forearm extensor Health RSI trigger point therapy

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!

11 replies on “Trigger point therapy for RSI progress report – 6 weeks”

Hi Alan

Great to hear an encouraging report. It sounds like good progress. I wonder whether you have attachment trigger points (p 22 Trigger Points Therapy Workbook) in the places near your joints. These are not true trigger points, according to Davies, who says, “they may be only highly sensitised connective tissue that has been abused by the stress of continuous muscle tension”

Also interesting that you have found a trigger pointing your bicep. I had the same thing and had to regularly massage my biceps with finger and thumb of the opposite hand.

Hi James,

it may well be sensitive connective tissue. Hopefully it will ease off with the muscles being more muscle like. Only time will tell.


I’m trying not to read too much into the page 22 reference on Attachment Trigger Points that states “In chronic conditions where trigger points have been in place for months or years, stresses at the site of muscle attachment are thought to cause degenerative changes in the joint”, but who knows, I have had this condition for 15 years now!
Fingers crossed I can prove this wrong.

Good to see some results Alan, that’s certainly hopeful. I’m using a slightly different approach that seems to be working well. I’m using a hard edged object – in this case a remote control which I can work into my arms. I’m listening and feeling for “crunchy” spots in my muscles that are knots. I’ve long since worked out all my sore spots and am now working on loosening my muscles. This seems to be a tough battle. Some days they are looser than others and some days they are extremely tight. I’ve been doing this for about 2 weeks now, plus going to physical therapy. I’ve got a long weekend this weekend which will be the first in which I’m not massaging my arms. Hopefully, I’ll get a nice break there and continue to progress when I get back.

Keep up the good work!

Hi Justin,

not sure I’d be able to hear ‘crunchy’ spots in my muscles! I’m mainly focussing on keeping the larger muscles more supple and exercised coupled with work on the sore ‘attachment point’ ligaments of the extensors. Not sure whether massage of the attachment points can ever be the same after 15 years of destructive forces but you never know. I also have an old wrist sensitivity that is I believe unrelated to trigger points and more ‘carpal tunnel’ like in nature, and way more intermittent.


“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!”

Hi Alan, just a quick comment regarding the above. For trigger points that are difficult to massage try ischaemic (or ischemic) pressure. This is where you simply press down hard upon the trigger point and hold for a minute or more. There’s no massage or movement, just constant, direct pressure on the trigger point. I notice that Justin mentioned ischemic pressure in an earlier post on trigger points and I have come across it elsewhere. You locate the trigger point, and then press down upon it for 60 seconds minimum (preferably with a tool rather than fingers) and then relax. Repeat regularly.

My experience was that ischaemic pressure was not as helpful as massage but if you are having trouble getting to certain trigger points it might be the best option. I’m not sure if you have The Concise Book of Trigger Points by Niel-Asher but it’s discussed on page 50.

Hi Alan,

First of all, thanks so much for your work, it really helped me identify what is the problem that I am having even before my doctor has been able to, this is exactly the way that I feel.

I would really like to know at this point what has the triggerpoint therapy done for you? I am feeling really hopeless of any relief.

I can’t do much with my arms right now and get really tired and tight arms out of anything that involves wrist usage, sometimes my forearms get tight even while just using my fork and knife to eat.

Thinking of any update soon?

Thanks again,


Hi Jose,

I’m glad you find my site interesting, the more we educate people on how to avoid/ deal with RSI the better.
The trigger therapy has been a great tool for finding muscle knots in my arms, and relieving those knots. However, in the process, I now have some ulnar compression going on in the nerve of the right hand manifesting in numbness in the outside edge of the pinkie (which I don’t know whether is related to the trigger therapy or not.) and I have currently stopper trigger therapy to focus on the ulnar issue.
Does this put me off trigger therapy? No! On the contrary it is one of the best methods I have encountered in understanding my condition, and potentially fixing it (long term). You have to remember that I am a 15 year sufferer so my condition is quite likely a bad case, but what I have found with trigger therapy is that you can deactivate a lot of the larger trigger points(muscle knots), which leaves for me anyway smaller much deeper tissue that still generates referred pain, and these seem harder to access and to deactivate. Like I say, I have backed off from heavy massage due to the numbness. Also keep in mind that I have an internal wrist issue with the right hand wrist as well, so its not just all muscle knots for me. I will do an updated post soon on my status. Hope you condition improves.


An idea for a different kind of tool for trigger points: I’ve had difficulty massaging trigger points too, ones that felt obvious when using a rubber ball as a massage tool went away (or so i thought) and then i found them again when pressing deeply with my fingers, but quickly losing them or my hands would get sore/tired. I found the perfect tool for finding the hard to reach trigger points, the eraser pen! It’s a narrow tube of eraser inside a plastic pen that works like a clutch pencil. Somehow the rubbery point of the eraser and the ability to place more targeted pressure (without making your hands tired) gets deep into the muscle and works pretty well. I was able to find trigger points that i couldn’t even feel with my fingers, though I have no idea whether all eraser pens will be effective, mines got a diameter of 6-7mm and is strong enough it doesn’t recede back into the pen when i place pressure on it.

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