What's the Point? :
Massage Therapy for Treatment of Muscle Release Points

Illustration adapted from page 18 in "The Basic Principles of Equine Massage/Muscle Therapy" by Mike Scott, illustration by Shawn Scott

By Mike Scott and Joyce Falese

Most people have heard the term "points" with regard to massage therapy for their horses or for themselves. There are stress points, trigger points, acupoints, and more - and each deserves a little explanation. Interestingly, many stress points, trigger points, and acupressure points seem to correlate in both physical location and in the effects of their treatment. Here are brief explanations of each.

Stress Point Therapy

One of the most uncomplicated and easy to apply systems used in massage therapy is stress point therapy. This technique was developed many years ago by Jack Meagher. A stress point is the result of a small knot or adhesion of muscle tissue which may cause discomfort and limit the full range of motion. The major intent of stress point therapy, which is the application of pressure to a stress point, is to prevent injury (by reducing muscular tightness which in turn overstresses joints), to promote healing, and to restore free range of motion. Although this system seems straightforward, a person employing this technique needs a thorough knowledge of anatomy to insure that accuracy is met. If the pressure is not delivered specifically to the stress point, the effort can be for nil. The horse would likely feel better, but the intention of increasing the range of motion (ROM), through the application of pressure to the specific point of stress, can be compromised.

Why and where stress points appear

Each muscle is comprised of an origin, a belly, and an insertion. The origin is the anchored part of the muscle that attaches the tendon to bone and is, for the most part, the immoveable part. The belly, the meaty part of the muscle, is responsible for the contraction to make the muscle work. The insertion is the section that crosses over the joint and helps to create movement through contraction. Between the belly of muscle and the tendon is the musculotendinous junction. The musculotendinous junction, at the origin, is where Meagher claims that most injury, and stress points, occur. This makes sense in that the immoveable part has more of a tendency to tear and/or become stressed.

 

Treatment

These stress points, once located, are treated with direct pressure to alter the blood flow in the area. After a durable hyperemia (long lasting blood supply) is achieved, the point may be further stimulated and loosened by applying friction to the area. Direct pressure and friction to these points are generally applied with the thumb or braced finger. Studies by Meagher and one of his associates, Jo Ann Wilson, were released in a number of publications over the past few years. After a controlled study involving this application to the points, increased range of motion was realized.

Trigger Point Therapy

Trigger points are abnormally sensitive, highly irritable areas of tissue found within muscles or around muscles that cause pain, limit range of joint motion, and constrict blood flow. Trigger point myotherapy (myotherapy = muscular therapy) is massage or stimulus applied to these trigger points to relieve pain and muscle tension and promote a sense of well being The system of trigger-point injection myotherapy was introduced many years ago by Drs. Janet Travell and David Simons. This included the injection of an anesthetic solution to a trigger point in order to cause a numbing effect that would interrupt the pain/spasm/pain cycle, thereby allowing restoration of free ROM and function to the area. Bonnie Prudden, a disciple of Janet Travell, discovered that trigger points may be equally relieved by the application of finger pressure to the point for approximately seven seconds. She achieved the same positive results with this natural, non-invasive technique when she employed the technique on animals.

Why and where trigger points arise

Trigger point myotherapy recognizes that the point of discomfort may be found in the belly, origin, insertion, or at the musculotendinous junction. Travell and Simons labeled each point of discomfort ‘active' or ‘latent', active representing the primary site of pain, and latent representing associated points causing discomfort upon the application of pressure. In most cases, when the primary (active) point is addressed, the latent (sometimes called satellite) points will also release or relax, resulting in freedom from pain. However it is also possible to treat the latent points and realize a reduction in discomfort in the active point. Trigger points can appear due to stress, strain or overexertion. They will usually present as a hyperirritable area that is extremely uncomfortable to touch or when trying to put a limb through a ROM.

Treatment

There are many ways to treat trigger points. Massage therapists will generally apply pressure to the area with thumb, finger or elbow. According to Travell, ‘release' is the result of denying the trigger point oxygen. (1. Bonnie Prudden. Pain Erasure: The Bonnie Prudden Way. 1980. Ballantine books. pg 15.) Doctors or veterinarians will treat these points by injection (xylocaine, a vitamin B solution, or another anesthetic quality solution depending on the desired result). Another technique accepted for humans by some physical therapists, doctors, and chiropractors is "spray and stretch". That is, a methyl ethyl chloride spray is introduced to the area to be treated. Once a trigger point is sufficiently numbed, the affected limb or area can be cautiously stretched (this needs to be performed by highly qualified practitioners only), resulting in muscle memory improvement that will, in theory, reduce pain.

Acupressure Points

An acupressure point, or "tsubo" in Japanese, is an energy point located along a meridian. Meridians are energy channels or pathways that flow through the body. There are twelve paired and two unpaired meridians that Oriental medicine believes are the main conduits for energy, or ‘chi'. These points are basically the same points as those treated with acupuncture. However acupuncture treats points with acupuncture needles, injection, laser, or mild electrical current. Acupressure treats points with fingers, thumbs, and elbows. Acupuncture originated thousands of years ago in ancient Chinese medicine and in other Asian cultures and has recently been accepted by Westerners, as has acupressure. Stimulating ‘blocked' tsubo until the energy blockages are released will restore proper energy flow, open up the meridians, and recharge the individual.

Why stimulate acupressure points?
It is also believed that the acupressure points on the meridians are related to internal organs or systems of the body. If a tsubo is blocked, energy cannot flow undisturbed through the body. Therefore the body's balance or well being (homeostasis) is thrown off, resulting in pain, illness, or disease. Acupressure points can also occur outside the meridians and are termed "Ah Shi points". These can arise spontaneously and, like trigger points, can be quite painful. They can also be treated with acupuncture and acupressure.

Treatment
As was the case with trigger points and stress points, the application of pressure must be exactly on the point to achieve the desired result. The pressure may be deep and sustained or may be lighter and intermittent, depending on the intent to either stimulate or sedate a point. The theories and techniques of acupuncture are rather complex and take years
to master.


Conclusion

Massage therapy should encompass a number of different strokes and applications to release fascial (connective tissue) adhesions and tight points in muscle. Treating our horses with the goal of releasing these points will hopefully enable them to live and work in greater comfort and with less chance of illness or injury.

It is imperative that the reader realize that the aforementioned techniques are extremely brief descriptions and there is much more to learn about them. A thorough understanding of anatomy, whether it be the horse, dog or human, would be most beneficial.

About the authors:

Mike Scott is the author of 'The Basic Principles of Equine Massage/Muscle Therapy'

(book and video) and the 'Equine Training Log and Health Care Diary'. He is also an MSA certified saddle fitter along the East Coast. www.saddleguy.com, www.equinemmt.com

Joyce Falese, a licensed and nationally certified massage therapist, has been working on horses and riders for the past 8 years. Her practice covers Massachusetts and Wellington, FL. Joyce co-teaches massage courses in basic and advanced techniques with Mike. Jfalese@juno.com

For more information:

Jack Meagher's book 'Beating Muscle Injuries for Horses' can be found at most tack shops and through popular equine catalogs.

More information and theory on Trigger Point Therapy can be found in Travell and Simons' book, 'Myofascial Pain and Dysfunction: The Trigger Point Manual'. Baltimore, 1984, Williams & Wilkins., or in Bonnie Prudden's book, 'Pain Erasure: The Bonnie Prudden Way'. NY, 1980, Ballantine Books.

Further info on Equine Acupressure can be found in 'Equine Acupressure - A Working Manual' by Zidonis, Snow and Soderberg. It can be found at www.animalacupressure.com, 303-681-3033.

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