Trigger point self-care-shoulder joint edition-: You can treat the cause of pain "trigger point" by yourself!

Table of contents :
Introduction
Trigger point symptoms
① Referred pain
②Compression of blood vessels and nerves
③ Movement disorder
④ Impact on autonomic nerves
⑤ Psychiatric symptoms
The method of massage
Treatment of trigger points
1: Rhomboid muscle
2: Supraspinatus
3: Infraspinatus muscle
4: Subscapularis
5: Teres minor muscle
6, 7: Teres major muscle, latissimus dorsi muscle
8: Deltoid muscle
9: pectoralis major muscle
10: pectoralis minor muscle
In conclusion

Citation preview

Introduction Thank you for picking up this book. Do you all know the word trigger point? ? There are many cases where this trigger point is actually the cause of common pain and those for which the cause is not well understood. A trigger point is, so to speak, an induration of a muscle, which causes various symptoms depending on the site where the trigger point is created. Symptoms range from headache to low back pain, arthritis and other joint pains, dizziness, nausea and chest pain, posture collapse, muscle weakness and swelling. The troublesome point of the trigger point is that the symptom appears at a distance from the place where the trigger point occurred, which is called referred pain. This can cause indefinite complaints such as pain, numbness, and heaviness in a very wide area of what is created in one place. If you currently have some symptoms and there is no particular change even if you are prescribed medicine, it is possible that the trigger point is involved as a direct cause. Painkillers are, so to speak, symptomatic treatments, and the cause remains the same, but they only relieve the symptom of "pain." In this book, we will also touch on trigger points that can be the cause of various pains, actual treatments, and simple self-care methods that you can do yourself. I made it so that you can treat yourself while actually using your own body, so please read it.

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Table of contents Introduction Trigger point symptoms ① Referred pain ② Compression of blood vessels and nerves ③ Movement disorder ④ Impact on autonomic nerves ⑤ Psychiatric symptoms The method of massage Treatment of trigger points 1: Rhomboid muscle 2: Supraspinatus 3: Infraspinatus muscle 4: Subscapularis 5: Teres minor muscle 6, 7: Teres major muscle, latissimus dorsi muscle 8: Deltoid muscle 9: pectoralis major muscle 10: pectoralis minor muscle In conclusion

What is a trigger point? What is a trigger point in the first place? It is said to be "in the chordal induration that is touched on the muscle tissue, where you feel sharp pain when you press it. " A cord-like induration is a band of muscles that is stiff like a cable, and it means that there is a trigger point in the band of stiff muscles. For example, there is a quadriceps muscle on the front of the thigh. If you put your thumb on your thigh and slide it left and right while applying pressure, most people will feel that something that looks like a muscular band hits. This hard band is a cord-like induration, and the trigger point is inside it. Normally, muscle fibers are stretched with approximately equal tension in all parts. However, when a trigger point is formed, only the hardened part contracts extremely. As a result, the surrounding normal muscle fibers are overstretched. At areas where muscle fibers are extremely contracted, such as trigger points, blood flow is reduced, resulting in oxygen deficiency and accumulation of waste products, which promotes pain. If you compare it with a rubber band, it may be easier to understand if you imagine the part that is tied up and lumped as a trigger point. The actual muscle fibers are not tied up, but the lumps do not move much even if pulled, but the surrounding rubber stretches by that much. In the treatment of the trigger point, if you loosen the dense part of B in the figure AB below, the surrounding muscle fibers can also return to the uniform tension like A.

A ： Normal muscle fibers

B ： Muscle fibers with trigger points formed

Trigger points are often found in multiple places within the same muscle fiber, but among them, there is a trigger point that is the cause, and it is called a central trigger point. And what is formed in other places derived from the induration that was made at the beginning is called a satellite trigger point. If the central trigger point is treated properly, the satellite trigger point created from it will also have no cause, so it will improve and disappear over time. Conversely, if the satellite trigger point is treated and the root cause of the central trigger point is not eliminated, it will relapse over time.

Trigger point symptoms

① Referred pain Referred pain is a characteristic of trigger point symptoms. Referred pain symptoms are characterized by intense deep pain. Pain may occur depending on the movement. Speaking of the back and lower back, trigger points formed in the hip joints, abdomen, and legs can also cause lower back pain. For example, there are people who have surgery due to spinal canal stenosis and their symptoms do not change much, or their condition worsens secondarily due to invasiveness or decreased activity due to surgery. In that case, it may be a fascial cause such as a trigger point. Lower abdominal pain and sexual function pain can also be caused by trigger points in the thighs, lower abdomen, and inside the pelvis. In this case, the trigger point is thought to lead to pain in the internal organs such as the uterus, testicles, penis, prostate, and bladder. When a trigger point is created in the abdomen, it may cause symptoms such as abdominal pain, arrhythmia, nausea, loss of appetite, diarrhea, and chest pain. In this way, referred pain affects not only the place where the trigger point is formed but also the place far away, which causes unexpected symptoms.

② Compression of blood vessels and nerves When a trigger point is formed in the muscle, it presses on nearby nerves and blood vessels in some areas. The compressed nerves become brittle and affect the electrical signals that travel through the nerves, causing numbness, pain, burning and dysesthesia. In addition, when blood vessels are compressed, blood flow is obstructed and the area below the compressed area becomes cold. If a trigger point is created on the calf, it may cause swelling or coldness on the toes and ankles.

③ Movement disorder 　 The trigger point deprives the muscles of elasticity by making the muscle fibers short and stiff. Therefore, the range of movement is narrowed. In addition, the trigger point is a state in which the muscles are constantly contracted, which makes it easier for you to get tired and reduces your resilience. Decreasing muscle contraction also makes it difficult to apply force, which causes muscle weakness and affects the sense of balance. Muscles have receptors in the muscle fibers that regulate the length of the muscle, called the muscle spindle. This is because when the muscles are contracted, they do not work as much as when the muscles are not contracted, and the sensations of the skin and joints become dull. I think it's easier to understand if you put a small object such as a grain of rice on your palm and compare it in a relaxed state. If you grab it hard, you probably lose the feeling of having a grain of rice. On the other hand, if you roll your palm in a relaxed state, you will feel that even a grain of rice is on your hand.

④ Impact on autonomic nerves It is known that depending on the site where the trigger point is formed, it may affect seemingly unrelated areas such as red eye, excessive saliva and tear secretion, runny nose and arrhythmia. For example, when a trigger point is formed in the sternocleidomastoid muscle in the neck, dizziness, nausea, and impaired balance are said to occur as one of the symptoms.

⑤　Psychiatric symptoms 　 　 If chronic pain continues for many years, I think that many people will suffer mentally. There are cases in which depression continues due to persistent pain of unknown cause. The formation of trigger points increases muscle tension, making it harder for you to get rid of fatigue and making it easier for you to experience symptoms such as chronic fatigue and lack of sleep.

The method of massage It is important to know how to massage to improve the trigger point. Regarding the force to be applied at this time, as a guide, keep it strong enough to cause pleasant pain. If the pushing force is too weak, sufficient stimulation will not reach the muscles, and the therapeutic effect will be reduced. If the pushing force is too strong, the pain will cause defensive muscle contraction, which will put unnecessary strain on the body. Therefore, when applying force, try to limit the pain to a pleasant pain, or about 7 in 10 steps (0 is no pain, 10 is unbearable pain). If you press it too short, the effect will be small, and if you press it longer than 1 minute, the effect will not change, or a new trigger point may be generated. To the extent that pleasant pain comes out, let's a guideline about 30 seconds to 1 minute less than. When you press it, you will inevitably get tired if you press it with your fingers, so it is safer to use tools such as tennis balls and sticks because it will not burden your fingers. If you do it without tools, you may get tired or hurt if you do it with your thumb or other four fingers. Therefore, it is a good idea to use both hands to reduce the strain on your fingers, or use bones such as your knuckles and elbows to push. The elbow cannot be used for the shoulder approach introduced here, but it is an excellent tool for self-care for the thighs and for massaging others. (In the treatment of the trigger point, I put a photo, but at that time I push it with one hand for the sake of visibility, but in reality I use both hands or tools)

Treatment of trigger points From here, let's actually touch on the treatment scene of the trigger point. This time, we are picking up the areas where the shoulder joint is being treated and where pain is likely to occur. Trigger point of the shoulder joint Rhomboid muscle Supraspinatus Infraspinatus Subscapularis Teres minor muscle Teres major muscle, latissimus dorsi Deltoid muscle Pectoralis major muscle Pectoralis minor muscle

1: Rhomboid muscle There are rhomboid major and rhomboid minor muscles, which start from the 6th to 7th cervical vertebrae and the 1st to 4th thoracic vertebrae (the spine where the ribs are attached) and are attached to the inside of the scapula. Its role is scapula adduction, elevation, and scapula stability. If the spine is the trunk of a tree, the scapula and humerus are like branches of a tree. The scapula is integrated with the trunk, but the structure is such that the scapula hangs from the spine. Therefore, the muscles above the scapula (trapezius muscle, levator scapula muscle, rhomboid muscle, etc.) tend to be a burden for humans who are in a bipedal posture. When the rhomboid muscles are weakened, the movement of pulling the scapula is weakened. Speaking of sports, the movement of opening the chest and pulling the arm like a volleyball block makes it impossible to stabilize the shoulder blades, and the performance of the movement deteriorates. In addition to the rhomboid muscles, by strengthening and loosening the muscles above the scapula, the posture and stability around the shoulders can be improved, and stiff shoulders can also be improved. The rhomboid trigger point causes pain inside the scapula. Repeated movements such as pulling the rope and pulling the arm back will overuse the rhomboid muscles and increase the burden. Also, when the chest and abdominal muscles become stiff and the back becomes rounded, the inside of the shoulder blades is overstretched. Attempting to correct that stretched posture also causes the rhomboid muscles to become tired. For self-care, place a ball with moderate hardness, such as a tennis ball, on the floor over the inside of the scapula. Lie on your back on the tennis ball and apply pressure. The floor has a high repulsive force, so if you are prone to pain, you can do

it in a place with a soft floor such as a futon or mattress to reduce the burden.

This is an image of the rhomboid muscle on the right side seen from the back. There is a slight cut, the thin one at the top is the rhomboid minor muscle, and the wide one at the bottom is the rhomboid major muscle.

The area of the rhomboid muscle trigger point and referred pain. Red is the area of referred pain.

This is an image of pressing the trigger point of the rhomboid muscle. 　　　　　　　　　　　　　　　

2: Supraspinatus The supraspinatus muscle begins in the Supraspinous fossa of the scapula and attaches to the Greater tubercle. In shoulder-related problems, the muscles are often complained of pain. The role is abduction and external rotation of the shoulder joint. The rotator cuff of the shoulder (supraspinatus, infraspinatus, subscapularis, teres minor) is also a muscle that has the function of maintaining the stability of the shoulder, which is originally an unstable structure. These muscles attach to the anterior and posterior deep layers of the scapula and wrap around the head of the humerus. Each one is not a big muscle, but it has an important role to support the movement of the shoulder. The trigger point of the supraspinatus muscle extends to the outside of the shoulder and sometimes extends to the forearm and wrist. It is the deepest muscle in the joint that connects the scapula and the humerus (the bone of the upper arm), and the supraspinatus muscle is the most vulnerable part. When a trigger point is formed on the supraspinatus muscle, there are restrictions on the movement of raising the hand such as washing and combing the hair. For self-care, place a ball or finger between the Spine of scapula and the Superior angle. To see the muscles, open your arms slightly to the side and you'll see the muscles contracting on the Spine of scapula. The supraspinatus muscle runs over the Spine of scapula, but there are two places where trigger points are likely to form. One is just below the Superior angle of the scapula, and the other is the raised area in front of the acromion. You can loosen them directly with your own hands, but they can easily get tired, so it's a good idea to put a massage device or tennis ball on the floor and lie down to loosen them, or have someone else push them for you. Training is also important. If the load is strong, it will work on the outer muscle that is shallower than the rotator cuff, so it is recommended to exercise with a low load using a rubber tube or the like. You can train the supraspinatus muscle by holding the rubber tube in your hand and performing a side raise (shoulder abduction). Once you get used to it, gradually increase the load, such as a light

dumbbell.

This is an image of the supraspinatus muscle on the right side seen from the left posterior surface. You can see it passing under the clavicle through the Supraspinous fossa of the scapula.

This is an image of the supraspinatus muscle on the right side seen from directly above. It passes through the arch of the acromioclavicular joint and attaches to the Greater tubercle.

The area of supraspinatus trigger point and referred pain. Referred pain also appears around the elbow joint.

It looks like you are pushing the trigger point at the base of the scapula, below the Superior angle of the scapula.

This is an image of tracing the Spine of scapula outward and pressing the trigger point in the depression in front of the acromion.

3: Infraspinatus muscle The muscle that begins in the Infraspinous fossa of the scapula and attaches to the Greater tubercle, covering most of the scapula. Its role is external rotation, extension, and adduction of the shoulder joint. Rotator cuff is a muscle that is also involved in shoulder stability. External rotation of the shoulders is like putting your elbows on your body and opening your palms outward. External rotation is used for movements such as holding an object and moving it sideways or reaching over the head. Other activities of daily living include washing hair and changing clothes. Since it is involved in shoulder stability as a rotator cuff, it is easy to hurt even in sports movements such as pitching movements, volleyball spikes, badminton smashes, etc. Pain caused by the trigger point of the infraspinatus muscle may cause referred pain on the anterior side of the shoulder, upper arm, forearm, and thumb side of the hand. If the infraspinatus muscle causes pain in the forearm, satellite trigger points may be formed in the forearm, creating a new cause of pain. The trigger point is likely to form between the Spine of scapula and the inferior scapular angle, and near it. There are places where you can feel pain when you press it. These can also be easily loosened by placing or sandwiching a massage device or tennis ball on the floor or wall and pressing it with your body. To train the infraspinatus muscle, the rotator cuff is common, but training using a rubber tube is recommended first. There is a method of external rotation of the shoulder using a tube (put the elbow on the body and open the hand outward. The tube should be wound at the same height as the elbow on the opposite side of the moving hand and pulled). You can train the infraspinatus muscle by external rotation of the shoulders with dumbbells (the side to be trained is in the lateral decubitus position with the hand on the training side up, and the hand is opened outward with the elbow on the body).

This is an image of the infraspinatus muscle on the right side seen from the back.

This is the trigger point for the infraspinatus muscle.

This is an image of pressing the trigger point of the infraspinatus muscle.

4: Subscapularis It is a muscle that starts from the subscapular fossa, which is the front of the scapula, and attaches to the Lesser tubercle. Since it is directly behind the above infraspinatus muscle, it is in a place that is difficult to touch. Its role is to stabilize the shoulder as an internal rotation of the shoulder joint and as a rotator cuff. In terms of the rotator cuff, it is in a state that wraps the Head of humerus from the front. Internal rotation of the shoulder is like putting your hand inside from a posture with your elbow on your body. In everyday life, changing clothes like putting your hands behind your hips, and in sports, pitching, punching, and swinging your racket are likely to be affected. By strengthening the rotator cuff, including the subscapularis muscle, it is less likely to injure the shoulder, and the stability of the shoulder will increase, making it easier to move the arm, which will also help improve sports performance. When a trigger point is formed in the subscapularis muscle, intense pain appears behind the shoulder. Referred pain may also appear on the back of the wrist, upper arm, and front of the shoulder. In terms of activities of daily living, as with all rotator cuffs, the movement of the arm is generally impaired because the stability of the shoulder is reduced, including the above-mentioned movement of changing clothes. Trigger points are likely to form near the outer edge of the scapula and can be touched with your fingers. It's just around the armpit. For self-care, place the treating hand on the opposite shoulder and use the other hand to insert your finger between the scapula and the ribs. Another method is to hang the treating side's hand on the floor from the sitting position on the chair, and insert the finger between the shoulder blades and ribs with the other hand. It's easy to mistake it for the latissimus dorsi, which will be described later, so let's imagine sliding your finger between the shoulder blades and ribs. When training the subscapularis muscle, there is an internal rotation of the shoulder using a rubber tube (the elbow is attached to the body and the arm is

opened inward. The rubber is wrapped on the opposite side to resist). You can train by exercises such as external rotation of the shoulders using dumbbells (sleeping sideways with the training side's hand down and lifting the hand inward).

This is an image of the right subscapularis muscle seen from the front. Due to the anterior thorax, it is structurally difficult to touch the entire subscapularis muscle.

The area of the subscapularis trigger point.Referred pain occurs on the front and back of the shoulder joint, on the upper arm and wrist.

It is a state that is touching the trigger point of the subscapularis.

This is an image of touching the trigger point of the subscapularis muscle. If you touch it yourself, you can insert your finger from the front of the scapula.

5: Teres minor muscle The teres minor muscle is the muscle that begins at the lateral edge of the scapula and attaches to the Greater tubercle. Like the infraspinatus muscle, it acts on the abduction, extension, and horizontal abduction of the shoulder joint, and is also involved in shoulder stability as a rotator cuff. Since it acts on the external rotation of the shoulder like the infraspinatus muscle, it is also used for movements such as raising the hand above the head, pitching movements, and swinging arms such as volleyball blocks. It also stabilizes the shoulders, helping to prevent injuries and stabilize hand movements. The trigger point of the teres minor muscle may cause pain in the back of the shoulder and referred pain such as numbness and aching in the ring finger and little finger. Trigger points are likely to form in the upper part of the outer edge of the scapula, around the posterior surface of the axilla. The muscles are on the outside of the infraspinatus muscle, so place the ball on the wall or floor and push the ball with your body. Training the teres minor muscle is similar to training with the infraspinatus muscle. Other examples include horizontal abduction of the shoulders with dumbbells (tilting the body forward and reaching back with the shoulders 90 ° open). In each case, you can train other muscles such as the deltoid muscle and the pectoralis major muscle in addition to the teres minor muscle.

This is an image of the teres minor muscle on the right side seen from the back.

Teres minor muscle trigger point and referred pain area.

This is an image that touches the trigger point of the teres minor muscle.

6, 7: Teres major muscle, latissimus dorsi muscle The teres major muscle is the muscle that begins at the inferior angle of the scapula and attaches to the Lesser tubercle of the humerus (from the medial to the anterior surface of the humerus). The latissimus dorsi is a large muscle that starts from the lower thoracic spine / lumbar spine (about the lower half of the back), the iliac crest (upper edge of the pelvis), the lower ribs and the Inferior angle of scapula, and is attached to the Lesser tubercle. The roles are extension, adduction, and internal rotation of the shoulder joint. The teres major and teres minor muscles work in the same way, and in daily life, you can do things like pulling things by wiping the floor or moving luggage, or pulling your arms back. In sports, pulling power is very important for martial arts such as racket swings, punches, and grappling. In particular, the latissimus dorsi is a large muscle that is attached from the lower part of the shoulder blade toward the pelvis upper part, has also been implicated in attitude not only the movement of the arm for that is attached to the waist. In addition, large muscles can increase metabolism by training, which also has the effect of tightening the body. If there is a trigger point in the teres major muscle, pain will run on the back of the shoulder when the arm is extended upward. In addition, if there is a trigger point on the latissimus dorsi muscle, referred pain may occur from the Inferior angle of the scapula to the vicinity of the back, the flank, the inside of the arm to the ring finger, and the little finger side. It is a muscle that is easily abused on a daily basis because it works particularly strongly when pulling down the arm. Trigger points are likely to form from the lower corner of the scapula to the outer edge, so you can loosen the two muscles together by pinching the thick part on the outside of the scapula with your hands. Or you can release the muscles efficiently by pushing the ball with the wall or floor.

When training these muscles, pull-ups are a way to do it by your own weight. Open a little wider than your shoulder width, hang it on a horizontal bar, and pull it up to tighten your sides. As a guide, the chin should touch the horizontal bar. If the load is heavy, you can use a horizontal bar that is high enough for your feet to touch the ground. Another is shoulder extension exercises with dumbbells. Hold the dumbbell in one hand and hang it toward the floor. Place the other limb on a bench or other platform to stabilize it. You can train the latissimus dorsi and teres major muscles, which are the extensor muscles of the shoulders, by pulling up the hand holding the dumbbell to the flank while keeping the consciousness of pulling the scapula back.

This is an image of the teres major muscle on the right side seen from the back. Similar to the teres minor muscle, but the teres major muscle has a humerus attachment to the Lesser tubercle, so the action on the arm differs between external and internal rotation.

This is an image of the latissimus dorsi on the right side seen from the back. Large muscles attached to the inferior angle, thoracic spine, lumbar spine and iliac crest (upper edge of the pelvis).

Teres major muscle trigger point and referred pain area.

The area of the latissimus dorsi trigger point and referred pain.

This is an image of pressing the trigger points of the teres major muscle and latissimus dorsi muscle. Since both muscles have the same attachment part, they can be released together by massaging the armpit area.

8: Deltoid muscle The deltoid muscle begins at the clavicle, Spine of scapula, and acromion, and attaches to the Deltoid tuberosity of the humerus deltoid muscle (outside the humerus), and attaches to the shoulder joint from the outside. Since it covers the shoulders, it can move in each direction such as flexion, extension, and abduction of the shoulders. Since each has a different role, the deltoid muscles are divided into anterior, middle, and posterior fibers. The role of the anterior fiber is shoulder flexion, horizontal adduction, and internal rotation. The role in the middle fibers is shoulder abduction. The role of the posterior fibers is shoulder extension, shoulder horizontal abduction, and shoulder abduction. The deltoid muscle is a large muscle at the base of the shoulder. It is an important muscle for strengthening the arm because it is a muscle related to almost all movement directions of the shoulder joint. Combined with the rotator cuff of the shoulder, training can also reduce shoulder injuries. Since it is the largest muscle in the arm, it also has the effect of increasing basal metabolism. When training, if you are doing your own weight, doing push-ups (with your arms closed) or back extension on the floor with your arms raised will put a load on your deltoid muscles. Use dumbbells for upright row (pull the dumbbells right in front of your chest), side raises (open your arms sideways with your elbows extended), front raises (raise your arms forward with your elbows extended), etc. Others include rear raises (tilting your upper body slightly forward and opening your arms back with your elbows extended) and shoulder press (lifting dumbbells overhead). The trigger points that can be formed on the deltoid muscles are mainly satellite trigger points, and the main causes are the scalene muscles, rotator cuffs, and pectoralis major muscles, which are easily formed. The trigger point is between the acromion and the Deltoid tuberosity (just where the muscles are raised).

It can form anywhere from the base of the shoulder to the Deltoid tuberosity of the deltoid muscle. If you do self-care, you will get tired even if you do it with your fingers, so it is a good idea to use the ball and wall to push the deltoid muscles and apply pressure.

This is an image of the deltoid muscle on the right side viewed from the right side. You can see that the muscle fibers are slightly different in the anterior, middle and posterior fibers.

The area of deltoid trigger points.

This is an image of pressing the trigger point at the front of the deltoid muscle.

This is an image of pressing the trigger point at the rear of the deltoid muscle.

This is an image of pressing the trigger point in the middle of the deltoid muscle.

9: pectoralis major muscle The pectoralis major is the muscle that begins at the clavicle, sternum, costal cartilage, and rectus abdominis sheath and attaches to the Greater tubercle. The role is flexion, adduction, and internal rotation of the shoulder joint. It will be a big muscle that wraps the entire chest. Since the running of muscle fibers differs depending on where they start, they are divided into the upper part (clavicle), the middle part (sternum), and the lower part (ribs). Trigger points on the pectoralis major cause referred pain in the front of the chest and shoulders, the inside of the arms and elbows, the ring finger, and the little finger. The trigger point of the pectoralis major is also known to cause symptoms of arrhythmia and chest pain. In addition, if the pectoralis major muscles contract excessively, the body will curl up to the front and naturally become a stoop posture. If this happens, it may cause respiratory distress, chronic fatigue, headache, neck pain, etc. due to decreased mobility of the chest. The pectoralis major is the muscle attached to the so-called chest plate. By training, you can expect a strong body for men and a bust-up effect for women. As with leg muscles, basal metabolism rises by training large muscles, so it is also effective for dieting. Also, since it is a part related to most of the movement of the arm, if you have a situation where you also do hard work, you can improve the efficiency at the time of work by training. When training, you can train efficiently because it has the effect of closing your shoulders inward (horizontal adduction or adduction) by doing push-ups as self-weight training. The trigger point depends on each part. When massaging, it is easier to use a ball and a wall or floor to loosen the entire chest, as it does not put a strain on your hands, but you can also use your fingers to loosen it. If you do it with your fingers, you can do it without burden by putting your hand on the finger to press.

This is an image of the pectoralis major muscle on the right side viewed from the front. When all the upper, middle and lower fibers are combined, it is large enough to cover the chest.

The upper fiber (clavicle) of the pectoralis major muscle.

The middle fiber of the pectoralis major (sternum).

The lower fibers (ribs) of the pectoralis major.

The middle part (sternum) causes pain around the chest and elbows. These form trigger points slightly outside the sternum and around the center of the chest.

The lower part (ribs) is responsible for pain in the nipple and breast, which forms a trigger point around the anterior edge of the chest.

Trigger points below the pectoralis major and referred pain areas.

10: pectoralis minor muscle The pectoralis minor is completely hidden under the pectoralis major and is the muscle that starts at the 3-5 ribs and attaches to the coracoid process of the scapula (around the depression in front of the shoulder joint). Its role is to pull down the scapula to fix it, to tilt the scapula forward (abduction), and to exhale strongly. People who are leaning forward often have stiff pectoralis major and pectoralis minor muscles. This is because the scapula is pulled forward from the coracoid process, which is the stop. For those who are facing the computer for a long time at desk work, the posture in which the shoulder blades are pulled forward continues, so the large and small pectoralis minor muscles must remain in a contracted posture, which creates a stoop. When the trigger point is formed, it causes referred pain in the front of the shoulder, the entire chest, the inside of the arm and elbow, and the ring finger and little finger. When this muscle becomes tense, it can sometimes compress the arteries and nerves that pass through the axilla, causing symptoms such as peripheral neuropathy of the hand. The trigger point is below the coracoid process and slightly above the nipple, so when using self-care, use a ball or finger to loosen it, just like the pectoralis major muscle. When stretching, hold your hand on the wall while facing sideways against the wall, reach the wall, and tilt your body forward. It is a posture that greatly deflects the arm to the back. If you feel your chest stretch on the side that hits the wall, it's proof that you're stretching. Stretching in this position stretches the pectoralis minor and pectoralis major muscles.

This is an image of the pectoralis minor muscle on the right side viewed from the front. It is difficult to touch directly because it is deep in the pectoralis major, but you can feel it under the pectoralis major.

The area of pectoralis minor trigger points and referred pain.

In conclusion Trigger points are like hard particles in muscles, but their effects on the body are greater than you might imagine, and they not only stiffen joint movements, but also cause muscle weakness. In addition, it can cause various symptoms such as pain, numbness, headache, dizziness, and chest pain depending on the site where the trigger point is formed. In fact, in clinical situations, not only pain in each joint and limited range of motion, but also symptoms such as eyestrain, headache, dizziness, and back pain in the lower back have improved. Trigger points and acupuncture points in oriental medicine are often related, and the meridians and fascia connections are very similar. In that sense, referred pain and trigger points may have been known for a long time. And it is quite possible that the cause of pain that has become chronic and the cause is unknown is the trigger point. If you are interested, please try the trigger point once.