Instep Dance Magazine Articles
Reprints of monthly column as first appearing in Instep Dance Magazine (no longer in print).
Ouch! My Shoulder and/or Arm Hurts -- Painful Trigger Points
By Rick Allen, DC
"Better health leads to better dancing."
Two of my patients, Sharon Johnson, who just came back from a dance competition in Hawaii, and Michelle Uttke, owner of Fancy Feet Grand Ballroom in Oregon City, both had pain in the shoulder blade and, most notably, down the arm. Whats the problem? What caused it? What can be done to help?
The Problem: Painful Trigger Points in the Supraspinatus and Infraspinatus Muscles
When you hold your arm up and out to the side the supraspinatus and infraspinatus muscles contract. As shown in drawings 1 and 2, the supraspinatus and infraspinatus muscles are located on the posterior surface of the shoulder blade or scapula. The supraspinatus is above the spine of the scapula, which you can feel running horizontally across the upper third of the scapula; the infraspinatus is below this ridge. They are especially active in movements that rotate the arm outward, such as typing, writing, and ballroom dancing. When held in this position for a long time, it becomes tight and tender, developing a myofascial trigger points (noted by x's in the drawings).
A trigger point is a hyperirritable spot located within a taut band of skeletal muscle or its fascia that hurts when pressed and has distinctive patterns of referred pain. Try locating these points on yourself press the muscles of the shoulder girdle until you find them. Almost everybody will have a few. In other words, they are common. However, they are not normal or healthy. President John Kennedys physician, Janet Travell, MD, wrote an entire book on the trigger points that occur throughout the muscles of the body. Since the 1960s, her work has been extensively quoted in the physical medicine and chiropractic literature, including the reference for this article, Functional Soft Tissue Examination and Treatment by Manual Methods by Warren Hammer, DC.
Side effect: Referred Pain
The referred pain patterns for the supraspinatus and infraspinatus muscles are similar down the arm, as shown in the drawings. (The infraspinatus typically refers further down into the hand.) Thats why Sharon and Michelle felt the pain most distinctively in the arm, rather than at the trigger point itself until I pressed it. And when a trigger point is pressed, Sharon, Michelle, and, if you tried the suggested experiment, you say, Ouch! The referred pain may create secondary trigger points, and, therefore, should also be treated.
The most effective treatment that I have found is a combination of:
Flushing the muscle with hot packs and/or rubbing vigorously with Tiger Balm.
Manual compression, massage, and active myofascial release techniques.
Perhaps further flushing the soft tissue with ultrasound.
Take proteolytic enzyme and herbal anti-inflammatory supplements. Metagenics (1-800-692-9400) makes a good combination of Biozyme and Inflavanoid Intensive Care. Ask your personal chiropractor for specifics.
Drink lots of water (8+ glasses per day) and sweat out the toxins. This is a key point for avoiding feeling like you have been run over by a truck. It is a good idea for overall optimum health, too.
You can minimize the formation of trigger points in the shoulder girdle by avoiding holding prolonged positions with the arms up and out. Take a stretch break when typing, writing or dancing. For optimum health, I further recommend stretching regularly, drinking lots of water each day (6-8 glasses per day), eating good food, and avoiding sugar in all its forms (sugar, soda, and high fructose corn sweeteners). In addition, just like you change the oil in your car to keep it running smoothly, I recommend regular chiropractic and massage treatment to help keep you healthy. For the vast majority of cases, conservative treatment and a healthy lifestyle will be all that is necessary to keep you dancing.
Next article: The Power Posture exercises that I promised for January should be ready with the help of Drs. John Christman and Joe Ventura.
Dr. Rick Allen is a chiropractor, massage therapist and dance student who is located in Trout Lake Washington. Dr. Rick welcomes your questions and suggestions for future articles. However, he cannot make specific diagnoses or treatment recommendations unless you visit him in person. He can be reached by phone at 509-395-0024 in Trout Lake email or on the World Wide Web: www.CascadeWellnessClinic.com
DISCLAIMER: The information included in this website is meant to encourage thinking concerning choices of care for and insight pertaining to possible causes of various problems. It is not a prescription for or diagnosis of any disease or condition. Suggestions are based on the assumption by the writer that a thorough examination was done previously and the reader is under care by a healthcare professional. This information is not a substitute for a live doctor.
© Dr. Rick Allen
Cascade Wellness Clinic