RE: Wrist Pain Connected to the AB-dominal Muscles:

NOTE: On a LinkedIn Group conversation of the American Massage Therapy Association, I recently wrote a description of how I would manage self-treatment of wrirst problems. Among other things, I mentioned that I had one Client who was an NMT therapist, and had developed a trigger point in her lateral abdominal muscles (obliques) that referred to her wrist. One of the readers of that Group conversation asked me how I thought that happened. Here was my response to her: 

First, the particular case I mentioned was an NMT therapist, yet this principle applies to anyone doing multiple, coordinated actions of the body. 

Say you’re sitting in a chair at the end of a massage table, treating a Client’s trigger points on the top of her shoulders. When you push forward with your finger into the trigger points in the trapezius, levator scap, or whatever, you are engaging your muscles, such as triceps, to push forward.

Newton’s Laws of Action & Reaction

Basic Physics says you will ALSO generate Equal & Opposite Force in the exact opposite direction that you are pressing. So, as you push forward, the opposing force will dissipate directly through your arm & shoulder behind you, through your body, along the line of that pressure.

Newtons Laws-Equal & Opposite Force

Bear in mind, too, that muscles cannot contract in only one direction. They pull in both directions simultaneously.

 Muscle-Pulls Both Directions

So, when your triceps muscle contracts across your elbow joint to straighten it, thereby pushing your wrist and hand forward, the same muscle (triceps) will also be contracting across your shoulder joint, transferring forces in that direction, as well.

Now, to maximize the force going forward into the trigger point, you have to counter that equal & opposite force thing by stabilizing your shoulder so it does not move rearward. Otherwise, the force you generate with triceps contraction will be dissipated through your shoulder and torso by at least 50%.

So, you stabilize your shoulder and torso with other muscles. Pectoralis major, deltoid and other muscles in the shoulder will (unconsciously) engage, of course, to create this stability. (It’s good that it’s unconscious to the extent that if you had to think about all that all the time, you’d go crazy. But you’ll see why it’s also a problem in a moment.)

However, THAT force TOO will have to be stabilized, otherwise, your whole rib cage will move rearward, dissipating the force behind you. So, to stabilize the rib cage from moving backwards, what muscles do you use? 

The AB-dominal wall, for one group, especially the external obliques. Your back muscles will tighten too, unless you are very careful. 

And if there is no back on your chair or stool (a VERY big mistake a lot of therapists are making) then you will also recruit psoas muscles and hip flexors to prevent the spine from moving rearward, which it has to do because of the equal & opposite forces pushing the whole torso rearward. 

(If you do not have a back on your chair, or if you do not USE the back of your chair, then the psoas & other muscles must contract to replace that potential and unused source of stability. The seat back can literally provide that source of stability, allowing your psoas, obliques, etc., to NOT have to contract for stabilization purposes. … Floor Rollers on the chair on a smooth floor are a complete other problem, because you have to engage your leg muscles to keep the chair from rolling backwards!)

Nerve Connections: What Fires Together, Wires Together

OKAY, now, here is where it gets interesting: You might have heard the old nerve principle saying **What Fires Together, Wires Together.** 

So, every time you press forward with your arm, if you also unconsciously contracting your AB muscles at the same time, those neuro-pathways will be Wired Together over time, but unnoticed by your conscious mind. They will become coordinated, probably through interneurons in the CNS. (I’m not a nerve geek, yet, so I don’t know exactly, but I’m close on this.)

It’s the same principle of any athlete or musician who has to coordinate multiple simultaneous movements, and eventually be able to do so with our thinking about each individual movement, if they want to be a master of their activity. To master those movements, the individual actions must facilitate into the unconscious parts of the nerve system. 

Now, one or the other nerve pathway being triggered by itself, might not be enough to manifest a pain pattern. And maybe not both of them together, either. But when there is enough stress in the overall system, including other stresses in other parts of the body, yet still connected via the CNS, there is a cumulative *spatial summation* of nerve impulses that, when triggered together, can cause a pain pattern. 

So, I probably could have relieved her wrist pain by JUST working in the forearm — temporarily. However, that would have allowed the referred point in the ABs to remain hidden for all of eternity. Well, almost all of eternity, but not quite. But if she was able to self treat that, she would eventually not have to keep getting it re-treated. Unless of course there was something going on somewhere else, as in this particular case.

But this is why so many people have to keep going back for trigger point therapy. The therapist — and the Client — assume that if the pain went away from treating the local area, they fixed the problem. They do not realize it when there are other (but not always), more distant *feeders* into the problem area. If you have to keep going back for treatment, unless you keep doing the same things that are causing the problem, there is more to the problem. 

That’s why I do my BIO-Structural approach. I search for ALL the other possible referring points in the body that can remain hidden, but will contribute to the total problem over time. The more contributing factors you can find, and relieve, then the less often the problem will happen. 

This is why I need a pretty wealthy & motivated, or desperate, clientele. Not many people want to afford the time & money necessary to explore and defuse all that stuff. Some do, but they are not commonly found. The one’s that do are generally looking for more than just getting out of pain. They want a more full body-mind integration process, as well.

Thanks for Reading,
David Scott Lynn (DSL)
DSL: Your Hi-Touch Up-Link to the Inner-Net
Inner-Net: Your Psycho-Neeuro-Musculo-Fascial Network

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