You have hand pain, or wrist pain, or even tingling. Is it in your thumb and index finger? Or in your ring finger and pinky? It makes your work uncomfortable and difficult. The pain even keeps you up at night. Before undergoing carpal tunnel release surgery or taking NSAIDS or other drugs that are associated with dangerous side-effects, you might want to see if your wrist, hand, or forearm pain (or all three) can be relieved by safer and more effective means, such as trigger point techniques you can do at home.
In this article, you’ll learn:
• What is a trigger point?
• Possible causes of trigger points
• How to find trigger points on your own arms and hands
• How to self-treat for hand and wrist pain
• The role of self-care in hand pain prevention and treatment
WHAT ARE “TRIGGER POINTS?”
Trigger points are described as “hypersensitive nodules” in many books on massage therapy. While there are many, many volumes, articles and entire websites devoted to the subject, most of which include trigger point “maps” that show common locations of these points, a trigger point can develop in any muscle anywhere on the body.
A majority of these points are located near the ends of the muscles, where the muscle tissue is denser as it turns to tendon. Tendons are parts of muscles, essentially the ends of the muscles that attach to bones. Trigger points also tend to be located right in the thickest part, or “belly” of the muscle.
There are many theories about what a trigger point actually is. You’ve heard the term “knots” used to describe a sore spot on your shoulder or back where, when rubbed, there is a feeling of a lump or bump in the muscle as it is manipulated that often dissipates or eases with massage. This can also be a trigger point, whether or not it’s on any chart.
These bumps are thought to be spasms in the tissue. Tight muscles may compress blood vessels and cause blood to sit longer in the muscle. Some suggest that it is a lactic acid buildup, although recent studies show that lactic acid might help muscle recovery after exercise, not cause further injury.
Whatever it is, if something blocks fluid flow in a muscle enough to cause it to get bumpy and sore, or a muscle tightens in spasm, it hurts and we want to get rid of it.
The best explanation of trigger point I’ve heard described it as a hypersensitive (meaning it hurts a lot, especially when compressed) section of muscle that in all likelihood consists of muscle fibers with adhesions, meaning that because of repetitive overwork and perhaps some dehydration, the fibers and fiber bundles in the muscles adhere to each other, stick together, causing the “knot” and pain or dysfunction. Because muscle tissue is interconnected with other muscles, nerves, and organs via the fascial web, this pain may refer to other areas.
TRIGGER POINTS AND MUSCLE ANATOMY; ACTIVE TRIGGER POINTS
We don’t have the space here to discuss muscle anatomy in detail, but just be aware that muscles are made of smaller sections called “fascicles” which are basically bundles of muscle fibers. Fascicles are like steel cables, without the twist. The fibers, which are the wires in the steel cable analogy, instead of being twisted like those wires, are parallel to each other and slide back and forth against each other with each movement, separated by thin sheets of fascia.
The fascicles, in their own fascial sheaths, also slide over each other. These different sections sliding back and forth allow different movements to occur, for example, lifting your leg to walk as opposed to lifting it to kick a ball, or perform a dance move.
All three require leg movement, with varying degrees of flexion, extension, rotation, etc., and the components of muscles allow these actions to happen with various subtle differences. When adhesions form, these fibers and fascicles adhere, causing knots, trigger points, pain and dysfunction.
Trigger points hurt when compressed. Sometimes they hurt a lot. Often, “active” trigger points refer pain to other muscles or parts of the body. This referral is probably conducted through nerves, but may also involve the fascia, or web of connective tissue that ties the body systems together.
Whatever the means of referral, when you press on an active trigger point in one place, it hurts on that spot and also on a different spot. That referral pain may be experienced in a different part of the same muscle, an adjacent muscle, or even on a different part of the body. For hand pain, trigger points in the forearm often refer pain to the hands and fingers.
FOREARM MUSCLES: EXTENSORS AND FLEXORS
The forearm muscles on the front or “palm-side” are referred to as “flexors,” because when they contract (muscles are either contracted or at rest, or some combination of the two, during any body movement), they cause the fingers to flex. For example, making a fist requires flexion of all fingers.
The muscles on the back side of your forearm are referred to as “extensors,” and do the opposite action of flexors (they are called “antagonists” of each other, in that they cause the opposite actions). Extending your hand for a handshake requires extension of all fingers.
Just for fun (this shows you how exciting my life is), pull up your sleeve and look at your arm. Wiggle your fingers, and you will see the muscles twitching in your forearms to move your fingers. You can see the tendons of the extensors on the back of your hand. The muscles run in the direction of the limb and bones, from elbow to hand. In fact, I’m watching my extensors move right now while typing, which doesn’t help my typing any.
My next article will be about maintaining one’s focus while working.
WHERE ARE TRIGGER POINTS AND HOW DO WE FIND THEM?
Trigger points are easy to find. If you press on them, they hurt, a lot more than adjacent points. When I taught massage therapy, I would have students draw X’s on their hands and arms where they found trigger points. You can also Google “trigger point” and find charts online that will show these points. But drawing on oneself is so much more entertaining.
There are also videos that show how to find trigger points on the forearm and the main location of the muscle origins that will help find the muscles you want to treat. Please refer to these videos or images to help guide you. You can search “trigger points in the forearm” and see many articles, photos, illustrations.
The trigger points shown in these resources approximate the location of your trigger points; in order to actually treat them, you’ll need to find them, which means you have to press on them to see if they hurt.
HOW TO FIND YOUR OWN TRIGGER POINTS
Just because a trigger point is on a chart or photo doesn’t mean it will be in the same exact spot on your arm. Trigger points vary with the size of a person, the amount of muscle density, the actual cause of the trigger point, and other factors.
It takes a lot of skill and experience for a chiropractor, massage therapist, acupuncturist, physical therapist or other practitioner to find trigger points in others. Often, they dialogue with the client or patient to help find them, putting pressure on a point and asking how much it hurts on a scale of 1 to 10. Fortunately, it’s much easier to find them on yourself. And no need for dialogue, unless of course you want to.
Most muscles in your forearms, called flexors and extensors, originate at or near the elbow and extend down toward the wrist, pass through the carpal tunnel (as narrow tendons), sharing that space with nerves and blood vessels, and then attach to the bones of the fingers and hand. These muscles control hand and finger movement. Consequently, when there is hand or wrist pain, often it is referred from trigger points in these muscles.
Sit at a desk or table, the right palm up and the back of your arm resting on the surface. The point of the elbow closest to your body is called the medial epicondyle of the humerus, a bony landmark on one of the three bones that form the elbow.
Using your thumb or index finger, probe from the bump of the bone where the medial epicondyle is, across to the other side of the forearm just below the elbow crease, stopping to feel where it is most sore. Also, probe down each section of muscle from near the elbow toward the wrist, concentrating on the “mound” of muscle just under the elbow. This is where many trigger points will be found, in addition to the points right where the muscles become tendon.
Most of these muscles turn to tendon halfway down the forearm, which is why the trigger points are mostly nearer to the elbow, where the bellies of these muscles are. That said, there are also points in the wrist and hand, between metacarpals (the bones in the hand that extend to the fingers) and carpals.
You’re basically covering this entire area by pressing on each point as you move across and up and down the muscles. It’s like playing “Battleship” only if you miss, you just go again. When you find a spot that is sorer than you’d expect, even with light pressure, and it is not just sore but almost a burning ache, that’s a trigger point.
If you hold on that point and feel pain elsewhere, like on the wrist, hand or opposite side of the arm, that’s referral pain and it’s an active trigger point. Pay attention to the location of the referral pain as you will want to come back to that later when you’re ready to self-treat.
Next, turn your arm over and explore the extensor (back side) muscles. Most of these originate from the bony bump on the opposite side of the elbow crease from the lateral epicondyle. There’s a new word for many, epicondyle.
Pain in the trigger points on the palm side of the forearm is often referred to as “medial epicondylitis,” better known as Tennis Elbow, while “Golfer’s Elbow” pain is often on the lateral side. If you are having difficulty finding the epicondyles, just enter the terms in a Google search and you’d find images galore.
Probe and palpate as you did on the front side of the forearm, up and down and across, to locate trigger points in the extensors. Note that sometimes you can actually feel a little bump or dent in the muscle tissue where the trigger point is. It is believed (by some) that this is a dimpling effect caused by the fiber or fibers of muscle being in contraction while the rest of the muscle is relaxed. In any event, if you find one of these, that’s just further proof that you’re on a trigger point.
In an interesting side note, many acupuncture points, also used in Shiatsu, Thai and acupressure massage, have a similar feel to the client as trigger points, and also to the therapist, as little bumps or grooves in the muscle tissue or bone.
Repeat the above examination on the left arm. And practice using “epicondyle” in a sentence. Great icebreaker at a party. By the way, stretching and trigger point massage are also great ways to relieve Tennis Elbow and Golfer’s Elbow.
TRIGGER POINT TREATMENT OF CARPAL TUNNEL PAIN
So, you’ve found trigger points that seem to be related to your hand, wrist and finger pain. Now what?
First, it’s likely that you don’t have “carpal tunnel syndrome.” This is not intended to be a diagnosis, but if your pain is caused by muscle tightness from overuse and strain, it’s probably not caused by the carpal tunnel being inflamed (or the tendons in the carpal tunnel being inflamed). In that case, it would seem logical to try other treatments before considering anything more serious like surgery.
If you can afford massage from a licensed therapist, great. You can even use your self-examination to help them locate the trigger points and release them using “ischemic compression,” a deep pressure directly on the trigger point (this can be painful, but just breathe through it). And don’t be shy. Massage therapists and other practitioners love working with clients who are tuned into their own bodies and what they need. And if yours doesn’t, consider finding another practitioner.
This technique causes “ischemia,” which means it pushes all the blood in the muscle tissue out of that area (like when you press down on a toothpaste tube, pushing the toothpaste away from the area being compressed so that it pushes out of the nozzle onto your toothbrush). Then, upon releasing the compression, the blood flows back in at once, thus actually INCREASING blood flow to the trigger point, bringing needed oxygen and nutrients that can help the point release.
While you palpate and press on your arm, if you find a trigger point, apply ischemic compression with your thumb or fingers, pushing firmly on the point for a minute to 90 seconds. You’ll notice the skin get lighter (ischemia causes blood to leave the area temporarily), and when you release, the color will return. If the pain is referred to another place, it is good to then massage that area as well. Continue to cover the other points until all of them have been treated.
SELF-CARE TREATMENT OPTIONS
There are several self-treatment options for hand and wrist pain. Stretching before and after work or tasks is always extremely helpful, and will be detailed in a future article. In addition to self-massage of trigger points, you can also look up stretching videos (e.g. search “stretching techniques for carpal tunnel).
My interest in treating my own hand and wrist pain as a massage therapist and educator led me to this interest in self-treatment. And I wasn’t alone. There are several commercially-available products that use rollers or rolling balls or other methods to deliver self-massage to the hands and arms.
They all work on the same basic application of massage theory and technique, applying pressure and movement (usually by the user) to replicate massage techniques like effleurage, muscle stripping, friction, deep tissue, and even trigger point. Any product that allows compression of trigger points in a strong, concentrated way can be used for trigger point technique, i.e. ischemic compression.
The products differ as to delivery of pressure, ease of use, portability and the big one for many: price. For example, one device attaches to a table or desk with scratch-free suction cups. Pressure is provided by internal springs, whereas with others, the user must supply the pressure by holding the arms of the massager together with the other hand, or by leaning or pushing downward (gravity) against the rollers.
All of these products have their own list of attributes. Look at what each product features, as well as price, size, etc. and see which one is best for you. If you live near a store that carries these tools, usually they will have a few to try out.
As with self-treatment, if you press on trigger points in one arm with the thumb of your opposite hand, it can help relieve the pain. But since you are using one hand to treat the other, it stands to reason that the treating hand will be strained by this, and then need to be treated as well. That’s why for some people, those who work with their hands, a self-care tool as opposed to self-massage, makes sense.
Massage therapy for carpal tunnel is great because the therapist has expertise and you are not straining your own hand to massage your arm, but massage can be costly. Self-care devices are not meant to replace massage, physical therapy or chiropractic, but rather to supplement and enhance it. In fact, many are sold by chiropractors and massage therapists to their patients and clients.
So even if you get a massage, or go to PT or a chiropractor or acupuncturist, a daily at home self-treatment, whether using only your fingers or employing a device or tool, will only enhance the professional’s work, making it more effective faster and help those effects last longer.