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Trigger Point Therapy Update

I thought I’d write a post as a follow up to my trigger point therapy post since its been a while since I updated you on my status.

Let me start off by saying that trigger point therapy has been a fantastic tool for finding muscle knots in my arms, relieving and deactivating those knots through massage, and generally helping me understand a large part of what is going on with my arms. In the process of the trigger point therapy, however, I experienced (and still have) some ulnar compression going on in the nerve of the right hand which manifests itself in numbness in the outside edge of the pinkie (I don’t know whether this is related to the therapy or not) and I have currently greatly reduced trigger point massage to focus on the ulnar issue.

Does this put me off trigger point therapy? No! On the contrary it is one of the best methods I have encountered in understanding my RSI condition (and other painful soft tissue conditions), and potentially fixing it long term.

I am a 15 year sufferer so my condition is most likely a bad case, but what I have found with trigger point therapy is that you can deactivate a lot of the larger trigger points (muscle knots). I have also noticed that I still have many sites of smaller, much deeper tissue that still generate a lot of referred pain. As these are deeper down in the forearm, they are harder to access, massage and deactivate. I am also amazed at how many trigger points that I have found in many areas of the forearms. It is apparent that computer use, repetitive injury and continual adjustments to try to ease the pain when using a computer can lead to muscle knots forming in all kinds of places in the forearm. It’s not much wonder that such conditions are hard to diagnose, treat and recover from.

So in summary, I have currently backed off from trigger point massage due to the ulnar nerve numbness, but I am still 100% bought into this therapy for helping RSI.

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Trigger point therapy for RSI progress report – 6 weeks

UpdateOK, time for a progress report on trigger point therapy, its been six weeks since I started to do some trigger point massage. Have I seen some improvements? Yes. Has my RSI pain improved? Yes!  Has my RSI gone? Not yet!

Trigger point therapy, as discussed previously in my post “Does forearm extensor trigger point massage offer a potential cure for RSI?”, is a method of massaging trigger points (muscle knots) that refer their pain elsewhere eg forearm extensors into hands and fingers.

Before starting Trigger Point Massage it is essential to understand the anatomy of the forearm muscles and what they do, where they form muscle knots and where they refer pain to, and as discussed in a previous post, the Trigger Point Therapy Workbook is a great place to start with this understanding.

Weeks 1/2

The first two weeks were mainly spent in a lot of pain, easily finding extremely sore trigger point muscles of the forearm extensor groups. I had exceptionally sore areas in the Extensor Carpal Radialis Longus, Extensor Carpal Radialus Brevis and the Extensor Digitorum. Couldn’t find anything going on in the Extensor Indicis despite having had a history of index finger overuse and pain previously.

Massage was done mainly by supported thumb, and knuckles, 3-4 times a day. Excruciating pain was experienced during massage from many of these trigger point areas, and as such can lead to a reluctance to continue, however I just had to keep saying to myself  “this muscle is sore and it shouldn’t be”, grit my teeth and keep massaging!

Most of this period was spent in continual pain from the massage. It is a recurring theme with trigger point massage. Your arms spend a large portion of time in pain from the massage as well as the RSI condition. So there is very little opportunity to asses any progress. I reckoned, however, that if I am massaging sore tissue then that must be a good thing!

Weeks 3/4

As the sore extensor muscles recovered from their intensive massaging of the previous weeks, the forearm felt less painful, but it was a gradual process. Sometimes taking a day or two off of massage treatments helps, just to give the arms time to recover and to allow you to assess progress. I had massaged out the eye-wateringly sore extensors, but there was some deeper down trigger points in lower muscle  tissues to try to access, as well as a persistent ache at the point where the extensors attach to the elbow. I also found a sore trigger point in my Extensor Carpi Ulnaris, which I subsequently found massaging can lead to a nerve type pain down the outer edge of the hand wrist and  little finger, which wasn’t good, and is something to be wary of. If you are trying trigger point therapy yourself, please be careful not to massage nerves!

I have used my thumb for massaging, but as stated in the Trigger Point Therapy Workbook, extended use of heavy pressure with the thumbs alone can lead to sore thumbs pretty quickly and as such is not advised.  The book recommends the use of balls eg tennis balls (or denser rubber ones) to roll your arm muscles against beside a wall. They also recommend a ‘Knobble’ which is a hardish object that you can grip with a knobbly protrusion which can be used as a pressure point for massage. I have generally just used my hands (knuckles and supported thumb) and a beach pebble (with smooth rounded edges) for massage through a fleece top, and both have worked quite well, although its very tempting to resort to using the thumbs which really should be avoided!

Weeks 5/6

After massaging out most of the extensor trigger point (muscle knots), I still have sensitive tissue areas around the elbow where the extensors attach, and this area is still being worked on. After a suggestion from James of How I Overcame RSI I also checked the inner forearm muscle called the Brachioradialis which is a muscle on the inner side of the arm that attaches to the lower end of the upper arm, and is used to bend the elbow. Under this is a smaller muscle called the Supinator which turns the hand palm side up. Much to my surprise, I found trigger points in both of these especially at the points close to the elbow/lower upper arm. The book suggests that trigger points here can refer pain to the thumb area as well as the inner forearm, but James also indicated that in his experience they also referred pain to much of the forearm too. I also found a small trigger point on the Brachialis (bicep) of the right arm, and have massaged it too. The Trigger Point Therapy book says that this point can refer pain to the thumb.


Progress is actually a difficult thing to asses on an ongoing basis. As I have mentioned before this is because you are in quite a lot of  pain from the massage for a large part of trigger point therapy. You literally spend a lot of time massaging, and even after the sorest muscles are less sore, there are still a lot of aches around and you are still stressing the forearm muscles with massage. The only real way to assess progress is to take a two/three day halt in proceedings, and see how they are. I’ve done this a couple of times, and yes the arm muscle pain of RSI does seem to be improving, it’s just not gone yet!

I am, however, very encouraged by the less screamingly sore muscles in my forearms, and am tending to focus on secondary areas now. I still feel pain from typing and mouse use, but much less intense than before, which must be a good thing. How sore the pain would be after a more demanding day of computer use is another question altogether though!

There are also other potential areas according to the Trigger Point Workbook that can refer pain to the arms and hands, including the Scalenes (shoulder neck area) and Triceps (back of upper arms), so more investigation of these areas for trigger points is required. I also am doing a lot of deep probing of the forearm extensors and finding a lot of  trigger points down there, which are very hard to reach and even harder to massage on a continual basis. Some of these small painful muscle fibres appear to be narrower than a fingers width and as soon as you get a finger on them to do massage they disappear to the left or right of your massaging finger before you get the opportunity to truly massage them, very frustrating!

I should also add in that I am doing some wrist rotations to work the extensor muscles in a fluid motion using a weight of about 1kg, and am also doing some work with a Powerball in slow motion.

I will continue to update on my progress here as therapy progresses, although I am at this stage very encouraged by Trigger Point Therapy as a potential solution!

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Trigger Points and RSI

Guest Post by James J of

** Post updated with additional material at end on 16 May 2011 **

Trigger Points and RSI

I’m delighted to be given space to say a few things about RSI and trigger points. I battled with RSI for several years before finally overcoming it several months ago and I now have a very small website that details my journey back to full health. What helped me was discovering that trigger points (a.k.a. muscle knots) can be a significant cause for repetitive strain injury. Alan has already posted on the essentials of what I found in an earlier post titled “Does forearm extensor trigger point massage offer a potential cure for RSI?” He talks about an excellent book by Clair Davies and how trigger points can cause referred pain elsewhere. I will try not to be repetitive and just highlight a few points that I would make in addition to Alan’s post.

Trigger Points Refer Pain Elsewhere

What this means is that the pain you feel is not necessarily at the site of the actual problem. Normally, injured tissue is painful at the site where the damage occurs — if I cut myself with a knife, the pain is located at the very site where the skin is pierced. However, with trigger points, we feel pain in places where there is no problem at all. What seems to happen is that the brain gets confused about where the pain stimulus is coming from and we end up feeling pain some distance away from the real source of the problem. In other words, the trigger point (or muscle knots) refers pain to another location. The site of the trigger point itself is often not particularly painful.

This is very important to realise because the danger is that you will end up pointlessly rubbing away or massaging muscles to no avail. For example, I had searing pain along the outside of my forearm (i.e. the upper side) but this was actually caused by a trigger point on the inside forearm (i.e. palm side or inside forearm) near the crease of the elbow. If I massaged the top of my forearm where it hurt, it did nothing to resolve the problem. Not until I started to massage the underside (palm side) of my forearm at a specific spot near the crease of the elbow did the forearm pain go away. If you have the book by Clair Davies, this is described on p116 with the accompanying diagram figure 6.9.

I mention this because I recently had a conversation with a work colleague about trigger points and RSI. He was getting pain in his arms. He was very interested in my success with massage. Unfortunately, I forgot to explain to him about referred pain and he thought you had to simply massage the spots where you feel pain. Thankfully, I later managed to explain to him how trigger points refer pain elsewhere and he’s now purchased a book which is hopefully setting him right.

Another example is that I had a very sharp pain in the front of my right shoulder. I used to rub away at this place because it was so painful. Unbeknownst to me, there was nothing wrong with my shoulder. The real pain came from a trigger point in the infraspinatus which is a muscle round the back over the shoulder blade. Only by treating a trigger point some distance away from the pain did this help. In Davies’ book, this is on pp90-91.

Trigger Points Weaken Muscles

If you have been suffering from trigger points for a long time, the affected muscles can weaken. In the words of my physiotherapist, they “shorten”. So, getting rid of a trigger point (by deep massage) may not be enough. You may also have to rebuild weakened or shortened muscles with targeted exercises. Having suffered from RSI in my forearm for several years, my muscles had become quite weak. I found it difficult to hold an umbrella or a mobile telephone to my ear. Even after the trigger point had been “deactivated” (to use the proper term), I still needed to rebuild strength in my shortened muscles. My physiotherapist told me to use very small weights of 1 kg max and gently hold them in the way I might hold a microphone. I would then gradually rotate my hand and bend my wrists to slowly rebuild the muscles. It’s important not to use weights that are too heavy because the point about computer usage (and other RSI-inducing activities) is that they are “low load” work. You need to rehabilitate the muscle’s ability to cope with low load endurance. By the way, my physiotherapist said that a tin of baked beans serves as a very good alternative to a hand weight! Another alternative is a Powerball which if you spin SLOWLY, can achieve the same effect. I actually used the Powerball more than small weights but I tend not to recommend it so much because there is a danger that users will spin it too quickly and therefore not achieve the “low load” effect.

Massage Immediately after a Session on the Computer

I found it was quite useful to do massage after working on the computer for a short time (say 5 mins). In other words, I deliberately waited until the RSI symptoms had arrived before doing the massage. Typically, I would spend about 5 min on a computer whereupon my arms and shoulder would start to hurt a lot. I would then do the massage because it’s easier to find where the trigger point is when my muscles were raging with pain!

Other Good Books

I recommend The Trigger Point Therapy Workbook by Clair Davies but there are other very good books too. I really like Simeon Niel-Asher’s Concise Book of Trigger Points which has very good colour drawings but I found that it doesn’t contain quite as much detailed information as Davis’ work. Also, some of the trigger points I suffer from are not mentioned, although to be fair, it is a “concise” book. There is also a useful book by Donna and Steven Finando called Trigger Point Therapy for Myofascial Pain. It is not especially well presented but has some useful information that can serve as a supplementary details. It’s not as good as Davies or Niel-Asher but it is certainly an interesting resource.

Okay, well that’s all I would add to the previous post. You can find out more on my website  How I Overcame RSI.  Don’t hesitate to e-mail if you have any questions.

James J

Additional Information  16/05/11 (from James J)

One thing I would note is that I don’t think the book by Davies’ covers all of the possible trigger points ( and nor do the books by Niel-Asher or Finando). I am convinced that I found some other trigger points causing pain along the topside (outer side) of my forearm; these points are not mentioned in those books so I may be wrong but I am personally 100% convinced that I had trigger points at those spots. Until I started massaging those spots, I didn’t get much better.

forearmHave a look at the image on the right. you will see that all of additional spots that I found are on the inside part of the forearm. Whenever I pressed them, they would have the characteristic pain of a trigger point i.e. they were exquisitely painful. Quite often, they referred pain elsewhere, although not necessarily to the outside of the forearm. You might want to give it a go. One of the spots, to be fair, is mentioned on page 116 of the book by Davies. It is figure 6.9 for the Brachioradialis. However, the pain pattern shows that only part of the outside forearm is shaded. I think that more of the forearm should be shaded – at least that was my experience. Of particular importance were the parts in the middle region of my inner forearm – see the four red dots placed together.

James J

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One thing I would note is that I don’t think the book by Davies’ covers all of the possible trigger points ( and nor do the books by Niel-Asher or Finando). I am convinced that I found some other trigger points causing pain along the topside (outer side) of my forearm; these points are not mentioned in those books so I may be wrong but I am personally 100% convinced that I had trigger points at those spots. Until I started massaging those spots, I didn’t get much better.

Have a look at the attachment I have sent to this e-mail. you will see that all of additional spots that I found are on the inside part of the forearm. Whenever I prsssed them, they would have the characteristic pain of a trigger point i.e. they were exquisitely painful. Quite often, they referred pain elsewhere, although not necessarily to the outside of the forearm. You might want to give it a go. One of the spots, to be fair, is mentioned on page 116 of the book by Davies. It is figure 6.9 for the brachioradialis. However, the pain pattern shows that only part of the outside forearm is shaded. I think that more of the forearm should be shaded – at least that was my experience. Of particular importance were the parts in the middle region of my inner forearm – see the four red dots placed together.
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Does forearm extensor trigger point massage offer a potential cure for RSI?

Trigger point Therapy Workbook
Trigger point Therapy Workbook

Occasionally you come across something that just makes sense, and after receiving an email from James, a fellow RSI sufferer, with a link to his website ‘How I Overcame RSI’, I had a whole new set of data to analyse and compare. The thing that was interesting was that James as well as having a shoulder RSI to deal with, also had a similar condition to mine with overused forearm extensor muscles.

I have long been aware of the fact that I have overused forearm extensor muscles, and have documented this extensively on this site. What I haven’t been able to understand over the years was how to get these muscles to perform as muscles again or, indeed, if they ever would.  I have frequently used short term massage techniques with the extensor muscles to get very temporary relief  from bad forearm pain, but the benefits from this massage have never lasted beyond a day or so.

I guess my understanding of  forearm muscles has not been what it should be. This lack of awareness was not helped by a previous consultation with a ‘RSI’ doctor (10 years ago in US) who told me that he didn’t know whether  my arm muscles would ever act as normal muscles again, hence I have been very pessimistic about ever finding  a cure. Massage from physiotherapists (including deep tissue massage) has also only been of limited success, although admittedly amounted to perhaps only a handful of 15 minute sessions.

So it is with this background that I read James’ website article, which gives a very detailed account of what he found out on his journey of RSI discovery. He has done a lot of the groundwork for us all, and for this we should be grateful. He has spent a lot of his own money on various treatments, and has clearly documented what worked and what didn’t work for him. What was enlightening was the fact that most of his learnings on RSI corroborated my thoughts on the subject too. So his insights immediately grabbed my attention.

What was most resonant with me was that James had managed to cure himself of a bad case of RSI simply by dedicated massage techniques and Powerball use alone. His techniques were based on ‘Trigger Point’  therapy, which, to cut a long story short, means that there are trigger points (muscle knots) in your forearm  tissue which create referred pain elsewhere, for example, in your hands. These trigger points can each be identified and massaged out using dedicated (up to 6 times daily) and sustained massage over a period of 1 to 2 months. The massage is best self administered since the chances of being able to see a physiotherapist 6 times a day for  two months would, I suspect, be zero! Keep in mind that you are also the person best suited to knowing where in your forearm actually hurts!

He recommended reading ‘The Trigger Point Therapy Workbook’ by Clair Davies, which provides self help for trigger point massage. I have purchased a copy of this book, and I too will pass on a big recommendation for anyone suffering from RSI. It really should be mandatory reading by every RSI sufferer, as well as every doctor and physiotherapist. It is one of the best books I have come across that describes RSI trigger points, along with individual muscle diagrams and very readable descriptions of the muscle functions. It also includes descriptions and diagrams of where those trigger points are located and where to expect referred pain. Basically, you look up where you have pain, and it tells you why and what to do. Although the book covers the forearms and hands, it is not limited in scope ie it covers the entire body, and may be of much use to anyone with any other aches and pains!

In my case it is the first time I have been able to identify individual forearm muscles their function, and the stresses that are placed on those muscles when using a computer. I have now started with (1 week) of self treated trigger point therapy (massage) and will report back here with regular updates. I have identified a lot of very very sore to massage trigger points in both my forearms!

Its difficult to assess effectiveness in the first week, as most of the week is spent literally in eye watering pain massaging the very painful knots in the muscles, and the tense ache of after massage muscles which naturally occurs. However after 7 days of this therapy some of the excruciatingly sore knots are less painful now when I rub them, so I have a lot of hope!

Will keep you all posted on my progress.

Many thanks to James for doing all the research, as well as sharing his findings.

Its the first time in ages I’ve felt slightly positive about my RSI condition.

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Understanding RSI

One of the particular frustrations with having an RSI condition is that, as devastating as its impact can be upon lives and careers, it can be easily dismissed as insignificant or “all in the head” by those who have had no insight into its nature. When even the medical community can be guilty of dismissiveness, it’s little wonder that others can be skeptical too.

It doesn’t help that RSI isn’t a terribly visible condition. Even so, when I was wearing 2 arm braces pretty much on a permanent basis, initially they attracted some comment along the lines of, “What have you done to your arm(s)?”. After some time, however, my colleagues became accustomed to seeing me wearing them and I simply became the guy with the arm braces. It also doesn’t help that an RSI such as mine can preclude the movements that caused it, ie working at a computer, but does not necessarily (and thankfully) mean that other activities can’t be undertaken, ie ones that do not employ the same worn-out muscles. When the activities that can still be engaged in happen to be recreational in nature, this only serves to feed suspicion that the RSI somehow isn’t genuine.

I am fortunate in that I can participate in an outdoor activity that involves the use of my arms, and that is kayaking. To the uninformed, that might seem like a contradiction. How is someone who gave up their career because of forearm pain able to paddle? Some brief consideration of the movements involved should answer that question. There is a substantial difference between clicking a computer mouse and a keyboard all day every day and lifting a paddle in and out of the water over a period of a few hours per week. Indeed, the latter could be deemed as a healthy movement involving mainly the upper arm muscle groups including biceps/triceps and shoulders, with minimal forearm motion, and only a light grip. Regardless, I do still have to be mindful of my paddling technique as, for example, incorrect paddle grip could lead to exacerbation of my RSI, especially in the right hand wrist. Indeed, I have invested in a “neutral bent shaft” paddle that is ergonomically designed to lessen the impact of paddle stroke upon the wrists. It is also exceptionally lightweight.

It is easy to form immediate judgements about others’ conditions, but I would encourage anyone who is suffering from an RSI, or who knows someone who is, to educate themselves on the subject thoroughly before jumping to conclusions concerning capabilities.

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My latest forearm extensor RSI rehab effort

homedics massager
Homedics massager

As you will know from reading this blog, I have had a chronic RSI condition in my forearms for over 14 years. I live with it by avoiding computer use as much as possible. Whilst resigned to having this condition long term,  I am always looking at ways to try to rehabilitate it somehow. Usually when things get more painful I resort to digging out an old, vigorous Homedics massager that I bought in the US. It’s a heavy duty one that is probably more designed for deep tissue massage of the back and neck, however, it can and is used by me to reach deep into the forearm extensor muscles for a relieving massage (although you have to be careful not to overdo it). This usually takes the pain down to background levels, at least temporarily.

The massager is, however, still only treating the symptoms of the RSI. What I really need is to try to strengthen the forearm muscles to an extent where they can resume being normal muscles tissue again (as opposed to the knotted, tense mass that is there right now). I have always drawn a blank as to how to do this.

NSD Power Ball gyroscope

I recently came across a friend with a NSD PowerBall Gyroscope (which I’d seen plenty of advertisements for but hadn’t got round to trying out), and my curiosity got the better of me. Amongst its claims is that it can be used as a “Rehabilitation product bringing gentle non-impact relief  to Carpal Tunnel syndrome (CTS), Repetitive strain injury (RSI), tendinitis, arthritis, and all wrist related ailments. Spinning for just five to seven minutes per day is enough to start your rehab!”.  Lofty claims indeed! I was keen to get my own Power Ball and get started!

The units are actually quite inexpensive (less than £10 for the basic model). The more expensive ones have electronic counters in them so you can count rotations and gyroscope speed RPM, which I decided was superfluous to my requirements. My NSD Power Ball arrived in a few days from Amazon and I ripped the package open with great enthusiasm and interest, as well as much hope!

The theory behind the Power Ball is that spinning the gyroscope inside the ball offers a resistance to motion of the ball. Spinning  the gyroscope is started by means of a short piece of string (or alternatively by means of an additional electric base unit at extra cost). Rotation of the ball with the hand/wrist keeps the gyroscope running and maintains resistance. The gyroscope, when in motion, will actually start to produce a gentle whirring sound. The faster the hand/wrist rotation, the faster the gyroscope spins and the more resistance the ball offers and vice versa. The resistance that you encounter is therefore  controllable in infinite degrees, and can be tailored to your own needs (or degrees of injury) which is useful.


What I have found thus far (after about 1 week’s use) is that it is a really good way of getting the forearm extensors exercised in an aerobic manner (as opposed to the continuous micro movements that computer keyboard/mouse input dictates, which can lead to RSI conditions). I can honestly say that I have never felt the forearm muscles heat up as much, which is surely a good thing (I can sense blood rushing into them, which will hopefully be good to promote healing).  I am also coupling this with using a medium/low strength Gripmaster hand exerciser, and adding in a few forearm stretches too. I am keeping this routine to 2 to 3 x 10 to 15 minute timeslots each day. I realise that it’s important not to overdo it!

Having had such a long term injury, I am under no illusions as to the uphill battle I face to rehabilitate it, and it’s still too early to assess the long term benefits of using the Power Ball Gyroscope with a forearm extensor RSI injury such as mine, but so far I haven’t needed to use the big massager for forearm extensor pain relief again which is a good sign! I will report back here after more prolonged use to let you know how things are working out. I at least have a little hope to cling on to for now!

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