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counterstrain self-treatment for some FMS tender points
Chapter Eighteen
Strain/counterstrain self-treatment for some FMS tender points
CHAPTER CONTENTS Using the tender points . . . . . . . . . . . . . . . . . . . Suboccipital muscles . . . . . . . Side of neck tender points Midpoint of upper trapezius muscle . . . Origin of the supraspinatus muscle above the shoulder blade . . . . . . . . . . . . . . . . . . . . Second rib tender points
407 408 408 409 409 410
The text in this chapter describes self-treatment of tender points that can be used for patient education. The aim is to help patients to learn to use SCS methods by focusing on five of the key tender points used in diagnosis of FMS. In doing so, the practical ‘how to’ principles of SCS selftreatment should become clear and usable in firstaid self-care on any painful area of the body. The basic rules, explained more fully in Chapter 16, are: • Find a painful point. • Score this as 10 while pressing it. • Slowly reposition your body, or part of the body, until the pain is reduced to a 3. • For pain in the front of the body, movements and positions that ease the pain usually involve bending forwards and towards the side of the pain. • For pain on the back of the body, movements that ease the pain usually involve bending backwards and away from the side of the pain. • The further pain is from the midline the more sidebending and rotation will be needed.
18
• For a pain point on a leg or arm, movement of the limb, in various directions, usually suggests which way to go to ease the palpated pain. • Hold the ‘position of ease’ for 1 minute at least, and slowly return to neutral. That’s all there is to SCS. As a rule movements that ‘slacken’ tissues housing the painful point helps reduce the score most. CAUTION: Do not treat more than four or five points on one day as the pain may increase for the first day or so after. If too many points are treated, pain may increase for a period. Try these methods on a few points. Judge the benefits several days after treating in this way. Are chronic areas less stiff and less painful? If so, treat sensitive areas in this way whenever the pain gets excessive.
Using the tender points Patient information should include the fact that the diagnosis of FMS depends on there being at least 11 tender points present out of 18 tested, using a set amount of pressure. Five of the diagnostic points for FMS have been used in this chapter to learn self-use of SCS, because they are almost universally painful in FMS: 1. Either side of the base of the skull where the
suboccipital muscles insert 2. Either side of the side of the neck between the
fifth and seventh cervical vertebrae (anterior aspects of inter-transverse space)
CHAPTER 18
Fibromyalgia syndrome
3. Either side of the body on the midpoint of the
muscle which runs from the neck to the shoulder (upper trapezius) 4. Either side of the body, origin of the
supraspinatus muscle which runs along the upper border of the shoulder blade 5. Either side, on the upper surface of the rib,
where the second rib meets the breast bone, in the pectoral muscle. Note: Self-treatment is described in the first person, so that the text and pictures can be copied for patients’ use.
Suboccipital muscles (Fig. 18.1) Lie down on your side with your head on a low pillow. The painful points lie at the base of your skull, in a hollow just to the side of the centre of the back of the neck. • Feel for the tender point on the side lying on the pillow with the hand on that same side. Press just hard enough to register pain and score the level of pain as a ‘10’ (where 10 is severe and 0 is no pain at all). • To ease the pain, take the head backwards slightly, and usually lean it and slightly turn it towards the side of pain. • First, take the head slightly backwards slowly, as though looking upwards. If the pain changes, give it a score. If it is now below 10 you are on the right lines. • Test the response with slightly more backward bending of the neck, until you find a position which reduces the pain to around a 6 or 7.
Figure 18.1 Strain/counterstrain self-treatment for suboccipital tender point.
408
• Now allow the head to turn and lean a little towards the pain side, until the score drops some more. • Keep ‘fine-tuning’ the position as you slowly reduce the pain score. You should eventually find a position where the score is 3 or less. • If the directions of movement of the head described above do not produce pain reduction, you may need to turn the head away from the side of pain, or find some other slight variation of position, to achieve ‘ease’. The directions given above are the most likely to help to bring the score down to a 3 or less. • Once the score is 3 or less, relax in that position. You do not need to maintain pressure on the tender point all the time. • It is important that the position that eases the pain should not produce any other pain. • Stay in the ease position for at least 1 minute and then slowly return to a neutral position, turn over and treat the other side in the same way.
Side of neck tender points (Fig. 18.2) These points lie near the side of the base of the neck, directly below the lobe of your ear. • You can locate the tenderness by running a finger very lightly down the side of your neck, starting just below the ear lobe. As you do so you should be able to feel the slight ‘bump’ as you pass over the tips of
Figure 18.2 Strain/counterstrain self-treatment for lateral cervical tender point.
Strain/counterstrain self-treatment for some FMS tender points
CHAPTER 18
the transverse processes – the parts of the vertebrae that stick out sideways. • When you get to the level of your neck that is more or less level with your chin, start to press in lightly after each ‘bump’, trying to find an area of tenderness on one side of your neck which, when pressed, allows you to give it a score of 10. • Once you have found this, lie down and allow your head to bend forwards. • As with the first point treated (above), you will find that tenderness will be reduced as you take your head forwards. Find the most ‘easy’ position by experimenting with different amounts of forward bending. • The tenderness will be reduced even more as you fine-tune the head/neck position by slightly sidebending and turning the head, either towards or away from the pain side, whichever reduces the ‘pain score’ most. • When you achieve a score of 3 or less, stay in that position for at least 1 minute and then slowly return to neutral, and seek out a tender point at the same level, on the other side of the neck, and treat it the same way.
squeeze the muscle fibres on the left, until something very tender is found. • If pressure is maintained on this tender point for 3 or 4 seconds it might well start to produce a radiating pain in a distant site, probably the head, in which case the tender point is also a trigger point (the same could be true of any of the tender points you are going to palpate, but this is one of the likeliest and commonest). • Lie down onto a pillow, on the side opposite that which you are treating. • Lightly compress the point between finger and thumb (using the hand on the non-treated side) to produce a score of 10. • Try altering the position of your other arm, perhaps taking it up and over your head, to ‘slacken’ the muscle you are palpating, or alter your neck position by sidebending it slightly towards the painful side, possibly by adding an additional pillow. • Fine-tune these positions until you reduce the score to 3 or less. Stay in that position for not less than 1 minute. • Slowly return to a neutral position, turn over and seek out and treat a tender point on the other side.
Midpoint of upper trapezius muscle (Fig. 18.3)
Origin of the supraspinatus muscle above the shoulder blade (Fig. 18.4)
The trapezius muscle runs from the neck to the shoulder. • You can access tender points by using a slight ‘pinching’ grip on the muscle, using your thumb and index finger of (say) the right hand to gently
Figure 18.3 Strain/counterstrain self-treatment for tender point in middle fibres of upper trapezius muscle.
• Lie on your back, head flat on the floor/bed/ surface and, resting your elbow on your chest, ease your hand over your opposite shoulder to feel for the upper surface of your other shoulder blade.
Figure 18.4 Strain/counterstrain self-treatment for supraspinatus tender point. 409
CHAPTER 18
Fibromyalgia syndrome
• Run your fingers along this upper surface, towards the spine, until you come to the end of the shoulder blade, and there press into the muscles a little, seeking a tender area. You may need to press a little down, or back towards the shoulder, until you find what you are looking for, and can score the sensitivity as a 10. • With your affected side arm resting at your side, and with a finger of the other hand in contact with the tender point, bend the arm on the affected side so that your fingertips rest close to your shoulder. • Now bring the elbow on the affected side towards the ceiling – very slowly – and let it fall slightly away from the shoulder about half way to the surface on which you are lying. Does this reduce the score? • Now start to use ‘fine-tuning’ of the arm position, by rotating the bent arm gently at the shoulder, twisting so that the elbow comes towards the chest and the hand moves away from the shoulder, until the pain is down to a score of 3 or less. (The score may also drop if you turn your head towards or away from the treated side.) • Hold the final ‘position of maximum ease’ (score 3 or less) for at least 1 minute, and then slowly return to neutral and do the same on the other side.
Second rib tender points (Fig. 18.5) • Sitting in a chair, rest your middle finger on the upper surface of your breast bone, and move it slowly sideways until you touch the end of your collar bone where it joins your breast bone. • Now run the finger towards your shoulder for not more than 1 inch (2.5 cm) along the collar bone, and then down towards the chest for a half an inch (1 cm) or so. You should feel a slight ‘valley’, after which you will come to the second rib (you cannot easily touch the first rib because it is hidden behind the collar bone). • Press the upper surface of the second rib firmly and it should be tender. • Search until you find a place where the pressure allows you to score a 10.
410
Figure 18.5 Strain/counterstrain selftreatment for second rib tender point.
• Now bend your head and your upper back forwards, slightly towards the side of the pain point, until you feel the pain reduce. • Find the most ‘easy’ position of forward and slight sidebending, and then see whether tilting the head one way or the other helps to reduce the score even more. • Take a full deep breath in and then slowly let the breath go, and see which part of your breathing cycle eases the tenderness most. • Once you have the score down to a 3 or less, add in that most ‘easy’ phase of the breath (hold the breath at that phase which eases the pain most) for 10–15 seconds. • Then breathe normally but retain the position of ease for at least 1 minute, before slowly returning to neutral and seeking out the tender point on the other side for similar attention. After treating these 10 points (five on each side) you can now use SCS to treat any painful point or muscle, using these same methods. The relief will be variable, lasting for a short or long period depending on what caused the pain. You now have a practical first-aid measure for reducing pain, often considerably, and often for a long period.
Strain/counterstrain self-treatment for some FMS tender points
CHAPTER CONTENTS Using the tender points . . . . . . . . . . . . . . . . . . . Suboccipital muscles . . . . . . . Side of neck tender points Midpoint of upper trapezius muscle . . . Origin of the supraspinatus muscle above the shoulder blade . . . . . . . . . . . . . . . . . . . . Second rib tender points
407 408 408 409 409 410
The text in this chapter describes self-treatment of tender points that can be used for patient education. The aim is to help patients to learn to use SCS methods by focusing on five of the key tender points used in diagnosis of FMS. In doing so, the practical ‘how to’ principles of SCS selftreatment should become clear and usable in firstaid self-care on any painful area of the body. The basic rules, explained more fully in Chapter 16, are: • Find a painful point. • Score this as 10 while pressing it. • Slowly reposition your body, or part of the body, until the pain is reduced to a 3. • For pain in the front of the body, movements and positions that ease the pain usually involve bending forwards and towards the side of the pain. • For pain on the back of the body, movements that ease the pain usually involve bending backwards and away from the side of the pain. • The further pain is from the midline the more sidebending and rotation will be needed.
18
• For a pain point on a leg or arm, movement of the limb, in various directions, usually suggests which way to go to ease the palpated pain. • Hold the ‘position of ease’ for 1 minute at least, and slowly return to neutral. That’s all there is to SCS. As a rule movements that ‘slacken’ tissues housing the painful point helps reduce the score most. CAUTION: Do not treat more than four or five points on one day as the pain may increase for the first day or so after. If too many points are treated, pain may increase for a period. Try these methods on a few points. Judge the benefits several days after treating in this way. Are chronic areas less stiff and less painful? If so, treat sensitive areas in this way whenever the pain gets excessive.
Using the tender points Patient information should include the fact that the diagnosis of FMS depends on there being at least 11 tender points present out of 18 tested, using a set amount of pressure. Five of the diagnostic points for FMS have been used in this chapter to learn self-use of SCS, because they are almost universally painful in FMS: 1. Either side of the base of the skull where the
suboccipital muscles insert 2. Either side of the side of the neck between the
fifth and seventh cervical vertebrae (anterior aspects of inter-transverse space)
CHAPTER 18
Fibromyalgia syndrome
3. Either side of the body on the midpoint of the
muscle which runs from the neck to the shoulder (upper trapezius) 4. Either side of the body, origin of the
supraspinatus muscle which runs along the upper border of the shoulder blade 5. Either side, on the upper surface of the rib,
where the second rib meets the breast bone, in the pectoral muscle. Note: Self-treatment is described in the first person, so that the text and pictures can be copied for patients’ use.
Suboccipital muscles (Fig. 18.1) Lie down on your side with your head on a low pillow. The painful points lie at the base of your skull, in a hollow just to the side of the centre of the back of the neck. • Feel for the tender point on the side lying on the pillow with the hand on that same side. Press just hard enough to register pain and score the level of pain as a ‘10’ (where 10 is severe and 0 is no pain at all). • To ease the pain, take the head backwards slightly, and usually lean it and slightly turn it towards the side of pain. • First, take the head slightly backwards slowly, as though looking upwards. If the pain changes, give it a score. If it is now below 10 you are on the right lines. • Test the response with slightly more backward bending of the neck, until you find a position which reduces the pain to around a 6 or 7.
Figure 18.1 Strain/counterstrain self-treatment for suboccipital tender point.
408
• Now allow the head to turn and lean a little towards the pain side, until the score drops some more. • Keep ‘fine-tuning’ the position as you slowly reduce the pain score. You should eventually find a position where the score is 3 or less. • If the directions of movement of the head described above do not produce pain reduction, you may need to turn the head away from the side of pain, or find some other slight variation of position, to achieve ‘ease’. The directions given above are the most likely to help to bring the score down to a 3 or less. • Once the score is 3 or less, relax in that position. You do not need to maintain pressure on the tender point all the time. • It is important that the position that eases the pain should not produce any other pain. • Stay in the ease position for at least 1 minute and then slowly return to a neutral position, turn over and treat the other side in the same way.
Side of neck tender points (Fig. 18.2) These points lie near the side of the base of the neck, directly below the lobe of your ear. • You can locate the tenderness by running a finger very lightly down the side of your neck, starting just below the ear lobe. As you do so you should be able to feel the slight ‘bump’ as you pass over the tips of
Figure 18.2 Strain/counterstrain self-treatment for lateral cervical tender point.
Strain/counterstrain self-treatment for some FMS tender points
CHAPTER 18
the transverse processes – the parts of the vertebrae that stick out sideways. • When you get to the level of your neck that is more or less level with your chin, start to press in lightly after each ‘bump’, trying to find an area of tenderness on one side of your neck which, when pressed, allows you to give it a score of 10. • Once you have found this, lie down and allow your head to bend forwards. • As with the first point treated (above), you will find that tenderness will be reduced as you take your head forwards. Find the most ‘easy’ position by experimenting with different amounts of forward bending. • The tenderness will be reduced even more as you fine-tune the head/neck position by slightly sidebending and turning the head, either towards or away from the pain side, whichever reduces the ‘pain score’ most. • When you achieve a score of 3 or less, stay in that position for at least 1 minute and then slowly return to neutral, and seek out a tender point at the same level, on the other side of the neck, and treat it the same way.
squeeze the muscle fibres on the left, until something very tender is found. • If pressure is maintained on this tender point for 3 or 4 seconds it might well start to produce a radiating pain in a distant site, probably the head, in which case the tender point is also a trigger point (the same could be true of any of the tender points you are going to palpate, but this is one of the likeliest and commonest). • Lie down onto a pillow, on the side opposite that which you are treating. • Lightly compress the point between finger and thumb (using the hand on the non-treated side) to produce a score of 10. • Try altering the position of your other arm, perhaps taking it up and over your head, to ‘slacken’ the muscle you are palpating, or alter your neck position by sidebending it slightly towards the painful side, possibly by adding an additional pillow. • Fine-tune these positions until you reduce the score to 3 or less. Stay in that position for not less than 1 minute. • Slowly return to a neutral position, turn over and seek out and treat a tender point on the other side.
Midpoint of upper trapezius muscle (Fig. 18.3)
Origin of the supraspinatus muscle above the shoulder blade (Fig. 18.4)
The trapezius muscle runs from the neck to the shoulder. • You can access tender points by using a slight ‘pinching’ grip on the muscle, using your thumb and index finger of (say) the right hand to gently
Figure 18.3 Strain/counterstrain self-treatment for tender point in middle fibres of upper trapezius muscle.
• Lie on your back, head flat on the floor/bed/ surface and, resting your elbow on your chest, ease your hand over your opposite shoulder to feel for the upper surface of your other shoulder blade.
Figure 18.4 Strain/counterstrain self-treatment for supraspinatus tender point. 409
CHAPTER 18
Fibromyalgia syndrome
• Run your fingers along this upper surface, towards the spine, until you come to the end of the shoulder blade, and there press into the muscles a little, seeking a tender area. You may need to press a little down, or back towards the shoulder, until you find what you are looking for, and can score the sensitivity as a 10. • With your affected side arm resting at your side, and with a finger of the other hand in contact with the tender point, bend the arm on the affected side so that your fingertips rest close to your shoulder. • Now bring the elbow on the affected side towards the ceiling – very slowly – and let it fall slightly away from the shoulder about half way to the surface on which you are lying. Does this reduce the score? • Now start to use ‘fine-tuning’ of the arm position, by rotating the bent arm gently at the shoulder, twisting so that the elbow comes towards the chest and the hand moves away from the shoulder, until the pain is down to a score of 3 or less. (The score may also drop if you turn your head towards or away from the treated side.) • Hold the final ‘position of maximum ease’ (score 3 or less) for at least 1 minute, and then slowly return to neutral and do the same on the other side.
Second rib tender points (Fig. 18.5) • Sitting in a chair, rest your middle finger on the upper surface of your breast bone, and move it slowly sideways until you touch the end of your collar bone where it joins your breast bone. • Now run the finger towards your shoulder for not more than 1 inch (2.5 cm) along the collar bone, and then down towards the chest for a half an inch (1 cm) or so. You should feel a slight ‘valley’, after which you will come to the second rib (you cannot easily touch the first rib because it is hidden behind the collar bone). • Press the upper surface of the second rib firmly and it should be tender. • Search until you find a place where the pressure allows you to score a 10.
410
Figure 18.5 Strain/counterstrain selftreatment for second rib tender point.
• Now bend your head and your upper back forwards, slightly towards the side of the pain point, until you feel the pain reduce. • Find the most ‘easy’ position of forward and slight sidebending, and then see whether tilting the head one way or the other helps to reduce the score even more. • Take a full deep breath in and then slowly let the breath go, and see which part of your breathing cycle eases the tenderness most. • Once you have the score down to a 3 or less, add in that most ‘easy’ phase of the breath (hold the breath at that phase which eases the pain most) for 10–15 seconds. • Then breathe normally but retain the position of ease for at least 1 minute, before slowly returning to neutral and seeking out the tender point on the other side for similar attention. After treating these 10 points (five on each side) you can now use SCS to treat any painful point or muscle, using these same methods. The relief will be variable, lasting for a short or long period depending on what caused the pain. You now have a practical first-aid measure for reducing pain, often considerably, and often for a long period.