Trigger Point Tennis Elbow and Head Pain

Since my last post I've been getting questions about trigger pointing various parts of the body that hurt - thanks everyone for your feedback and keep 'em coming! Here are two recent practise cases.

Trigger pointing Dy's Head Pain

I got the opportunity to practise on Dy the other day. He complained of horrible pain all along the left side of his head, like it was 'inside' his head. He also suffered muscle twitching and pain when he tried to turn his head to the right. I immediately suspected trigger points somewhere in his neck muscles were causing 'referred pain' in his head. 

Trigger points are apparently 'remarkably common' - perhaps contributing to up to 93% of pain seen in pain clinics (Gerwin 1995 in Davies' 2004 'The Trigger Point Therapy Workbook'). Dy is a prime candidate for trigger points because he is tense and on guard all the time. I mean like, all the time (more causes of trigger point given later). I flipped through the book and found under the chapter 'Head and Neck Pain', the diagram that showed a referred pain pattern that looked like Dy's. Notice that the central trigger points (those black dots) are located right in the 'belly' of the muscle (the biggest part of the muscle). 

As I felt carefully along the muscles of Dy's neck with my fingers, I found one nodule about the size of a jellybean, that was very tender and painful for Dy when I pressed on it. This was nodule exactly where the diagram pictured a trigger point might be found. So I firmly rubbed on it a few times with my thumb - sort of a smooth rolling motion. Dy said the pain went away! I told him to keep feeling at the back of his neck and rubbing it out every hour or two, just to make sure. It's been two days and so far so good! Sometimes it takes up to two weeks if the trigger points are really bad, but I guess in Dy's case, they weren't too bad. 

(Credit: The Trigger Point Therapy Workbook)  

Trigger Pointing Spencer's Tennis Elbow

Spencer has the worst case of tennis or golfer's elbow ever. I tried trigger pointing it a few weeks ago, but it didn't seem to help. I am still learning after all, and sometimes I have trouble figuring out the diagrams in the Trigger Point Therapy Book. 

Anyway, I had another good look at the book, practised locating the muscles and potential trigger points on my own arm. 

Then I took another shot at Spencer's elbow. 

Guess what? This time, I really did find the nodule - it was quite a large one - a grape-sized lump in the middle of his tricep, nearer his elbow. It was very painful for Spencer when I pressed on it. I firmly rubbed on it about 12 times. I also used my fingertips and thumbs to feel along the muscles around the elbow, trying to find any other trigger points. Didn't find any more though.  

By the time I got done with that, Spencer had already passed out on the massage table. :p

When he awoke from the nap later, he said the pain had eased tremendously. I'm so pleased about that!

What Causes Trigger Points?

Okay before I wrap up this post, I'll briefly go over the main causes of trigger points so you can see if you're a candidate too:

• Abnormal bone structure such as a short leg, Morton's foot (the second toe longer than the big toe), can strain the muscles.
• Bad posture while sitting and standing (especially for long periods of time) can cause muscle tightness.
• Repetitive movement such as typing, forces the muscles of the shoulders, neck and back to be still while the muscles in the arms and hands strain.
• Stress and subconsciously holding the muscles tight will also strain the muscles.
• Health problems especially those involving chemical, nutritional, glandular imbalances/deficiencies (eg. hypothyroid, hypoglycemia, anemia, uricemia) can predispose you to trigger points too.

Next post, I'll delve into the physiology of a trigger point and how to trigger point the vastus medialis to help with ITB (iliotibial band) pain. 

In the meantime, do keep your questions and comments coming. Do you think you suffer from trigger points? Any specific parts that you have bad pain? I love hearing from you!

xo Gracie

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Plantar Fasciitis: Cure and Pain Relief FAST with the Kitchen Sink Prescription

Those of you who know me, know that I'd been whining - it seems like forever - about not being able to run because of Plantar Fasciitis (henceforth referred to as PF). After over half a year of trying everything recommended by friends etc, with no apparent relief, I quite suddenly found the solution to my PF! It might be yours too!


How I got Plantar Fasciitis
As I weaned off the meds, as my body healed from half a lifetime's worth of major health problems, I rediscovered my love of Running - in a big way. I'd pack my Camelbak Skeeter with water, dodol ('Malaysian Gu Chomps'), a few ringgit, phone, and first aid kit, and take off into the FRIM Bukit Lagong forest behind my apartment, running for 6 - 7 hours at a pop (don't be impressed - I'm just really slow hehe). I never wanted to stop.

But I had to. (Dang you PF!)

In my eagerness to run more and more, I had done too much too soon. The over mileaging - even in the minimal running shoes that greatly helped my arthritic knees - had over-stressed my feet before they had the chance to adapt and and get stronger.

The run that 'broke' my feet was probably the MPIR run in Jan early this year, where I went out in a blaze of glory - I actually won something for doing something athletic, for the first time ever! That evening, the sharp shooting pain through the heel of my foot began, and it didn't go away for the next seven months. Plantar fasciitis? Bone or heel spur?

Most of you are already familiar with PF symptoms (e.g., heel pain especially in the morning and after periods of sitting/inactivity), so I won't go into detail here but will save that for another post.

I think I pretty much tried everything except steroid shots (cortisone injections), extracorporeal shockwave therapy (ESWT) and surgery. Below is what I felt helped and what hurt my efforts to recover. And also what gave me almost instantaneous relief and The Cure :)


What Not to do for Plantar Fasciitis
I was informed by the physio doc that I should lay off running because the PF would not go away otherwise. It seems my years on steroids predisposed me to PF because the steroids hastened aging and had caused the natural fat pads at the bottom of my feet to deteriorate. With no cushion, the plantar fascia is susceptible to bruising, damage and inflammation.

I stopped running (which I actually didn't need to - read on below).

I wore cushioned shoes 24/7 - from the time I woke up till the time I went to bed, even in the house (shouldn't have). This was supposed to protect my feet while giving relief from the heel pain. All that cushioning did help my pain, but the PF didn't go away. Interestingly, my lovely high arches disappeared. At the end of six months of practically living in my shoes, I had become flat-footed! I now understand that all the little muscles in my foot - when I was barefoot - work together to give that 'spring' to my step. Cocooning them in shoes made the foot muscles weak. The muscles supporting my arch no longer did, so my arch flattened out. (I understood this phenomena better after reading Born to Run).

I got custom insoles (hard and painful, PF stayed) and tried off-the-shelf insoles too (pain relief but PF stayed). The physio doc said those $100 hard insoles would provide support to my arch, taking pressure off my heel. They hurt my arch and my heel. My pain threshold is up there, but I lasted only a week in those things. The Dr Scholl's Pro Pain Relief insoles were nice and cushy (and muuuch cheaper), but didn't seem to be doing anything to make the PF go away.

Awful. Just awful. 

What To Do for Plantar Fasciitis (What I did anyways)

For the first six months I did things that I think helped, but didn't resolve the PF:

• I stretched. Especially calf stretches. The physiotherapist I saw at HUKM taught me a few good plantar fascia and calf stretches (will cover these in future posts).
• I massaged my feet and calves. This was well and good, but as I didn't really know what to do at that time, it didn't resolve the PF.
• I iced. This was torture. I'd soak my feet in a bath of really cold water to bring down the inflammation. 
• Night splints (the plantar fasciitis boots). This was really the most effective way to keep the PF pain manageable and at bay. It works by keeping the plantar fascia extended while you sleep. I also stopped sleeping on my tummy. Sleeping on the stomach results in the feet being pointed and the plantar fascia kept in a shortened state for long periods of time (baaaad).

At Month Six, I started seeing a chiropractor. This was Dr Scott Mills, who specializes in treating athletes. That was when things started to get better. 

The New Balance Minimus

• Barefoot exercises. Scott prescribed a series of exercises to strengthen my feet. These worked the little muscles in my feet, and I was to do them on grass. They took about 20 minutes everyday. (Will cover these in my next post). 
• I finally ditched my shoes and started going barefoot as much as possible. And I went back to wearing my beloved New Balance Minimus and other minimal shoes that allowed me to feel the ground. 
• Active Release Technique (ART). Scott used ART to perform a controlled break down of the scar tissue surrounding my plantar fascia. He applied pressure all along the plantar fascia while manipulating my foot at certain angles. The aim was to actually start some fresh inflammation in the area so that healing begin could occur.
• Icing. Icing was now done in the evenings, particularly on days I received ART treatment. It was to bring down the inflammation caused by the treatment (think of it as a 'controlled inflammation'). 
• Night splints. I continued wearing them.

After a month of all that, the scar tissue on my heel had dissipated for most part, and I was really pleased about that. However, I still experienced heel pain after periods of sitting down, and I still needed to wear the foot splints, else the morning heel pain would be present.

Fast Plantar Fasciitis Relief - Trigger Point Yourself

At the end of June, as my PF treatments with the chiropractor were wrapping up, and with heel pain still present, I read the "Trigger Point Therapy Workbook: Your Self Treatment Guide for Pain Relief" (2nd edition, by Clair and Amber Davies).

I applied pressure to and rubbed at the specified 'trigger points' in my feet and calves that the book said would help with PF. And the pain vanished. Just like that. I kid you not. I was stunned. It really worked for me. The next morning, I woke up for the first time in ages not wearing my PF boots - pain free.

It might help you too. It's easy to do, takes just a few minutes a few times a day (gosh, I'm sounding like a salesman but this book has like, 396 gushing reviews on Amazon ya know). The book contains helpful diagrams showing where the trigger points are in relation to the 'referred' pain, for pain in various parts of the body. I've definitely got more posts planned on this topic.

I think it is interesting and relevant that the book says to think of your calf muscles as extensions of your foot muscles.

"You may not have ever thought about it, but the eleven muscles of the lower leg are actually foot muscles. Anatomists call them extrinsic foot muscles, meaning they operate from outside the foot. The muscles in the foot itself are intrinsic foot muscles, meaning they work from inside the foot. The implication of these facts is that the pain in your feet may not be coming from your feet themselves. You can waste a lot of time rubbing and soaking feet if the cause of your pain is trigger points in your calves and shins."

Progress, Finally!
I'm back on the trails! I'm running again. No more pain. No more foot splints. In fact, I trigger point myself whenever I have knee pain or any sort of pain anywhere in my body. To say I'm sold on trigger point now is an understatement.

Do you have plantar fasciitis pain? Has anything worked for you? Would love to hear your PF tale of misery and victory. Leave a comment!

xo Gracie

Garmin GPS Forerunner 910xt: $10 off plus free ship

The Garmin GPS Forerunner 910xt is currently the best out there for triathletes and multisport athletes. I did some online research today on their prices:

Surefireshops.com offers it at an an unbelievably low $129 (plus $40) shipping worldwide from China. But since it's based in China, and since it's not yet been reviewed, I wouldn't feel comfy about giving my money to them. Or any of the other non-customer-rated blogs.

The Factory Outlet Store seems to be the best option as it is reviewed and rated by past customers and it's the cheapest (among the rated/reviewed stores) at $339 (Here's a $10 discount coupon plus free shipping)

Next up is the reliable and trustworthy Amazon at $400 (with free ship).

Well, if you're willing to wait, the Garmin Fenix with its low profile, sleek gazillion-featured watch is coming out in the fall....

All hail the Garmin Fenix

As mentioned before I'm offering shipping forwarding services from USA to Singapore (free at the moment). Email me or leave a comment if you need a quote!

xo Gracie

p.s. It would be AWESOME if you could click on any ad below - my sponsors give me a few cents per click. Thanks for supporting my blog!

Total Immersion Malaysia Level 1: Current Packages Available

I've received several inquiries about the cost of taking Level 1 and Level 2 and here's the latest information hot-of-the-press for Level 1 (see also how to get your RM25 discount HERE):

Level 1 Package Price: NOOB Swimmers

• For noob swimmers (can barely freestyle 25 m), take the 'Complete Step-by-Step' package that gives you eight (that's 8) sessions in the pool. Each session is 1.5 hours long. 
• You'll get video analysis of your stroke (tip: wear a nice swim suit!) and tips on how to improve your current stroke
• You'll learn the 'superman', skating, over switch, snorkel swim, and breathing. (See Bambi do the 'Superman' HERE). 
• Receive a certificate, course notes, cool blue 'Can you swim well' drifit shirt, 'Easy Freestyle' TI DVD and TI Silicone swim cap.
• Price: RM838 (if paid in full. Instalment pricing available too). This works out to about RM70 an hour. Good value considering all the quality stuff you'll get. Also, TI classes here in the US cost USD70 an hour... *sigh*
• Miscellaneous expenses will be RM100 for a snorkel. You might be able to buy secondhand from TI graduates, or borrow. You'll be using the snorkel in Level 2, so it's good to have one. 

Note: This is a scuba snorkel.
You'll need the center-mount snorkel,
the sort that Finis makes :p
(see clickable pic of the Finis Swimmer's Snorkel
 below for an idea of what it's like)

Level 1 Package Price: GOOD Swimmers

• For good swimmers (no problem freestyling 25 m), take the 'Express Class' package that gives you an intense weekend (two-day) course. Count on 4.5 hours of solid instruction per day.
• You'll cover everything the noobs cover, and receive all the goodies they get also. 
• Price: RM645 (if paid in full. Installment pricing available too). This works out to RM71 an hour. Again a bargain considering TI classes in the US cost USD70 an hour ... *SIGH!*
• You'll need to beg, borrow or steal a snorkel for the classes. Or buy one.

Here's my two cents, having taken both Level 1 and 2 myself: You'll need to be prepared to work hard and it's not exactly pocket change, but this is one investment that is worth scrimping and saving for. Why? Because  you'll come away with the ability to swim 'fishlike', effortlessly, and even when you're 90 years old, you'll be able to enjoy the pleasure of an effortless swim and all the accompanying benefits. Not to mention, Total Immersion swimmers look stunning in the water (see TI coach Shinji Takeuchi swim on Youtube).

Ask Advanced Aquatics (Contact Page or Facebook) about signing up. Say Grace sent you to receive RM25 off the package price! You're welcome to subscribe to my blogposts to receive TI updates and promo notifications in your email inbox (click on 'subscribe by email' on the right sidebar). I'm currently putting together a video of my swim before and after TI (Level 1 and 2). Stay tuned!

Questions? Comments? Love Total Immersion? Leave your message at the bottom of this post - I LOVE hearing from you!

xo Gracie

p.s. It would be AWESOME if you could click on any ad here - my sponsors give me a few cents per click. Thanks for supporting my blog!

Total Immersion Classes Malaysia: RM25 Discount off Level 1

Folks,

Since Total Immersion came to Malaysia last year, the programme has taken off big time! Advanced Aquatics who provides TI classes in Kuala Lumpur has graduated over 60 fishlike swimmers for Level 1 so far, and word of mouth from TI converts (including yours truly) continues to draw more people in.

Is Total Immersion for me?
Yes! TI will help you swim more efficiently. You'll use the high-elbow, gravity-aided 'spear' and hip rotation to slice quietly into, and glide powerfully through the water. (All technical-sounding but it basically means 'to swim fishlike' :p). And you'll be pleasantly surprised that you're going farther with so much less effort since your stroke will no longer be powered by churning arms and legs (as conventionally taught), but instead, by your core. Yes, that's right - your core (read: abs). 'How am I going to swim with my core?', you may ask. Well you'll find out when you start your TI journey :)

For triathletes (who comprise the majority of TI students), a more efficient swim translates to having more in the tank for the bike and run legs in a triathlon. That makes for a more enjoyable race, maybe even a spot on the podium :)

For total noobs who just want to be able to enjoy swimming instead of struggling breathlessly to get to the other end of the pool, swimming will become relaxing - even effortless ... Total Immersion completely changed the way I swim, the way I perceive swimming, and distances of 4 km (such as for the Ironman swim) or more, are now achievable. I smile when I remember how 25 m in the pool was such a 'workout'!

Where can I find more info?
Hook up with Advanced Aquatics through their Contact Page or through Facebook to ask about the Level 1 Total Immersion class packages. Say Grace sent you to receive RM25 off the package price! Advanced Aquatics also has great value-added promotions from time to time and you can stay updated by liking them on Facebook. You can also subscribe to my blogposts to receive TI updates and promo notifications in your email inbox (click on 'subscribe by email' on the right sidebar). I'm currently putting together a video of my swim before and after TI (Level 1 and 2). Stay tuned!

Questions? Comments? Love Total Immersion? Leave your message at the bottom of this post - I LOVE hearing from you!

xo Gracie

p.s. It would be AWESOME if you could click on any ad here - my sponsors give me a few cents per click! Thanks for supporting my blog!

Total immersion students imprinting 'high elbow' in their muscle memory at the Sri KDU pool. Small class size and experienced coaches ensure you'll receive personal attention and progress well.

How to Survive Triathlon Swim Starts: Beach, Deep-water, Pontoon

Most triathlon noobs are nervous (if not straight out terrified) of swimming in open water, and the thought of being mauled, punched, kicked and/or swum over at the mass swim starts, adds a thousandfold to the trepidation. How does one get off to a good swim start? This post covers the types of starts, and what you can do to survive the swim start. Now, I'm most definitely not any expert on triathloning and haven't done any Ironmans or anything like that, but I can claim to having survived a bunch of swim starts :p

Types of Starts

A common start is from the beach, where tri- (or try-) athletes run into the water and keep running until it becomes more efficient to swim, then they start swimming. A few dolphin dives are usually thrown in for good measure, between the run and swim bits. A variation of this is a start in the water, just off the beach. Here, racers are about waist deep and can proceed directly to the business of swimming upon gun start.

Starting in waist deep water at Moraine State Park, Butler YMCA Triathlon 2012.

Deep water starts have the swimmer taking off from a treading water position. You'll see this is Ironman races. And pontoon starts such as seen in the Olympic triathlon events or ITU races, have swimmers dive from a platform. The Port Dickson International Triathlon Sprint had a pontoon start the year I took part.

Triathletes launch off at the pontoon start at the London 2012 Olympics. Photo from london2012.com.

Start Survival Strategy
If you're a total newbie taking part in your virgin triathlon, the best way to have an uneventful (read non-violent) swim start is to hang back and let the crowd go first. If there is a buoy line marking the course and you wish to swim right next to it, you can do that after first letting everyone go first. If you're next to the line and at the front of the start group, you risk getting boxed in and swum over if you don't swim fast enough.

Letting others go first helps avoid water-maulings at triathlon swim starts. Photo by Reza Ali.

For fast swimmers on a beach start, you'll do well to run side-to-side style with your knees high and pulling your foot out of the water. Dive when it is deep enough, then dolphin a few times by pushing off the bottom and launching yourself forward. That will get you ahead of slowpokes (like me) who wade in leisure-like. It's a good idea to do a practice run on the beach where you'll be racing, just so you know how many strides you'll take before dolphining.

The Port Dickson International Triathlon Olympic Distance beach start. Note Hong Kong pro Lee (front) with high knees, feet pulled clear of the water, and side-to-side run stride. Photo by Tey Eng Tiong.

There are a few ways you can execute your pontoon start. Again if you're not fast or if you're nervous in any way, start at the back of the pack. Make sure there's enough clearance in the water so that when you dive (or cannonball) in, you won't land on someone else. For deep water starts, the key is to get from a treading water position into a more horizontal position about 30 secs before the gun start, then use a breast stroke kick to start the swim.

That wraps up today's post. I'll cover sighting and breathing in my next one. (Which is going to be funny, because I have a problem swimming straight myself!).

How did your first swim start go? Any tips for newbies? I LOVE hearing from you. Please leave your comments at the end of the post!

xo Gracie

p.s. It would be AWESOME if you could click on any ad here - my sponsors give me a few cents per click. Thanks for supporting my blog!

The Rachel Carson Trail: Secret Treneng Files

The past two weeks I have been running every few days at the Harrison Hills Park. Nothing major, as I want to be careful to prevent Mr Plantar Fasciitis from rearing his ugly head. I've also been trigger-pointing myself throughout the day and that has effectively stopped my heel pain. (I promise I'll blog about my plantar fasciitis cure soon. Promise!)

Today I decided to try a section of the Rachel Carson Trail, which conveniently starts right next to our home. With the Rachel Carson Trail Challenge (34 miles) fresh in my mind, thanks to my ultra marathon buds Ben Brucker (who won first place - out of 582 participants - with a sub seven hour time), I now harbored some vague hope of attempting it next year :p

I'm going to call it the Rachel Carson Obstacle Course. In the short 5 km section of trail I went on, I had to climb over 6 fallen trees, ford two rivers, flee from a mob of feral horses, a rafter of turkeys, assorted deer, a rabid fox and other wildlife!!

Ok, well, I'm exaggerating just a bit, about the river crossings. They were just little streamlets. 

And ok, the horses weren't wild, they were just trying to be friendly. 

Just seconds later I was fleeing for my life as the horses started running towards me. Maybe they wanted a carrot.

But I had to cross an electric fence. For real.