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General Concerns such as:

Carpal Tunnel Syndrome, Frozen Shoulder, Knee , Lower Back Pain,

Migraine and Headaches, TMJD, Upper Back Pain, Hip and Buttocks and Groin,

Morton’s Foot Structure





Carpal Tunnel Syndrome (return to top)


We have all noticed people with wrist supports, the customary marker of carpal tunnel syndrome (CTS).

So what is the cause of this sometimes painful affliction?

Your wrist bones (8 of them) are collectively called carpals. There is a ‘tunnel’ through them, where the median nerve and tendons pass through, to your thumb and fingers.

If there is tissue swelling in the tunnel area, then you will get numbness, tingling, and sometimes sharp pain that can go up the arm.

How is it treated?

Traditionally, the wrist is supported to restrict movement. This allows the swelling to subside. In severe cases a doctor may inject cortisone into the ‘tunnel’ to help reduce the swelling and thus, the pain. In extreme cases, surgery is the only apparent option.

Here’s the likely trigger point connection to CTS.

The Scalene muscle group (in your neck) attaches to the c-spine and also to the first and second ribs. Scalene trigger points can shorten the muscle which in turn may compress the cervical spine and as well, pull the first two ribs UP towards your collar bone (clavicle).

If you are experiencing wrist pain (e.g. CTS), and/or swelling in the hand/wrist, you may be suffering from trigger points in your scalene muscles.

The first rib, when pulled too close to the clavicle, will squeeze the blood vessels and nerves that pass through this area (a.k.a. thoracic outlet) on their way to and from the arm. The impeded returning blood flow and disturbed nerve impulses may cause pain, swelling and numbness in the arm and hand. These symptoms are commonly termed "thoracic outlet syndrome"; although the symptoms are often incorrectly diagnosed as carpal tunnel syndrome.

Keep in mind that other muscles in the arm that have trigger points, may also play a role in CTS.

When trigger points are causal to the CTS symptoms, removing them will  eliminate the pain, swelling and numbness.

Please note: The referred pain from the scalenes can be almost anywhere in the arm, from the shoulder down to the wrist and into the fingers (tingling /numbness to middle, index finger and thumb). Some describe the pain, as having a toothache in the arm! 


Elbows (return to top)

Suffering with tennis elbow, golfer’s elbow or epicondylitis? Doesn’t matter what it’s hurts!

Elbow problems sometimes get relief by using an elastic arm brace; affixed just above or below the elbow. This bandage protocol does help to diminish the pain; however, paradoxically these braces further restrict the proper function of the already compromised muscles that contain trigger points and are causal to the elbow pain.

Trigger points in the triceps are a major player with elbow troubles. Also involved, may be muscles in the forearm; e.g. the anconeus, extensor digitorum.

The triceps (knots) can also cause the ‘tip’ of your elbow to be hypersensitive to even the slightest touch, making it unbearable to rest it on almost any surface.

Few therapists realize that myofascial trigger points in the pectoralis’ major, minor, and the supraspinatus (a rotator cuff muscle) also play a big part in elbow misery.

An achy elbow may be resulting from a distressed scalene muscle in the neck. When scalenes are involved you’ll not likely obtain symptomatic relief from the arm supports/braces. Other more common sources of achy elbow may be from trigger points in the brachialis and biceps muscles.

With the properly implemented trigger point massage technique applied, the elbow usually responds quite nicely and full potential performance is returned.

Tennis players, swimmers and rowers for example, will greatly benefit from appropriate trigger point work. Needless to say, anyone who uses upper limbs as an essential part of their skill (work) will have maximum potential realized, if causal and active trigger points are removed.


Frozen Shoulder (return to top)

Shoulder Issues

I seem to often “go against the flow”, when it comes to conventional ideas and methodology, concerning the initial approach to rehabilitation of shoulder issues.

I commonly find when there is a problem with the shoulder, that exercise and stretching is the primary rehab technique employed. Fundamentally, I do agree with this methodology, but only if the muscles have first been checked for trigger points (TrPs). Keep in mind that muscles that have trigger points, will NOT build mass (i.e. strengthen). If you subscribe to the belief that the shoulder muscles have to be strengthened, then shouldn’t you also have to ask WHY these muscles have become weak and in need of exercise?

Note: TrPs will always cause the involved muscle(s) to be weak and easily fatigue. The TrPs will also prohibit the involved muscles from building mass. Given this fact, wouldn't it make more sense to first check the shoulder area for TrPs and if found, remove them? This makes much more sense than spending a lot of time trying to strengthen a muscle that will not strengthen! Not to mention, that if TrPs are present, this well intended exercise will cause further stress to the involved muscle and cause other muscles (that do similar work) to become stressed, as they now have to compensate for the muscle that is compromised by trigger points.

The usual diagnosis (and often misdiagnosis) for shoulder issues, is arthritis, rotator tear, adhesive capsulitis (frozen shoulder), bicipital tendinitis and bursitis. Of course there may be true structural damage to the joint, however trigger points are very often the true cause of the pain issue. Unfortunately most health professionals are not familiar with the effects of TrPs nor how to effectively treat them.

The Trigger Point Perspective:

Trigger points will cause involved muscle to be weak and fatigue easily. I have found that about 95% of my clients who suffer from shoulder issues, also have TrPs in the supraspinatus, infraspinatus, teres minor and subscapularus (the SITS muscles) and other scapular muscles. Of course, there are other medical causes for muscle weakness and this should be checked by your primary health care provider. 

A muscle that has TrPs, will not build mass. Exercising any muscle that has TrPs, will be a waste of time since the involved muscle(s) will not build mass. And since the primary purpose of the exercise is to strengthen the muscle(s) (i.e. build mass), one has to ask if this exercise protocol should be the “first approach” for client recovery. I’m sure all rehab specialists and fitness trainers have seen some client’s shoulder symptoms exacerbated during/after exercise and stretching routines are employed.

When I talk about procedure for healing a shoulder issue, I have consistently found that a specific Trigger Point protocol must be followed for reliable success. (Please read below "Recommended Trigger Point protocol for rehabilitating shoulder issues:")


Shoulder Pain and Range of Motion Issues

There are many muscles involved in the movement and stabilization of your shoulder. And they should all be working in concert to maintain a healthy, pain free shoulder joint.

The supraspinatus, infraspinatus, teres minor and subscapularis, are your rotator cuff muscles. They are the first muscles that should be perused for trigger points when there is a shoulder joint issue.

Then there are the stabilizers; levator scapulae, rhomboids, pectoralis minor, trapezius, and serratus anterior... the list goes on.

So you see, there are a lot of muscle issues that could come into play, which may be causative to shoulder distress!

***Trigger points always refer pain in a predictable pattern.***

Therefore, depending on your symptoms, it is not too difficult to find those knots that are immediately responsible for your misery. Then we determine where the problem may have got its start. Perhaps an old or recent injury, work related, aggressive workouts, or perhaps improper stretching techniques.

Medical diagnosis for shoulder conditions usually focus on the joint: arthritis, bursitis, tendinitis, rotator cuff injury, adhesive capsulitis, etc. Also, this pain can be blamed on the presumed deterioration of joint cartilage. However, it can be a mistake to automatically assume that the trouble is within the shoulder joint.

Trigger points in nearby muscles are often the real cause of pain. This becomes apparent, when the knots are removed and the pain goes away!

The fact of the matter is this: If you have trigger points and don’t remove them from the involved muscles, you will NOT get lasting relief from your pain or other symptoms, period!

Recommended Trigger Point protocol for rehabilitating shoulder issues:

- Check all related muscles for TrPs (this includes the rotator cuff muscles (SITS), scapular suspension muscles and all muscles that may be an underlying cause to the perpetuation or recurrence of the issue(s).
If TrPs are found - work to remove them. Self-treatment can be effective or see a knowledgeable Trigger Point bodyworker. During this stage, you should cease exercising and stretching the muscles that have the TrPs. This doesn’t mean stop all movement (not healthy for the muscle tissue), but severely limit the strain you place to the involved muscle(s). SITS muscles are relatively small, considering the work they must carry out every day and consequently highly susceptible to re-affliction if they are exercised or stretched while TrPs are present.

- Keep those involved muscles warm! If you apply ice to the muscles with TrPs, the treatments will fail. The cold will cause muscular contraction and further “entrench” the TrPs, thereby causing perpetuation of the issue. Only use ice if there is inflammation or swelling... and then only for about 20 minutes. Do not place the ice directly on the skin. Typically, once the swelling/inflammation has subsided, you may then go back to the moist heat.

- Muscle is an organ and like any other organ in the body, when damaged, needs time to heal. Once the TrPs are removed, you must wait at least 2 weeks prior to starting an exercise routine. (Caution - the shoulder issue may feel better, but there still may be TrPs present.) This is crucial to allow the afflicted muscle to heal and return to normal function. Once the muscle has healed I highly recommend finding a good trainer (preferably one who really knows shoulders) for the next part of your rehab. You must start very gently (shoulder issues are difficult to resolve because "SITS" muscles are easily re-injured) and slowly build-up the exercise routine. The muscles can now build mass and strengthen the shoulder area.

Note: The same protocol is used for TrPs throughout the body, however some muscles will actually benefit from very mild (preferably passive) stretching during the TrP treatment phase of the rehab. I strongly discourage stretching for shoulder TrP issues.

We offer Continuing Education hands-on workshops, for shoulder issues.

The Knee (return to top)
(And the pain)

Hurt when you run?

Do you have a ‘trick’ knee? Perhaps when you climb stairs or do squats? Can you hike up the mountain... but have to be carried down, because of the knee pain?

The knee is a complex piece of machinery. And like most complex things, vulnerable to problems.

The most common issues seem to be ligament related. At least that’s what is commonly thought.

Yes, ligaments do give us grief and as anyone who has suffered with torn ligaments will tell you; they can take a long while to heal! But even if it truly is a ligament issue, you may shorten your recovery time by incorporating trigger point massage into your ‘repair’ protocol. When a ligament is damaged, it usually means that an event has taken place to facilitate injury or stress to other tissue... such as muscle. So check for trigger points (in the appropriate muscles) and if found, remove them and recovery will happen much sooner.

But there is more!

Did you know that a great number of knee pain issues are caused by trigger points in the quadriceps? We’ve treated many knees that were thought to be ligament problems; however, by deactivating the trigger points in the rectus femoris or vastus lateralis, the pain soon disappears. The vastus’ medialis and intermedius also would be perused for knots. The quadriceps TrPs are often responsible for anterior, medial and lateral knee pain. Pain at the back of the knee could be from TrPs in the hamstring muscles. Almost all knee problems have a myofascial component that is playing a part in the knee problem. Remember, remove the knots and the pain will likely be greatly reduced or disappear completely.

How about issues with the I.T. Tract (iliotibial tract) - also known as I.T. Band. We always assess the tensor fasciae latae (TFL) and the gluteus maximus. The TFL joins with the gluteus maximus and forms the iliotibial tract. So if either of these muscles is compromised by trigger points, it will very likely influence the ITT. Remove the knots and the pain usually goes too. Keep in mind that a good deal of the time that pain alongside the ITT (ITB) is actually originating from trigger points in the vastus lateralis and therefore, not a true iliotibial problem.

It’s not difficult for someone well versed in the Trigger Point modality, to check for the underlying source of knee pain.

If you have knee pain it’s not getting better - get those quadriceps checked for trigger points!


Lower Back Pain (return to top)

Note: We now offer continuing education, hands-on workshops for lumbar, hips, buttocks, and groin issues. CECs 6 hours.

Most of us have experienced the stiffness or agony of lower back pain. For those of you who have not... be thankful!

Lower back pain is another common complaint I hear about from clients; and as a former sufferer of the aforementioned condition... I can in fact, relate to their misery! And when it’s bad... it’s BAD! Even "thinking" about moving, causes a stabbing pain!

The last back event that I had was years ago, prior to my "discovering" Trigger Point. Previous to that, I would get an "attack" on average, once a year. It would take several days to get back to work. Now that I keep those back muscles free from trigger points, I have been relatively pain free.

So what is this issue of lower back pain?

Trigger points in the Quadratus Lumborum (QL), Psoas and Gluteus Medius, are the ‘heavy hitters’ in this department. The Quadratus Lumborum (TrPs) can literally bring you to your knees! It feels like there is some serious damage happening with the spine when this “knotty” muscle acts up! The QL is affected by emotional stress as well; so this could explain why your back tends to “go out” when you are under a lot of stress.

Of course day to day physical stuff, can cause latent* trigger points to become active*... then the pain can strike swiftly and stop you in your tracks! It can get so bad, that you are literally unable to move without excruciating pain!

The good news is; if trigger points are the cause of this pain, then removing the nasty knots will bring relief... almost no doubt about it!

All back pain has a myofascial component! If back muscles are not free from knots, it is unlikely that any lasting relief will be obtained. 

I have worked with people who have all sorts of back “conditions” and most of them respond very well indeed, to my trigger point technique.

There is a lot more information on this topic (too much to list here); however if you are suffering with low back pain, or any other pain and you are not getting better, then you owe it to yourself to try Trigger Point bodywork!

*Latent trigger points are in the muscle, but do not cause pain/symptoms.

*Active trigger points produce pain/symptoms. Trigger points can change from active to latent, which can lead you to believe that the problem is  "better", when actually the trigger points are still in the muscle. All trigger points must be removed before lasting relief is obtained.



Migraine and Headaches (return to top)

I find it encouraging that over 90% of my clients who come to me for headaches or migraine issues, get relief after 2 or 3 sessions. (However, it's sad that so many folks suffer for years, needlessly, due to the unawareness of myofascial trigger points.) Many of our clients have total and permanent cessation of their migraines or headaches... while others gain considerable improvement, but may have to have occasional TrP treatments when the involved muscles flair-up causing the issue(s) to return. These flair-ups usually occur during times of physical/emotional stress.

When medical professionals cannot find the source of your headaches or migraines, then it is about 95% sure that TrPs are causing the issue. Therefore, if the TrPs are removed, the pain should cease!

Fact: The most common TrPs that produce migraine are found in the trapezius, sternocleidomastoids, suboccipitals and temporalis muscles.

This TrP source also applies to women whose migraines are “caused” by hormonal changes (i.e. at ovulation and/or on or about the first day of menstruation). We have found that these women have “latent” migraine producing trigger points. Latent TrPs do NOT produce symptoms, but will only cause the muscles to be weak and fatigue easily. When the hormones change during the cycle, (at ovulation or just before the period) it appears to cause the “latent” TrPs to become “active”. And “active” TrPs produce symptoms... and in this case the symptoms are headache or migraine.  

To have successful results from Trigger Point Therapy, you must find a therapist or bodyworker who has extensive knowledge in this field and implements it on a daily basis. Improperly applied TrP therapy will very likely result in only partial success (or more likely failure) with resolving your issue(s).

Note: I receive many inquiries regarding recurring headaches/migraines that are a result of motor vehicle accidents or similar trauma. Some have had these debilitating issues for years. They are commonly treated with Rx medications (because nobody seems to mention or realize that the cause could be trigger points). These Rx meds, often have little effect on the migraine or headache and tend to cause undesirable mental and physical consequences/side-effects. I've found that about 90% of those who I treat with these complaints, have trigger points that produce these pain issues... and once they're removed the headaches/migraines cease and the client can get off the medications (under their doctor's supervision of course)!

More on Headache and Migraine

Surprisingly, the pectoralis muscles, when afflicted with trigger points can be the underlying cause for years of headache misery.These “knotted” pectoralis muscles will invariably pull the shoulders forward and thus put tension on the upper back muscles, including the trapezius. Then the neck muscles get stressed and before you know it... a nasty headache!

Your pectoralis muscles should always be checked for trigger points (knots), when dealing with headaches or migraine.

We have many (very) happy migraine clients who finally got relief after trigger point treatments! In fact this type of neuromuscular bodywork can eliminate migraine and headache, if trigger points were the cause. Many women who get "menstrual cycle" related headaches/migraines, (often during ovulation and/or first day of period) have also responded very well when the trigger points are removed from the upper shoulder, neck and the base of the skull... almost all of these clients, happily reporting no further occurrences!

However, keep in mind that there are many factors that can perpetuate or re-establish trigger points in any muscle group; things like poor diet, work, exercise and postural abnormalities, to name a few. These possibilities should be discussed during your trigger point appointment.

Note: We offer Continuing Education hands-on workshops, for headache and migraine issues.


TMJD (return to top)
(And related problems)

I am convinced that most of the time, pain in or around the TMJ is caused by trigger points. I see many clients who complain of this issue, and we always find extensive TrPs in the muscles around the jaw . The TrPs and involved muscles that play a major roll in TMJD are the masseter, lateral and medial pterygoid, temporalis and sternocleidomastoid. These muscles should ALWAYS, be checked for trigger points, if you are suffering from TMJD or other jaw/bite issues. 

Many people suffer from temporomandibular joint (TMJ) problems. The symptoms can vary; from the occasional slight annoyance, to frequent and extreme misery. 

Dentists, orthodontists and doctors, are usually the professionals we seek to treat this painful disorder. This seems to make logical sense because the problem is around the mouth, teeth, jaw, the TMJ, etc. But keep in mind that muscles very often develop trigger points in this area too.

We have had considerable success with treating TMJ issues. This success is achieved without the need for mouth-guards, splints, teeth filing, jaw modification, or other orthodontic work. We achieve this success by simply removing the causal trigger points... the involved muscle(s) returns to normal and the referred pain/symptoms disappear. Many clients notice an improvement after only a few treatments. Seems so simple doesn't it?

Prior to knowing about trigger points, I had such extreme TMJ issues that at times I could not open my mouth. (I’m sure some people thought it a blessing!) Now I keep my jaw muscles (e.g. masseters, lateral pterygoids and digastrics) free from trigger points... and have had no problems with TMJD, for years.

The various muscles that control jaw function have to be working in concert for optimal jaw performance and comfort. One relatively small muscle (i.e. the lateral pterygoid) if "shortened" by trigger points, can easily cause jaw alignment chaos. Just a slight misalignment of the mandible (lower jaw) can change how the teeth mesh... the problems then begin... and usually get worse with time.

I’m hoping you’ve already given up on chewing gum? If not... spit it out now! Constant chewing overtaxes the muscles of the TMJ and will lead to problems.

TMJD might also cause other trigger point related problems such as vertigo, vision disorders, ringing in the ear(s), or itchiness deep in the ear, sinus issues, toothache and more!

If you are suffering from jaw (joint) pain or jaw clicking or popping, or limited jaw mobility and it’s not getting better, you may (and in my opinion, most likely do) have trigger points.

There are other conditions that will cause jaw problems, and of course you should consult your dentist as part of your overall health care.

Note: Clients who suffer from extreme pain in the outer (external) ear, are usually suffering from TrPs in the temporalis, sternocleidomastoid, and masseter muscles. They typically seem to experience this external ear pain at night when they sleep - often being so severe it awakens them. My clients who have this condition, get relief when the causal TrPs are treated.

If you would like more information on the relationship between trigger points and temporomandibular joint dysfunction, contact me at my e-mail address.


Upper Back Pain (return to top)
(Or ache, or burning sensations)

What is the problem here?

Well let’s start with some of the muscles you will find in the upper back. The rhomboids, serratus posterior superior, trapezius, splenius, levator scapulae, multifidi, rotatores, and latissimus dorsi are the major players.

Then there are the rotator cuff muscles (see: Frozen Shoulder) which can make your life (and back) miserable!

But how many of you, have had a back treatment done, which included working on the pectoralis muscles? I know that many good bodyworkers and massage therapists understand the importance of treating the pectoralis (major and minor) as part of a “back” session. These anterior muscles (the pecs) will wreak havoc with the upper back if left unattended! 

The problem with doing the back and not the front as well, is that these “frontal muscles” (with the trigger points) if left untreated, will pull the shoulders forward and also tug and tilt the shoulder blades (aka scapulae). This will, in effect pull on those back muscles and either perpetuate the back problem or possibly make it worse!

Whenever I work on someone’s upper back problem... I ALWAYS include the flip side (yes, the chest) and I always seem to find trigger points there. what?

Have you already seen a M.D.? Maybe you’re seeing a chiropractor or massage therapist? Is the pain still there after umpteen treatments? Is everyone scratching their head, wondering what to do next?

Perhaps you should get your upper back checked for trigger points (and those pecs too) by a knowledgeable Trigger Point bodyworker/therapist. Actually a good practitioner will check out a few other areas on you as well... that’s the right way to do things in my opinion.

Want more info on the upper back?

Contact me...I’d be happy to help with your questions.


The Hip and Buttocks
...and Groin (return to top)

Hands-on Workshop for Lumbar, Hips, Buttocks, and Groin Issues

Note: We now offer continuing education, hands-on workshops for lumbar, hips, buttocks, and groin issues. CECs 6 hours.

There are muscles with trigger points that will cause hip pain. Vastus lateralis, gluteus’ maximus and minimus, piriformis, quadratus lumborum and tensor fascia latae (TFL) are the main players. When affected from active trigger points, they'll cause pain patterns that many times may be misdiagnosed.Trigger points can refer pain to the hip joint and surrounding areas, including the buttocks, tailbone and even the groin.

These muscles, along with your hamstrings, superficial spinal muscles and soleus, might also affect the buttocks.

The typical diagnosis for pain in the hip or buttocks is; arthritis, cartilage degeneration / thinning, disk problems, sciatica, or bursitis in the hip.

These diagnoses even if proven, do NOT necessarily mean you should have pain as well. (E.g. I have arthritis (x-ray proven) in my neck, but do not have any pain.)

TrPs in the gluteus minimus is a very common cause of sciatic-like pain that refers down the side or back of the leg. Also, the piriformis, if it is knotted up, can also compress the sciatic nerve! Gluteus maximus can easily cause your tailbone to be sore. The TFL will give pain referral to the front of the hip joint.

The adductor magnus (thigh adductor) often cause groin pain that is typically felt inside the pelvis. This pain may be diffuse or may be a sudden sharp explosion of pain at the pubic bone, the vagina, rectum, or rectal area (proctalgia fugax), prostate or bladder.

Many clients find that their chronic bladder issues, such as frequency or urgency (rush to the bathroom), are greatly reduced or eliminated once we remove the trigger points from their rectus abdominis muscles.

**Unawareness of trigger points that cause internal pelvic pain can lead to a wide array of mistaken diagnoses and unnecessary surgery**

Morton's Foot Structure (return to top)

Morton’s foot structure is a congenital (present at birth) condition where the second metatarsal (not the toe itself) is longer than the first metatarsal.

This has the effect of destabilizing the foot (feet) (hyperpronation and a slight wobble effect) and can possibly be the underlying cause for muscle and postural problems throughout the body.

Runners are especially vulnerable to the effects of Morton’s foot.
Since it causes hyperpronation, (and a foot wobble) Morton’s Foot Structure will affect the intrinsic and extrinsic foot muscles. Particularly vulnerable is the Achilles tendon and the associated muscles, gastrocnemius, soleus and plantaris. As well, the tibialis posterior may become involved.

Morton’s Foot Structure is treatable without (if you so choose) expensive custom insoles. Here's the basic instructions -

  • To correct the negative effects of Morton’s Foot Structure, a foam pad should be placed on the underside a shoe insole. This foam material usually is found in a "sheet" form. You will have to cut what you need from this sheet, and one sheet should give you about 8 pads.The 1 sheet pkg. will only cost a few bucks.
  • The foam pad placement should align with the head of the first metatarsal - i.e. it should be positioned directly under the head of the 1st metatarsal.
  • The pad should have an adhesive on one side, so it will adhere to the underside of your shoe's insole.
  • It should be a diameter of between 20mm - 30mm, depending on the size of your  foot and should be about 4mm thick.
  • Replace it when it has compressed to a non-beneficial thickness. (you'll see that the pad is flattened) How frequently you have to replace the foam pad will depend on the intensity your daily "foot" activity.
  • Use the pad(s) (every day) in all your footwear, including slippers. Of course some footwear will not be appropriate for insoles - but you must realize the importance of using the pad as often as possible to maximize the benefits!
  • The foam pad will slightly lift the 1st metatarsal and thereby correct the hyperpronation and wobble that is caused by the Morton's Foot.
  • It should NOT be placed anywhere else on the insole, and should never be placed directly on the skin. 

Once the hyperpronation problem is remedied, via these inexpensive  footwear inserts, the associated trigger points can then be effectively removed. Related pains should diminish and muscle performance will significantly improve!

If you are suffering from pain in the feet, Achilles tendon, legs, hips, TFL, IT band or gluteus muscles and it’s not getting better, you may have Morton’s foot structure.



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