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How can I reduce knots in my shoulders (trapezius muscles)?

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From a reader:

How can I reduce knots in my shoulders (trapezius muscles)? I work at a computer most of the day, and have tight knots in my shoulders; specifically, in my trapezius muscles. How can I reduce the tension in these muscles, without having someone else massage them? Are there self-massage techniques I can use? What are appropriate stretches?

Trazpezius

My answer:

EVERYBODY gets tension (and sometimes, pain) in the neck and shoulders as well as in between the shoulder blades. This has, of course, increased in these times when we’re all looking down and hunching up at our phones and laptops. Here’s how to get rid of it. Based on the reader’s questions, I’ve broken up my answer into 3 sections below.

 

How do I reduce tension in these muscles?

This is the most important question. You could have the best therapist to resolve the tension for a time, but if you continue to do the actions that result in the tension and pain, they will just keep coming back and probably keep getting worse.

The most common problem that exacerbates tension and pain in the neck and shoulders is holding the neck in an unnatural position. The two most common are looking down for extended periods and craning the neck and head forward (most probably to focus on miniscule print on a device such as a smartphone or laptop). The answer is to figure out how to keep the head as upright and without rotation as possible, while you relax your shoulders and arms at your sides.

The trapezius itself is, ironically, not the most common cause of neck/shoulder pain in the curve of the shoulder (the levator scapula is). However, TrP1 (Trigger Point 1) at the curve of the neck/shoulder is one of the myofascial TrPs observed the most often [1]:

Trigger Point 1

There are about seven common trigger points located in the upper, middle and lower portions of the trapezius muscle:

Trigger points located in the trapezius muscle

Point 7 (x) produces pilomtor activity or “gooseflesh” to the upper extremity [2]

Trapezius trigger point 7

“In study of static loading, Bearns (1961) discovered that the upper fibers of trapezius, contrary to universal teaching, ‘play no active part in the support of the shoulder girdle in the relaxed upright posture.” [3]

 

Are there self-massage techniques I can use?

ABSOLUTELY.

FIRST, you must have been assured by a proper diagnostician (MD/DO) that there are no problems (such as a herniated disc, bone spurs, etc.) that will constantly madden the nerves that feed the musculature of the neck and shoulder. If there is such an inflammatory component, anything I write here will be transitory because the true cause has not been addressed. My suggestions below can temporarily interrupt the pain signal, which has benefit, but ALL pieces of the problem must be addressed to have lasting comfort.

First, it is very helpful to heat the area first. This will dilate blood and lymph vessels, bringing an influx of fresh blood into the area. It will also soften the connective tissue (fascia) that surrounds and binds the muscle fibers and heads, which will make the whole area more amenable to stretching. This step also prepares the tissue for massage (flushing) of the inflammatory chemicals that are making it hurt.

You can use a couple Swedish massage techniques to soften and relax the tissue. These are friction (rubbing along the fiber) and kneading (like with bread dough). For more information, see my blog entry What is the difference between kneading, rolling, percussion, and vibration?

For trigger point deactivation, you can use point-compression with fingertip(s) or a pressure tool (such as a backnobber or theracane):

Using a backnobber

You can also use a tennis or pinky ball against a wall, but they are notoriously difficult to use on the curve of the shoulder. I’ve found the backnobber to be the most useful. It’s only $30, and the product and subsequent comfort can last the rest of your life (no affiliation, just a big, big fan of one of the coolest designs EVER!) [4]

Here’s what you do:

  1. Find the trigger point (any “x” in the above diagrams) that produces the pain pattern that you have, or alternately find a knot in a band of muscle in the curve of the neck/shoulder.

  2. Heat first!

  3. Apply pressure with a fingertip or tool, just enough to “feel it,” and HOLD for 15-60 seconds, until it feels like it is “dissolving/softening,” or until it feels “done.”

  4. Apply the same technique to adjacent and associated trigger points

  5. At this point, you MUST take the muscles released through their normal resting range of motion!

 

What are appropriate stretches?

This is a tricky one for the neck and shoulder, which have an astonishing array of motion capabilities.

PLEASE NOTE: The exercises below will NOT help and will probably be painful and/or harmful if the tissue is not softened first. Before doing any of the below stretches, follow steps 1 and 2 above. Take it slow and EASY, and remember to breathe. Do NOT make it hurt, just stop at the first point of stretch and relax into it.

Stretches that are most helpful for neck/shoulder pain are as follows:

Stretches helpful for neck and shoulder pain (points 4-7)

(points 4-7)

Stretches helpful for neck and shoulder pain (points 5-7)

(points 5-7)

Stretches helpful for neck and shoulder pain

If you follow the steps above, you should get immediate, long-lasting relief from neck/shoulder pain from computer use. If you do not, it’s time to see a pain-management doctor. Don’t wait. The longer these muscles go on in an inflamed, irritated, shortened state, the longer it takes to deactivate and rehabilitate them.

Ultimately, the triggers must be eliminated, the tissue must be softened/relaxed/deactivated, and then it must be strengthened within its current capability.

[1] Myofascial Pain and Dysfunction; the Trigger Point Manual, Travell and Simons, pg.184

[2] Ibid., pg.186

[3] Muscles Alive; Their Functions Revealed by Electromyography, John V. Basmajian, Carlo J. DeLuca, pg.266

[4] The Pressure Positive Company

What should I do to relieve a nerve pain above my fingers?

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Finger pain

My answer here is based on the following question: (paraphrased) “I work on a computer keyboard quite a lot. When doing so for a long time, I get pain in the circled area (above). If I take a rest of around 2 days, the pain goes away. However, I have to work at the keyboard, and taking breaks of that length is not an option. Are there any exercises, medicines or foods that can help me with this?”

First of all, you MUST get a physical exam from a physician to receive the best advice. Another thing to address is whether or not you might be holding your hand in slight extension/elevation above your keyboard when you type, like this:

Conventional keyboard trays can increase injury risks

This position puts undue strain on the Extensor Carpi Radialis Brevis muscle (which extends the hand at the wrist), and can produce a pain pattern as follows:

The extensor carpi radialis brevis muscle

You might examine your keyboard and hand positions during typing and bring them both back to neutral (straight).

Another thing you might try involves the following steps:

  1. Heat the forearm (particularly the muscles, around where the “x” is above),

  2. Compress the muscle knot (trigger point) around the x until it feels dissolved,

  3. Then massage and lightly stretch the muscle, like this:

Massaging the arm

(image: Page on Easyvigor)

Be sure not to stretch so hard that it produces pain; this could further irritate the muscle and tendon.

What is the difference between kneading, rolling, percussion, and vibration?

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All the different useful procedures of massage can be classified under eight main categories.

Passive Touch is passive (still). It consists of lightly touching the body with one or more fingers, the whole hand or both hands. This technique is used in Swedish massage, Myofascial Release and Craniosacral therapy, to name a few. Physiological effects include elevation of temperature via heat from the hand, and sensory influence on the cutaneous nerves, often associated with comfort.

Simple touch can be remarkably effective in relieving hypersensitivities, especially in the head and joints. Nervous irritability can be quieted sometimes by simple touch of the hand on the head.

Compression consists of making light or heavy pressure with the whole hand or one or more fingers. This is used in manual deactivation of a myofascial trigger point or to temporarily numb an irritated nerve such as in trigeminal neuralgia or sciatica. When administered correctly, the effect of compression is to diminish swelling and circulatory congestion, and to slightly numb the nerves pressed upon.

Stroking is simply light touch combined with motion. The tips of two to five fingers or the entire palmar surface of one or both hands are moved slowly and gently over the skin with minimal contact at a rate of 1-2 inches per second in the direction of arterial (heart-outward) flow only.

There are many different techniques and reasons for stroking, both direct and reflex. The main effect of stroking is a decided sedative effect. However, very light stroking may produce a very powerful reflex effect, like a tickle or stimulant to spinal nerve roots. This can be very useful to alleviate sleeplessness or hypersensitivity such as a nervous headache (very useful with upset babies and children). Neuralgic pain and numbness may also be somewhat abated with this technique. It can be used abdominally to reflexively stimulate digestion: think of how you gently rub your stomach when you have overeaten or have indigestion.

Friction is where the whole or part of the hand is moved steadily over the surface of the skin following venous flow (toward the heart) with a varying but significant degree of pressure according to the “thickness” of the area being worked on. There are many different techniques for friction depending on the influence you want on the tissue. As a rule, some lubricant such as oil, lotion or powder should be utilized to avoid overstimulation, abrasion and irritation of the skin.

The principal objective of friction is to encourage better circulation, thus emptying the veins and lymphatic spaces and channels of waste matter and painful chemicals. It is probably the most valuable of the various massage procedures.

Swedish massage, Cross-Fiber massage and Active Release Technique use deep friction to break up scar tissue in different structures such as skin, muscle, tendon or ligament. Manual Lymphatic Drainage uses very light friction to clear swelling and congestion from joints and lymphatic outlets.

Friction and kneading are probably the most widely used massage techniques worldwide.

Kneading is probably the best known massage procedure, as familiar as kneading dough. It essentially consists of alternating and intermittent compression and squeezing of the tissue, either by grasping it or compressing it against underlying bony surfaces. Kneading differs from friction in that the skin is held in firm contact with the surface of the hand.

Kneading techniques can either be superficial or deep, and can be further delineated by specific techniques. These include superficial/deep kneading (like a baker kneads dough), skin rolling, wringing, and palm/fist/finger kneading, to name a few. Swedish massage and Deep Tissue Massage utilize these heavily. The main goal of kneading is to stimulate all the vital activities of the body part being worked on, including the nerves, blood vessels, glands and cellular exchanges of the tissue. Deep kneading assists muscles to increase in size and function through better circulatory exchange, and assists in the removal of painful chemicals and connective tissue adhesion. Superficial kneading is especially indicated for swelling and any other condition where the skin and superficial circulatory channels need to be more active.

Vibration consists of fine vibratory or shaking movements from the therapist’s hands to the area worked on. This can be subdivided into lateral, knuckle, superficial, deep, shaking and digital vibration, depending on how the therapist uses his or her hands to address the patient’s needs.

Vibration primarily stimulates. It can cause muscle contraction, a pleasant tingling sensation due to stimulation of sensory nerves, and increased blood flow and subsequent temperature rise of the region. It is valuable in cases of paralysis, neuralgia or neurological weakness or fatigue, where stimulation of the area’s function is needed. I have found it to be especially helpful in cases where the patient is unable to relax a muscle or has trouble with neurologic dysfunction and spasm (such as with Cerebral Palsy).

Percussion consists of blows to the tissue using the hands or fingers with varying degrees of technique and force. The movement is always elastic and from the wrist, which penetrates deeply without bruising superficial structures. As a rule, the hand should strike the body transversely across the muscle’s fibers. Different techniques include tapping strike w/ finger’s ends, spatting (strike w/ fingertips), clapping (strike w/ whole palm), hacking (strike w/ pinky side of hand) and beating (strike with palmar side of a closed fist).

Percussion is a powerful stimulant for both the skin and underlying structures. A short, light application produces a momentary spasm, and thus blanching, of the superficial vessels. Strong percussion dilates the vessels a great deal, as evidenced by the reddening which follows. If very strong, percussion can produce nerve paralysis, as any martial artist knows. Other effects include stimulation of the organs through reflex centers and the spinal cord, and assisting with dislodging mucus congestion in the lungs.

Joint Movement obviously consists of the therapist moving the patient’s joint through a range of motion. This can be combined with other techniques such as deep friction (as in Active Release technique) or touch (as in Myofascial Release and Unwinding). It may be either passive (no effort from the patient) or resistive (as in Proprioceptive Neuromuscular Facilitation, Lewit technique, etc.). Joint Movement strongly affects fluid flow through both the joint and the joint’s connective and adjacent structures. It is useful in cases where there is stiffness, pain, swelling and hyperstimulation. Think of how you shake your hand when it feels tired or stiff.

All this being said, reading this or any other blog does not make one a massage therapist. If you want to truly learn these techniques, whether to give a better backrub or to become a licensed therapist, check out good schools nearby and take an appropriate class.  The internet and certifying massage school associations, such as AMTA (American Massage Therapy Association), can help with this. The skills gained will benefit you and your loved ones throughout your lives.

There are many wonderful books about massage, but my favorite one on basic technique is “Art of Massage” (John Harvey Kellogg, MD, reprint 1975 by Health Research, CA), which was our main textbook in 1988. Most of the information on our Medical Board exam for licensure was taken from this text.