The trapezius, a diamond-shaped muscle that extends from the neck to the upper back, is often the site of myofascial trigger points that can cause local and radiating pain. Among the treatment techniques used in osteopathy, ischemic compression proves to be an effective approach to relieving muscular tension. In this article, we will explore the ischemic compression method for treating trapezius trigger points in detail.
1. Understand the Trigger Points of the Trapezoid:
Trapezius trigger points are hyper-irritable areas of the muscle that can cause local pain and referred pain. They can result from various factors such as stress, muscular overuse or postural dysfunctions.
2. Ischemic Compression Explained:
Ischemic compression is a therapeutic technique that involves the application of sustained pressure to the trigger point. The goal is to temporarily restrict blood supply to the area, followed by relaxation to allow regenerative blood flow. This technique aims to reduce muscle tension and promote the release of toxins accumulated in the area.
3. Patient Preparation:
Before initiating treatment, the osteopathic practitioner must conduct a thorough assessment to understand the patient’s medical history, the nature of their pain, and identify specific trapezius trigger points. Open communication is crucial to building trust and informing the patient about the treatment process.
4. Optimal Positioning:
The patient is placed in a position that allows easy access to the trapezius area. It can be seated or lying down, depending on the patient’s preference and the precise location of the trigger points.
5. Location of Trigger Points:
Trapezius trigger points are specific areas of the trapezius muscle that are hypersensitive and can cause local or radiating pain. The precise location of these trigger points can vary from person to person, but there are areas commonly associated with the trapezius. Here is a description of common trapezius trigger point locations:
TrP1 (Figure 6.1):
- Location: Central part of the anterior border of the upper trapezius.
- Pain Reference: Unilateral referred pain upward along the posterolateral part of the neck to the mastoid process. Major source of “cervical tension” and can cause headaches. Severe pain that may extend to the side of the head, concentrating at the temple and behind the eye socket. May include jaw angle.
TrP2 (Figure 1):
- Location: Central part of the anterior border of the upper trapezius (similar to TrP1).
- Pain Reference: Similar to TrP1, with unilateral pain up the neck to the mastoid process. Also contributes to “neck tension” and headaches.
TrP3 (Figure 2):
- Location: Central part of the lower trapezius, usually near the lower border.
- Pain Referral: Severely refers pain to the high cervical region.
TrP4 (Figure 3):
- Location: Near the musculotendinous junctions of the middle fibers of the trapezius.
- Pain Reference: Shooting pain at the top of the shoulder or acromion. The tenderness is probably due to enthesopathy secondary to TrP4 of the middle trapezius.
TrP5 (Figure 3):
- Location: Also near the musculotendinous junctions of the middle fibers of the trapezius.
- Pain Reference: Induces stabbing pain at the top of the shoulder or acromion. The tenderness is probably due to enthesopathy secondary to TrP5 of the middle trapezius.
TrP6 (Figure 3):
- Location: Superficial, probably cutaneous, in the circled area in Figure 3.
- Sensation Reference: May produce an unpleasant “goosebumps” sensation with pilomotor erection on the lateral aspect of the ipsilateral arm and sometimes the thigh. Referred activity can be induced by simply stroking the skin over the trigger point area.
TrP7 (Figure 3):
- Location: Superficial, probably cutaneous, in the circled area in Figure 3.
- Sensation Reference: May produce an unpleasant “goosebumps” sensation with pilomotor erection on the lateral aspect of the ipsilateral arm and sometimes the thigh. Referred activity can be induced by simply stroking the skin over the trigger point area.
These trigger points are specific areas of the trapezius associated with referred pain or specific skin sensations. For effective relief, it is recommended to consult a specialized healthcare professional, such as an osteopath, for targeted treatment.
6. Application of Ischemic Compression:
Ischemic compression is applied with the practitioner’s fingers, thumbs, or elbows, depending on preference and preferred technique. Sustained pressure is exerted on the identified trigger point, with a pressure level adapted to the patient’s tolerance.
7. Patient Reaction:
It is common for the patient to feel an initial sensation of discomfort when pressure is applied to the trigger point. However, this sensation should evolve into a release of muscle tension. The practitioner must remain in constant communication with the patient to adjust the pressure based on their responses.
8. Duration of Compression:
The duration of ischemic compression can vary, but is generally maintained for a period of 30 seconds to 2 minutes, depending on the response of the muscle tissue and the patient’s tolerance. A series of compression and release cycles can be performed.
9. Release and Reassessment:
After the compression period, the practitioner releases the pressure, allowing blood flow to return to the area. A reassessment is performed to assess changes in muscle tension and patient discomfort.
10. Integration of Complementary Techniques:
Ischemic compression can be complemented by other osteopathic techniques, such as muscle stretching, joint mobilization, or specific exercises aimed at strengthening and stabilizing the trapezius.
11. Monitoring and Prevention:
The osteopathic practitioner should discuss preventive measures with the patient, including postural adjustments, strengthening exercises, and self-management techniques to prolong the benefits of treatment.
Conclusion :
Ischemic compression is emerging as a promising approach for the treatment of trapezius trigger points in osteopathy. By combining accurate assessment, open communication with the patient, and careful application of this technique, practitioners can help relieve pain, restore muscle function, and improve the quality of life of patients suffering from tension in the trapezoid. The key lies in a holistic approach that adapts to the specific needs of each individual, promoting lasting recovery.
