Sep 24, 2008

Knotted Muscles / Trigger Points

Muscle soreness while training is common and by itself, is really not a big issue. Usually, sore muscles are caused by microscopic tears in muscle fibers. The soreness typically goes away within three days.

But when muscles remain sore for weeks or even months, and the pain is centered in a particular spot, or a "knot" you very well may have a Trigger Point problem. Trigger points are typically found in muscles, tendons and ligaments. Technically, the doctors call this "myofascial pain syndrome."

These are very sore, long lasting aches and sometimes produce sharp electrical-type pains that are often caused by trauma, repetitive strain or pushing beyond any reasonable norm.

I have had a consistent problem in my upper back, in the Trapezoid area. My Trigger Point always flares-up when I do long bike rides, and 100% of the time when I am in the aero position on the Time Trial bike.

Essentially, it is an acutely knotted mass of muscle strands in a very specific spot. The muscle is in a constant and palpable contraction (shortening of the muscle) that will not release and thus results in a taut band and a hard fibrous nodule, lump, or knot. No amount or rubbing or massaging or pressure or anything else will relieve the pain.

Aggressive, deep tissue massage will tend to break up the knot a bit, but typically, there is also a lot of bruising that goes along with the deep tissue massage. Plus, the relief is at best, only temporary and never complete.

I have tried literally every recognized cure for this problem, including:

  • sports massage
  • deep tissue massage
  • heat packs
  • electrical stimulation
  • chiropractors
  • anti-inflammatories
  • prescription pain killers
  • physical therapy
  • electro-magnetic therapy
  • weight training
  • Lidocaine patches
  • Cortisone injections
  • Lidocaine injections
  • and finally, rest.

Of all these, only one thing

However, since rest is not an option while training for an Ironman, I have been working with a pain management specialist. No oral pain killers or anti-inflammatories have helped whatsoever. So now we are to the point of "wet needling."

The goal is to deactivate the contracted muscle. One option is to paralyze the muscle with Botox, and this would normally be a viable option. However, since my Trigger Point is located in the upper back and shoulder region, I could lose the ability to fully control my shoulder due to the temporary paralysis of the muscle. Odds are low that this would happen, but due to the risk, they don't want to go that route. Instead, we are now trying a wet needling procedure.

Wet needling involves the injection of a mixture of Steroids, Lidocaine and Cortisone directly into the muscle knot. A significant amount of care is taken to precisely identify the muscle strand, and once so identified, a shot of the mixture is injected right into that fiber. Then they move up the fiber ever so slightly and inject the fiber in another spot, and another, and so on.

What they are looking for is for the muscle to start twitching or firing. Once they physically observe the muscle twitching then they know that it is beginning to release from its contracted state.

Today, I went in for this wet needling process. As the four or five injections were made, I could feel the muscle "release" and the doctor was pretty excited when he saw the muscle firing and twitching which was the visual cue he needed to confirm that this process was working.

Three hours later, the spot is still sore, not from the shots, but probably from the excessively-hard rubbing and pressure that I have been constantly applying to this spot over the past few days trying to relieve this knot.

Hopefully in a few days, we will know for sure if this has worked.

Being Tough or Just Stubborn?

It has been said that over 90% of all those training for an Ironman incur at least one injury that requires over a week of recovery. But the whole idea of completing an Ironman is to test one's resolve.

There are very few opportunities in modern life where one can literally test the ultimate limit of one's physical and mental boundaries.

Look at any Ironman event and you'll see athletes who've pushed themselves to the point of collapse, exhaustion, dehydration and even passing out.

In the months leading up to the Ironman event, injuries first start as minor inconveniences. A subtle twitch, a funny feeling, a stiff muscle, an ache that wasn't there before. These are the first signs.

Rarely does one just run down the road and then all of the sudden...SNAP....something rips or tears or breaks. It's far more likely that we will experience an odd sensation, a soreness or a muscle fibre that just sort of seems out of place, is twitching strangely or is aching.

So what to do when this occurs?

The first thing we should do is to slow down. Check it out. Try to figure out what is going on. Massage it a little, walk a little, etc.

But there is a big difference between what we "should do" and what we often end up doing. It's the difference between being smart and being stubborn.

I know I should slow down and figure out what is going on when these things hit. But more often than not, I catch myself saying:

"You want to be an Ironman? Then start acting like an Ironman and pick up the pace. Tough it out. Be strong. Are you going to quit during your Ironman debut like you are quitting right now?"

Tough thoughts to be sure and this stubborness often gets me to ignore the first signs of trouble. To be smart, to ultimately go the full distance, we must pay attention to the very first signs of trouble.

Before we ever get a blister, we always get a "hot spot." This is a hot sensation where the skin is rubbing. We can take a couple of minutes and deal with it right away, or if we are bull-headed, we ignore it, and then pay the price for the next 7 - 10 days as the raw, oozing blister just festers and is re-aggravated with each successive workout!

This is bull-headed and stubborn. Like my brilliant coach, David Warden, tells me, "Keep your eye on the prize."

But the prize is not finishing the workout in record time or toughing it out through an obvious early warning signal, just to "prove" that I have what it takes. The prize is finishing the full Ironman race.

What good does it do to finish the workout at record pace if you must spend the next 3 - 5 days limping around and recovering?

I need to adjust my perspective.

Being an Ironman is not just about being tough and stubborn. An Ironman must also be smart.
Smart about pacing, about nutrition, about rest, about balance.

And smart about paying attention and taking appropriate action at the early warning signs that an injury may be looming.