yogabook / functional exercises / pressure massage

If muscles have excessive tone, a pressure massage can be helpful in addition to stretching. In a few cases, it is simply difficult to stretch a muscle sufficiently to relieve the tension, e.g. in the case of tightness.For example, pars transversa and pars descendens of the trapezius. Pressure massage is then a simple way to reduce the uncomfortably high tension – if someone is present who is willing and able to perform it. Especially in the case of the trapezius, it is difficult to give yourself a pressure massage with the opposite hand of the side to be worked on without tensing up there. This is also difficult in the case of the supraspinatus and even more so in the case of the infraspinatus.

Basic procedure

To determine the tolerable intensity, this supporter must rely on the verbal feedback of the person being treated and their facial expressions. Above a certain intensity of approx. NRS 9, a grimace phenomenon would inevitably occur and breathing would lose its regularity, even if verbal feedback is deliberately suppressed. For the pressure massage, it is recommended to work at a small safety distance from NRS 9, i.e. only up to NRS 8 at most, as there is a risk that the person being treated will tense up elsewhere if the intensity is too high.

In order to find the optimum point – or if there are several very effective ones – a useful starting point for the treatment, the supporter may need to test several points from ventral to dorsal, start with gentle pressure at each point and, if necessary, slowly increase the pressure significantly with very small movements. Where no sensation of at least NRS 5 can be triggered, no sufficient effectiveness can be assumed for the time being. Once a starting point has been found and the pressure has been sufficiently intensified, this point should be held for longer than one minute if possible. It is not uncommon to observe a slow decrease in pain intensity over time with identical pressure.

It is not uncommon for the supporter to be unable to maintain the pressure for as long as the patient could tolerate, forcing the patient to use a different finger. In principle, the dorsal sides of the DIP can also be used for less resilient fingers, even if the sensitivity is largely lacking there.

Trapezius

The trapezius is a three-part allochthonous back muscle, which runs from large parts of the spine (beginning of the cervical spine down to Th12) on the outer upper edge of the shoulder blades and the clavicles and moves the shoulder blades: All parts are involved in external rotation and retraction of the shoulder blade, Pars descendens lifts the shoulder blade (elevation), Pars ascendens pulls it towards the pelvis.
The position on the back alone makes it difficult to perform a manual self-massage. It is easier to press the muscle on an object lying on the floor.

The upper two parts are particularly prone to tension, especially pars descendens, because many people tend to keep the shoulder blades raised. Another reason for increased tonus is overhead activities such as writing upside down on a blackboard.

If there is a nice person standing by who wants to do something good for you as a supporter to relieve you, the trapezius from above with the thumb roughly centred between the cervical spine and the base of the trapezius on the shoulder blade as described in the basic procedure.

If the tone is increased, the exercises listed in the FAQ can also be performed. If the tone is increased more frequently, it is also necessary to check whether the shoulder blades are kept raised (elevated) to some extent in everyday life. There can be various reasons for this, tension, anxiety and cold sensation are just three of them.

Supraspinatus

The supraspinatus is not a muscle that performs larger movements and is well trained in the process. It only performs the initial lateral abduction of the arm up to around 15°. It is therefore less well trained and also less resilient. The latter can easily lead to tension, which becomes noticeable in the pit above the spina scapulae. For orientation, the acromion as the most lateral part of the scapula can be localised on the one hand and, on the other, with a grip of ventral to dorsal flat over the shoulder the spina scapulae, which is usually located approximately under the fingertips. A little ventral of the spina scapulae and a little medial of the acromion, the supporter now begins to search for the point of best effectiveness.

The supraspinatus is a muscle that is worth looking after. As a rule, it is the first to be affected by an age-related degenerative rotator cuff lesion, partly due to the fact that its attachment tendon rests on the humeral head for the vast majority of its life and receives a poorer supply due to the – albeit moderate – pressure. Regular strength training should pay off here. The supraspinatus training strengthens it without increasing its tonus unpleasantly. In cases of excessive tone, it can reduce it.

Infraspinatus

The infraspinatus is the strongest exorotator of the shoulder joint. Most people are unlikely to use it much in everyday life, so it is not uncommon for it to be affected by a rotator cuff lesion with increasing age. Basically, the low level of use and the correspondingly low level of training can also lead to the muscle being quickly overstrained when it is used, or it contracts and takes on an uncomfortably increased tonus when the arm is placed in an exorcised position for a long time.

To locate the supraspinatus, it is helpful to locate the margo medialis (inner edge of the shoulder blade). This is easy to do if the shoulder blades are moved slightly forwards and backwards, i.e. in the direction of protraction and retraction. The next landmark to be found is the spina scapulae, which can be palpated as an easily palpable bony elevation in the upper third of the scapula. The infraspinatus now arises over a large area below the spina scapulae and lateral of the margo medialis up to the margo lateralis. If it is tense, there are usually several points where a pressure massage works well and provides relief over time.

In some cases, people have been given the recommendation to train the infraspinatus, which usually makes sense. On the one hand, this serves to prevent rotator cuff lesions at its insertion tendon; on the other hand, this muscle is usually underdeveloped compared to the strong endorotators of the shoulder joint, so that a muscular dysbalance occurs, which can also lead to disorders of the shoulder joint. During this training, however, care must be taken to ensure that the working area is not predominantly in a short sarcomere length, as this can lead to an unpleasant, often painful increase in tone.

Those who frequently practise asanas in which the arms are twisted out should not have an essential lack of strength in this muscle, but they are not immune to increased tonus. This can occur as a result of incorrect postures in which the arm is held in a widely exorotated position for a long time.

In addition to pressure massage, postures with widely endorotated arms such as maricyasana 1 and maricyasana 3 can also contribute to this, reduce the tonus of a tense infraspinatus.

Levator scapulae

Due to its course from the upper cervical spine to the upper margo medialis, the levator scapulae is the scapula especially elevator of the shoulder blade, but also has a retracting effect. All too often it comes under increased tonus due to the fact that the shoulder blades are held slightly raised in everyday life, see also the explanation of this in trapezius. A very good way to perform a pressure massage of the levator scapulae is to press the base of the garudasana. Due to the posture, the body is already under high tension, so the manual pressure also ensures an increased effect. With a suitable grip, the supporter can also hold the shoulder blade in full depression.

Trigger points?

This guide avoids the familiar terms trigger point massage and pressure point massage.

The concept of the trigger point is that small-volume muscle hardening in the millimetre range triggers pain, which may radiate to other parts of the body. The following causes are given: overloading, incorrect overloading, strains, muscle injuries, altered biomechanics. An arterial undersupply is also discussed, which is caused by the increased tension and the associated compression of small vessels. The trigger points are said to have localised pressure pain and palpability as hardening, optionally also pain radiation, the ability to cause muscle weakness or impaired coordination, even paraesthesia is under discussion. Trigger points in the neck area are said to be able to lead to nuchal headaches, those in the gluteal area to pseudo-radicular complaints.

The muscle hardening referred to as trigger points is said to exist in the smallest permanently contracted muscle areas, and various methods are cited as therapeutic intervention: Acupressure, injection of local anaesthetic, dry needling with acupuncture needles and shock waves. However, there are very few studies on trigger points. Neither could they be clearly determined (different sources provide different information on the location), nor is there any proof of efficacy for the injection of local anaesthetic. There is also no evidence for the existence of projected pain. However, the existence of locally significantly increased muscle tone has been confirmed using various imaging techniques. This means that at the moment it can only be said that trigger points are more of a descriptive concept than an entity with a clear aetiology.

Pressure point massage?

The term pressure point massage is even less clear. It usually refers to the pressing or massaging of points according to various systems, such as TCM or Shiatsu, or the trigger point massage mentioned above.

The above instructions deliberately make no reference to these terms, but merely offer an algorithm that serves to locate particularly painful areas or generally increased tonus in the musculature and alleviate it by means of pressure massage, without claiming any aetiology.