Dealing with clients with muscle pain and very tender trigger points

You are working on a client with muscle pain and very tender trigger points (TPs). As you dig into the muscle with manual therapy or massage, the client is jumping and complaining about the pain. What do you do? Choices:

1. Keep digging, you think, no pain, no gain.

2. Stop digging and work on another area.

3. Apply ice to mitigate the sensitivity.

4. Start exercise since they cannot tolerate the manual therapy.

5. Tell them to take some medication before the next visit so it doesn’t hurt so much.

6. Press your thumb into the trigger point and hold it for awhile. They will be so happy when you release it they will feel better.

There is an alternative: positional release. If the pain is related to trigger points, simply pushing more may cause undue discomfort. Ischemic compression is often beneficial to reduce the painful sensitivity of those TPs; however, it is painful to press on them. Applying pressure may mitigate the pain afterwards by “gating” the pain. (Melzack and Wall’s theory) It may also stimulate A fibers to override the C fibers carrying pain messages. Is there a way to reduce the tenderness without causing more pain? Yes, if the pain is related to a reflex dysfunction. If the muscle spindle bias is elevated, they muscle is more sensitive to stretch, and the muscle may tense even when it is not in a stretch. using positional release (also known as Strain-Counterstrain) may reduce or even eliminate the tenderness and abnormal tension in the muscle by resetting the spindle threshold (the bias) to a more normal level of sensitivity. In most positional releases, the muscle attachments are approximated to remove all tension, and the position is held for about 90 seconds. Not too long to wait to make a difference! Educise offers courses in positional release and integrated neuromuscular re-education to address the abnormal tension and pain associated with TPs. There is ample evidence to prove it works, too!

Leave a Comment

Mindful Drum Circle July 12th 7pm Newbury NHRelax with traditional drumming meditation for wellness

Mindful Drum Circle:  7-9pm 7/12/22 for wellness of body-mind-spirit!

Enjoy a guided meditation journey to the sound of drumming & singing bowls. 
Bring a drum/rattle, or listen in to connect with your Higher Power with us.

Location: SENT UPON REGISTRATION,  just 4 miles from Mt. Sunapee

877-281-3382  donation: $11

Register at:

Circle is held outside by the fire, weather permitting, or indoors in rain.  Bring your lawn chair. 

Rehab Summit: 42 courses, 4 days! Oct. 8-12, 2022Top speakers, great connections! Get a year's worth of CE in one weekend

The Largest Multi-Disciplinary Rehab Conference in the Nation

If you’re interested in working with today’s leading experts and the most talented and passionate individuals in the industry, this is YOUR event. For the last 14 years, hundreds of the world’s brightest rehab professionals (physical therapists, occupational therapists, speech-language pathologists, athletic trainers, licensed massage therapists, and chiropractors) have come together to learn what’s new, what’s actually working, and what’s just around the corner in their field.

Now’s your chance to attend the only rehab conference that allows you to tailor your education to your specialty area and network with your peers from multiple disciplines — plus you’ll earn up to a year’s worth of CE hours.

FREE Relaxing Meditation VideoJust simply fill out your name and email below.

Once you submit your name and email, you will then receive an email with your FREE Relaxing Meditation video: Journey To Relaxation to help you release stress and tension, fast and easy!

Gratitude is everything! Educise thanks you with a $35 BOGO coupon!Be grateful to master skills with Educise home study today!

Did you see Dr. Theresa's articles in Massage Journal  this month?

SPECIAL! Buy One-Get One: use code bogoedu for home study courses at checkout: 

$35 value!

Join Dr. Theresa, the Clinical Strategist with Educise VIP membership!

·       Monthly Top Tips to maximize clinical skills online

·       Unlimited VIP access to our course content online

·       Quarterly virtual coaching meetings Q&A with expert faculty

·       Members-only discounts on courses and products

Scroll to Top