Self Trigger-point-therapy - An MSK Therapy perspective
Understanding when and in what circumstances to use a particular technique is a crucial aspect of being a clinician. Being an advanced diploma qualified clinical sports and remedial massage therapist, educator and musculoskeletal professional, the author, understands this. As with foam rollers and when used correctly, the use of massage balls for self trigger-point therapy can produce some good results. Massage balls and foam rollers can prove an extremely beneficial addition to ones self-massage and self-maintenance routine. However, there are different massage principles behind using a foam roller and a massage ball for self trigger point therapy. The following link has more details on what myofasical trigger points (TrPs) are and their relevance. Unfortunately, not all of those people using or instructing in the use of foam rollers, massage balls or trigger point therapy techniques have any form of massage training and in some cases little to no training in anatomy or physiology. Hence, it is common to see incorrect use of foam rollers (see the foam roller article). Although self-massage methods can be quite useful, they will never be as good as or replace the effectiveness of a good myofascial therapist. Furthermore, it is not possible to effectively self-treat all areas of the body. Also, limitations associated with the application of techniques in a self-treatment context can affect treatable tissues. Hence, even the author has to seek regular treatment between 4-6 weeks, and top-level athletes seek treatments far more frequently. Some Olympians may require a daily mix of soft tissue and musculoskeletal therapy treatments while training for events. Other athletes may need fewer treatments a week, fortnightly or even monthly. However, just because such athletes have access to various forms of soft-tissue therapy, they will also have a self-treatment or maintenance routine. Such a routine may consist of stretching, foam roller massage and other forms of self-myofascial release.
Foam Roller vs Massage Balls and Trigger Point Tools
Foam Rollers myofascial release techniques have their origins in techniques from Sports Massage, such as stripping and petrissage. Massage balls and trigger point therapy tools have a lineage from soft tissue techniques such as acupressure, trigger point therapy (TPT) and Neuromuscular Therapy (NMT). These three methods have many similarities in the way they are applied. To save confusion, the remainder of this article will use the term trigger point therapy (TPT) to cover acupressure and NMT. Many TPT tools came about to help reduce the loads on the hands of therapists and not specifically for self-treatment usage. That said the therapist market is relatively small compared to the general populous.
Some typical examples of Trigger Point Therapy Tools
Not only are Foam Rollers and Massage Ball's shaped very differently but the massage techniques that they are looking to replicate work in very different ways too. As with massage therapy, a massage therapist has training in multiple techniques or tools. Good soft-tissue therapists also know when to apply each method and under what circumstances. If a massage therapist were to pick the wrong treatment modality, then they could cause damage or make symptoms considerably worse for an extended period. The same rules around techniques and the application of them apply to home users of Foam Rollers and Massage Balls. Therefore, please do be careful before using a Foam Roller or Massage Ball, as you can make things worse. There are also contraindications to any form of Massage Therapy, even self-myofascial release massage and one should check that it is safe to perform self-massage, before embarking on any self-treatment. If in any doubt, please do consult a suitably qualified professional before any self-treatment. There are almost as many variations of massage balls and TPT tools, as there are of foam rollers.
Some typical examples of Self Massage type treatment Balls
Muscles Spasms / Cramps Considerations
In essence, it is not usually a good idea to attempt to stretch a muscle that is in spasm/cramping. Tissues can go into spasm as a protective (bracing or splinting) measure, due to a perceived risk of tissue damage. Muscles can also "spasm or cramp" for other reasons including lack of fluids, vitamin and mineral deficiencies, over-shortening or extending/stretching tissue structures and other medical conditions. When the muscles are in "spasm or cramping" the fibres within the muscle tissues become highly contracted, which can prove extremely painful. Hence, applying force to lengthen these structures tends to result in further muscle contraction (a protective measure), more pain and even the possibility of tearing additional muscle fibres. Foam Rollers effectively stretch muscles and other underlying tissues and so tend NOT to work well with muscle spasms or cramps. One can use Massage balls in two ways; similar to a Foam Roller or as a means of applying self-trigger point therapy. Trigger point therapy techniques in effect shorten a section of muscle fibres, which in turn can create a relaxation of the muscle fibres. The exact mechanisms regarding how all of this works are far from being completely understood, yet the author can see links with Positional Release Technique (PRT) and Dry Needling.
Massage Ball Versatility as a Roller and for TPT
Massage Ball's have the versatility of being able to apply many techniques, though generally over small areas or smaller muscles. As with a Foam Roller, it can often be quite tricky using a Massage Ball correctly. As with massage, techniques work best when muscles are not under load. When one is lying on a massage bench, the muscles are not under load. Tissues will react to pressure too, which is why so many people view sports massage as painful, though it does not have to be. A therapist can either work with the consumer's body or fight it. Fighting the consumer's body tends to be thoroughly unpleasant and painful for you consumer. Too much pressure can hurt, due to the muscles tensing, and this cycle continues as the therapist beats the muscles into submission, all completely unnecessary. Pain is also one of many “stressors” which can then initiate the body’s “fight, flight or freeze” response (see the article on "stress").
Self Trigger Point Therapy basics
Trigger Point Therapy can be applied quite easily to many areas of the body, such as the legs and arms. As with self Foam Roller massage, the application of the TPT technique ideally requires the tissues to be in an unloaded state (non-tensed). One may have to get creative with towels or pillows to hold the body in a position that enables muscles to be as relaxed as possible during treatment. One would then apply the Massage Ball or TPT tool to the affected area and try to relax. There is no need to roll the TPT ball or device around or move the tissues during treatment. In theory, pain in the area under treatment should either maintain or start to drop off within the first 12-20 seconds of applying the technique. If pain, continues to increase, then there is a good chance that there may be some acute tissue damage present and one should stop self-treatment and seek professional advice. If tissues have somewhat released during the initial application, then one can then reapply the technique to other areas. It is possible to overwork tissues too, as in massage and so it is worth spending a few minutes or less per treatment area. Massage Balls can also be used similarly to a Foam Roller. Unlike a Foam Roller, Massage Balls are excellent for treating smaller areas of tissue and are a better shaped for treating such muscles than a Foam Roller. The principles for safely using a Foam Roller, equally apply to the use of a Massage Ball in a Foam Roller context.
- It is always worth seeking advice from a suitably qualified professional before embarking on self-treatment.
- Avoid self-treatment if you meet any of the standard contraindications for Massage Therapy of any kind.
- Do not treat tissues which are inflamed, bruised or cut.
- Avoid applying to much pressure to tissues when self-treating (a rough guide discomfort is ok, though pain is not).
- Avoid treating muscles that are under load or additional load.
- Avoid overworking tissues, which can result in additional pain, bruising and inflammation.
If in doubt seek advice from a suitably qualified therapist or primary care practitioner. There is also a more recent article about treating the Hamstrings and calf muscles using a spiky massage ball for Self-Myofascial Release (SMR) here.
The article was written by Terry Davis MChiro, BSc (Hons), Adv. Dip. Rem. Massag., Cert. WHS.
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About the Author
As of December 31st 2020, the author chose to leave the Chiropractic profession, due to a planned move back to Australia and where is training and education are not recognised. He no longer works as a Chiropractor and works as a Myotherapist in Morningside, Brisbane. The author possesses an unusual background for somebody who trained in the McTimoney Chiropractic technique. His education, training, and practical experience span over two decades and relate to both health's physical and mental aspects. He has also needed to push his own body and mind to the limits of physical and psychological endurance as part of his time serving in Britain's elite military forces. His education includes a bachelor of science degree in Business Management, with a specialisation in psychology and mental health in the workplace, an Integrated Masters in Chiropractic, MChiro and a multitude of soft-tissue therapy qualifications (see the about section for more details). His soft tissue qualifications range from certificate level right through to a BTEC Level 5 Advanced Diploma in Clinical Sports and Remedial Massage Therapy. Terry also has extensive experience in security, work, health and safety and holds relevant certifications. He has also taught as a senior course coach at Advanced Diploma level (Myotherapy / Musculoskeletal Therapy) in Australia, both theoretical and practical aspects including advanced Myofascial Release Techniques and has certification in training and assessment. Terry will have taught many of the first students to train as Myotherapists in Brisbane. Terry's combination of knowledge through education, training, elite military service, and personal injury history has paid dividends for the consumers he sees and has treated over the last 15 years. He has extensive experience treating chronic pain and work and sports-related musculoskeletal injuries. Terry is still very active and enjoys distance running, kayaking, mountain biking and endurance-type activities.