Below are the answers to the following questions:

• How long will it take to feel better?
• What does tenderness say about a muscle?
• How does massage help the body heal?
• How is scar tissue formed and how does massage therapy affect it?
• Why does putting pressure on a tender spot make it feel better?
• What is a Trigger Point?
• How are Trigger Points located?
• What is a pain referral pattern?
• How are trigger points treated?
• How will I know if the treatments are working?
• Will one treatment be enough?
• What do I need to do to make the benefits of massage last longer?

(Please scroll down to find a specific question.)

How long will it take to feel better?

The length of time to feel better can vary depending on the severity of the injury and how long the pain pattern has been present.  Feeling “better” is usually easy to accomplish.  Most people feel better after one or two sessions. 

The real goal, however, is to feel “good,” not just better.  Good is defined as full pain-free range of motion with enough joint stability and muscle strength to do your normal activities without pain.

Serious injuries or long-standing pain patterns may benefit from 6 to 10 treatments.  Each session should result in more progress as the tissues involved become healthier.  Every session provides an opportunity to re-evaluate and fine-tune the treatments.

What does tenderness say about a muscle?

Healthy muscles don't hurt when touched. Instead, it feels good when pressure is applied during massage. Sore muscles and specific spots that are tender to touch want to get healthy.  Tenderness in response to light-to-moderate-touch is an indication that the tissue needs attention and will benefit from therapeutic massage. 

How does massage help the body heal?

Increasing circulation to the affected tissues is a key to bringing healing oxygen and nutrients to the area.  Increased blood flow washes out metabolic waste and injured cells. Massage therapy can be beneficail to the long term outcome and functional performance of the injured tissues.

A second benefit of massage is the release and prevention of adhesions.  Adhesions limit normal circulation and range of motion.  As the muscle heals, scar tissue forms at the injured site.  Restricted movement due to swelling and pain results in adhesion formation.  Releasing the adhesions is essential to restoring  normal function and performance.

Injuries are classified into acute, sub-acute, and chronic.  These three categories correspond to the time since the injury occurred and correlate to a stage in the healing process. 

Acute injuries are generally treated with RICE—Rest, Ice, Compression and Elevation.  During the first 24 to 72 hours, the body deals with the initial shock of the injury and starts to mobilize the cells and processes that are necessary to bring healing to the tissue. 

How is scar tissue formed and how does massage affect it?

When scar tissue is needed to repair and injury, its primary job is to close the gap.  Think of what happens with a cut finger.  Scar tissue plugs the hole and holds the edges of the cut together.  Its job is to hold neighboring tissues together and to seal the wound. Scar tissue does a great job in a crisis situation.  It keeps the wound together and stops the bleeding.

However, the long-term impact of this binding-together quality is not beneficial to muscle and facial function.  Muscle fibers do their work by contracting and gliding next to each other.  Fascia, the membrane that separates the tissues of the body, helps all tissues slide and glide on each other.  When scar tissue and other adhesions restrict this free slide and glide movement, tightness and decreased function are the result.

Massage therapy, properly applied, actually “remodels” scar tissue.  Existing adhesions are broken up and new ones are prevented.  Collagen fibers, a key component of scar tissue, are re-organized in line with the stresses actually encountered by a muscle or tendon.  Dysfunctional scar tissue is changed into functional scar tissue. Normal, pain free function is restored.  

Why does putting pressure on a tender spot make it feel better?

Massage therapy uses a combination of gliding and static pressure to affect the muscle and connective tissue.  Gliding strokes warm the muscle and increase circulation.  These strokes also can break up adhesions between tissues that are temporarily stuck together. 

Static holds or compressions temporarily restrict the blood flow to the compressed fibers.   Sensitivity to touch may also indicate the presence of a trigger point.

What is a trigger point? 

A trigger point is a chronically shortened, contracted portion of a muscle.  There are two key characteristics: they are tender to touch and they have a signature pain referral pattern to another location on the body.

Trigger points are often formed as a result of trauma to a muscle.  For example, a car accident or fall, repetitive stress, overwork, fatigue, or poor mechanics can all initiate trigger points. 

Chronically contracted muscle fibers of a trigger point create tension in the muscle and add extra stress to the tendons that attach muscles to bones.  That’s why tender spots are often located near muscle attachment sites.

Muscles fibers that are constantly contracted restrict circulation, create metabolic waste from constant energy production, fatigue easily, are weakened and are usually sore.  Muscles generally do there work by shortening.  Contracted muscle fibers, due to trigger points, have a reduced ability to shorten when we require them to work.  Therefore, affected muscles may lose range of motion and/or strength.

How are trigger points located?  

Trigger points show up in the muscles in a variety of ways.  Sometimes trigger points and knots in the muscle are thought of as being the same.  However, all tight-knotted areas in muscle are not trigger points.  Some are simply bands of tight or adhered muscle fibers.  Tenderness and the signature pain referral pattern are the characteristics that distinguish between the two.

To a skilled massage therapist, trigger points feel like a tight band (like a thin piece of spaghetti), a small node (like a small pea), or a tissue of different texture.  Some trigger points are relatively easy to find and others are more difficult.

What is a pain referral pattern?

By definition, active trigger points are tender to touch and have a signature referral pain pattern.  This referral pattern explains why the pain is often in a location removed from the trigger point.  Where it hurts is not always where the problem is. Each muscle has its own pattern of pain referral.  Knowing these patterns is essential to troubleshooting soft tissue pain.  Referral pattern knowledge also helps distinguish between the cause and the symptom. 

Referral sensations may include: sharp or diffuse pain, mild pressure, headache type discomfort, burning, tingling, goose bumps, cough and even a slight feeling of nausea.  Most often it is mild discomfort.

How are trigger points treated?

The most effective treatment for trigger points is called an “ischemic compression.”  Once the tender site is located, pressure is applied to compress the trigger point.  This compression can be compared to wringing out a sponge. 

Several changes are initiated, on the cellular level, by the compression:  Static pressure temporarily restricts blood flow to the compressed fibers. Metabolic waste caused by constant contraction (which produces irritation and pain) is flushed from the area. 

Second, the compression works on the neurology of the affected area. The contraction-spasm-pain cycle is interrupted.  Similar to restarting a computer, the brain resets the nerve impuleses controlling this area. 

Another sequence is started when the compression is lifted.  Fresh blood rushes in, bringing new oxygen and nutrients to the starved muscle fibers.  The brain sends normal neurological signals to the muscle fibers allowing them to break out of the contract-spasm-pain cycle.

How will I know if my treatment is working?

Many times there in an immediate change in the tenderness and referral pattern pain.  The tenderness eases as the muscle relaxes and is replenished with oxygen and nutrients. Referral pain can ease or disappear.

As the muscle tissue gets more healthy, greater pressure can be applied without triggering a pain response.  Once the trigger point is released the referral pain is no longer present.

Other signs of progress toward healthy muscles include:  flare ups are less intense and recovery is faster.

Will one treatment be enough?

One treatment can bring major relief even to long-term chronic pain.  Unraveling the mystery of trigger point referrals is a powerful treatment for myofascial pain.  Many times follow-up treatments are used to clear out remaining or stubborn trigger points. 

There may be perpetuating factors that need to be addressed.  For example, biomechanical stress from poor posture, a poorly designed work setting or repetitive stress situations may work to perpetuate trigger point development.  These problems need to be addressed before long lasting releif will be realized.

Also, trigger point therapy may be slightly uncomfortable.  Time and client comfort levels limit how much work can be done in one session.   It may take several treatments to clear trigger points and restore healthy, functional muscle tissue.

What do I need to do to make the benefits of massage last longer?

Self-care is a key to long lasting results from massage therapy.  Reducing repetitive stress, developing a quality exercise program and smart stretching to maintain normal range of motion for joints are all essential.  “Move it or lose it” is a true saying when it comes to the function of muscles and connective tissue.