walk,” Dr. Garber said.

This time he had a severe stress fracture near where his calf muscles attach to his tibia. It was so bad that Stanford now uses his X-rays as a teaching tool. “It’s the worst stress fracture they have ever seen,” Dr. Garber said. He spent eight weeks on crutches before beginning his path back to running.

Last year, he fell while running down a steep hill, twisting his ankle so badly that he tore his ligaments. Another long recuperation followed.

Now he’s hurt his hip from vigorous workouts on a rowing machine.

But Dr. Garber learned to cope. “I go into recovery mode,” Dr. Garber said. At each stage of his recovery, he seizes upon the things he can do.

When he had the severe stress fracture, he could not kick when he tried to swim. So he swam with a pull buoy. The day he was finally able to kick was fabulous. He graduated to pool running, jumping into the deep end of a pool and moving his legs and arms as though he were running. He loved it. He could use an elliptical cross-trainer when he got a little better. Sheer joy.

Ordinarily, swimming or pool running or an elliptical cross-trainer would seem like a bore to Dr. Garber. But he finds himself looking forward to those workouts. And, he said, he tells himself: “I’ve recovered before. I just have to switch to exercises that I can still do.”