levator trigger points and a chronic pain case history

TRIGGER POINTS OF THE LEVATOR SCAPULAE AND SURROUNDING MUSCLES
A CHRONIC PAIN / AUTOIMMUNITY CASE HISTORY

Levator Scapulae Trigger Points

Anatomography

Levator Scapulae Trigger Points

Anatomography

If you click on the pictures directly above (left & right), you’ll notice that the Levator Scapulae muscle has it’s insertion points (upper attachment) in, among other places, the lateral mass of the Atlas (C1 vertebrae).  Why is this important to know?  The Atlas is the one vertebrae in the spine where SUBLUXATION not only causes irritation of the associated spinal nerves, it actually has the potential to irritate the cord itself — just below the point where the brain / brainstem becomes spinal cord.  This is why upper cervical subluxation (misalignment of the Atlas / Axis — C1 / C2) is so important to diagnose and correct.  Not only is it the area where spine-related HEADACHES are likely to occur, but if things like SINUS, ALLERGIES, ASTHMA, IMMUNE SYSTEM DYSFUNCTION, etc, etc, etc are occurring due to irritation of the nervous system, this is usually the area that’s the culprit.  For example, it was adjusting an Atlas subluxation that “cured” Rex’s deafness, despite the fact I had no idea he was deaf (HERE).

TRIGGER POINTS are small bundles of muscles that are innervated by the same nerve branch, which for any number of reasons, get turned on and refuse to turn themselves off.  My suggestion to you if you deal with TP’s, watch the ten short videos in the link.  Somewhat boring,  at times quite technical, but short, and in the end, you’ll understand why watching was important.  Also, if you look at the other posts filed under the link, you’ll notice several ways to deal with Trigger Points.  It won’t come as a surprise to learn that the mixture of Trigger Points with the C1 vertebra is problematic for many people.

Levator Scapulae SCM Trigger Points

Patrick Lynch Medical Illustrator & Hamzakitar

Not only is the Levator arguably the single most common place that people develop them, but what’s doubly interesting is that Trigger Points in the Levator Scapulae are intimately associated with Trigger Points in the Pec Minor as well (chest — see below).   Those of you who have the hardcore Trigger Point(s) at the upper portion of the bottom red circle in the pic above left, will frequently find a Trigger Point (or points) in the Pec Minor (below right). 

It’s almost like if you stuck a long knitting needle straight through from front to back (or vice versa — not that I am recommending it mind you), you could pierce both.  Oh; one more fun fact.  Problems with Pec Minor also happen to be heavily involved with both RADICULOPATHY (numbness and / or tingling into the arms) and TOS (Thoracic Outlet Syndrome).   And even if there is no radiculopathy involved, when a Levator TP goes into hyperdrive, it can pull hard enough at C1 to totally lock the neck — especially in left and right rotation (common).

Lest we forget, there are other major muscles in the area — chiefly the Rhomboids and Trapezius, the latter lying over the top of the former — in which Trigger Points can cause similar pains.  The Trigger Points in both these muscles tend to be more localized than radicular (although they can certainly be both).  However, because the Trapezius is so huge and spread out, and because the top part of the muscle anchors to the base of the SKULL, it has a larger referral pattern. 
Rhomboid Trigger Points

Anatomography

What do I recommend for hardcore Trigger Points in these areas; particularly in the Levator?  For the short haul, things like NEEDLING, deep and intense massage (usually needs to be really intense), Thera-cane or similar, myofascial release, FASCIAL REMODELING, etc, etc, etc, seem to work fairly well, with the needling arguably being the best of the bunch.  However, the thing that I believe addresses the source of the problem better than others is EXTENSION THERAPY

Although ET can take many forms, it can be done both over a ball (helps address trunk and upper back flexion — see link), or with a Dakota Traction Device.  The Dakota is a simple, inexpensive, tool you use at home to specifically address FORWARD HEAD POSTURE (FHP).   THIS shows just how critical dealing with FHP really is for most people struggling with CHRONIC NECK PAIN of many kinds.   By the way, after a person has been through PHASE I and had their SCAR TISSUE and FIBROSIS addressed, the Dakota is the cat’s meow for dealing with SCM TP’s.

CASE HISTORY WITH LEVATOR TRIGGER POINTS
AND OTHER SOURCES OF CHRONIC PAIN

Today you’re going to get another CASE HISTORY.  I have now seen “Roger” three times in the last year or so.  He was fairly debilitated when he first came in to see me, not being able to sit in a plane or a vehicle for significant time without taking Vicodin or similar.  Despite lots and lots of EXAMINATIONS and IMAGING (as well as a slew of chiros, and therapists of all sorts), Roger was having a tough time sorting this thing out and seeing any sort of real or tangible improvement.  The thing that helped him most up to the point I saw Roger was Upper Cervical Chiropractic Adjustments in the form of something called NUCCA.  This is the history I got from Roger a bit over a year ago.

The first injury that I can remember was in 3rd grade. I was skiing with a fanny pack on…with some bubble tape gum in the fanny pack… I went off a jump and landed flat on my back. I was done for the day. It hurt really bad, especially for a 3rd grader who would be pretty resilient.  When 5th and 6th grade came around I was playing JR football. This was where I discovered that I could not do a sit up without someone sitting on my feet due to pain. Doing leg lifts and sit ups, were painful.  Fast forward to high school…  My lower back always seemed to hurt when running sprints during basketball.

After graduating high school in 2001, I was skiing later that year. It was incredible skiing conditions, very deep snow, my dad and I were at the top of the mountain… I took two turns and one of my ski’s popped up (in a weird way) hit me in the left temple (the ski did not fall off). Long story short, I ended up being airlifted after skiing down to the medical room and showing signs off head injury. CT scans came up clean and I suffered a bad concussion.  The first odd thing I noticed, post-concussion, was that when I did a “leg curl”, you could visibly see that big cord (tendon or ligament?) pop over. It wasn’t painful, but it did limit the strength of the leg.

2003/2004/2005. I started to show signs of pretty bad low back pain. In 2005 I can remember getting out of my office chair and actually falling to the ground as a result of losing feeling in my left leg. This happened several more times over the next couple years at random. I had self-determined that I must have sciatica. The lower back pain was now affecting my day to day life. I would complain all the time to my wife… who of course said “everyone has back pain”. I basically just dealt with it and didn’t see a doctor.

In 2005/2006/2007. I would go skiing and have excruciating pain in my feet. So I went to an expert ski boot fitter. After working with me for a couple months he told me that he’s never had someone like me that he couldn’t get fit properly. I determined that it probably wasn’t my feet, but my lower back and my legs and feet compensating for the back pain. By 2008 I gave up skiing because it was too painful.

2008/2009/2010. The back pain just kept getting worse. In January 2010 I went to a chiro through a referral who was well known for seeing professional athletes etc. He was an honest guy and told me to give him 23 visits and he’ll be able to get to the bottom of it. Well, after a couple months of going to him 2-3 times per week… he proceeded to tell me “man, you’re messed up!” He didn’t think he could help and said that it was very likely that an MRI would reveal a subluxation or herniated disc(s) in my lower back… but he felt there was no point. He would hate to see someone my age get surgery.

In January 2011 I went to Seattle see a NUCCA doctor (Neurological Upper Cervical Chiropractic Association).  This guy really helps tons of people and is tops in his field. He only adjusts the Atlas. I went to him from 2011 until 2015. I couldn’t hold an adjustment for more than three weeks max (usually 1-2 weeks). He told me that he has only had a handful of patients like myself that could not hold an adjustment. [Roger moved a few years ago and has not been able to find a NUCCA practitioner that has helped him].

In 2009 I had to quit doing anything physically demanding such as Flag Football, Basketball, etc. I couldn’t run without having bad pain in my lower back. I’ve continued to play golf, as it’s one swing at a time and not terribly painful.

Since 2010 the pain and pain locations have increased. I tried Pilates in September 2014. The instructor commented on my incredible strength & range of motion… and then I told her that I felt like certain motions would simply tear my muscle or whatever. She observed and said that I shouldn’t do Pilates until I got that figured out.  I have a couple different foam rollers and some trigger point therapy balls and workbooks. Doing this mostly seems to exacerbate the symptoms. 

When people look at me they guess my weight always to be between 175-195… I weigh around 210/215 due to incredibly high muscle density. My massage therapist has commented many many times about how she hasn’t come across anyone like me with how thick my muscles are and how tight they are. I get told to relax… and I respond with how relaxed I already am! I guess I have those twitch muscles. I was always the quickest on any team I’ve played on. At 5’10” I dunked in a high school basketball game. I have never worked out… I’ve been to the gym and screwed around with buddy’s, but have never actively lifted weights.

Symptoms:

  • I did notice that my hair really wouldn’t grow around my left sideburn / lower temple area too well. That was kind of weird.
  • I’ve had times were I would be talking and just start choking and not be able to talk. This has only happened 6/8 times
  • I’ve had times were swallowing was difficult, like there was something stuck in my throat.
  • This hasn’t happened in a while, but there was times when I would open my mouth too wide or at the wrong angle and it felt like my jaw was going to be ripped off my head. The worst feeling.
  • Lower back pain, mid back pain, upper back pain, neck pain, left jaw pain, hip pain
  • Weakness & Atrophy in my left arm
    • If I flex my left arm, it trembles.
  • Weakness & atrophy in my left leg (calf)
  • Sensitive to the touch
    • Left bicep, left forearm, left armpit, left inner thigh, left hamstring, left inner knee, left back of knee, left inner calf, lower back, mid back, upper back near right shoulder blade
  • My bones pop and crack all the time. Even sometimes when I take a deep breath.
    • I can pop just about anything… and then in a short while, I can pop it again.
  • Whole body seems to be out of alignment
  • Left jaw cracks when I rotate it to the left side
    • Left inner ear is uncomfortable
    • Left tonsil is different than right tonsil (visually from inside of mouth)
  • Upper right back near shoulder blade has something deep that I can’t get out (massage can’t get it out etc.)
  • I’m very flexible… but at the same time very tight.
  • I crack my neck all the time
  • Doing a bench press, my left arm will “short out” on me.
  • Poor sleep
  • Randomly dropping things (ex: subconsciously loosen grip & drop my keys)
  • Whole left side of body is weak.
  • Can’t run (shooting pain)
  • Tightness everywhere. I wish I had a personal Trainor to stretch me out everyday
  • Starting to see mild symptoms on my right side over the past year.
  • Absolutely cannot do any ab exercises at all. Very painful.
  • Doing physical work such as doing landscaping in my yard, hurts after a short time period and has lasting implications for a week.
  • Sciatica or something
  • I cannot hold an adjustment.
  • I’m 33 going on 53.

I have done extensive Tissue Remodeling on Roger with excellent effect.  He says that he is probably 80% better than when he first came in.  While he is defintely much much better, my opinion is that 80% might be pushing it a bit. One of the really cool things I was able to successfully address on Roger’s first visit was his THORACOLUMBAR FASCIA — it was pure gristle.  Not that I recommend situps (HERE), but Roger hadn’t been able to do a situp since he was a little kid — it hurt too bad.  After his first treatment, not only was that pain gone when doing situps, but he could sit and ride without pain.  His biggest complaint now seems to be the Levator Trigger Points, which he is dealing with.

As for the dense muscles, I’m not sure what the solution is for that.  I have one other patients with similar, who has a wide array of problems himself.  Both these individuals have muscles that are not necessarily tighter than other people I routinely see, but just plain dense.  This might provide some of the basis for Roger not bouncing back from early injuries, and not recovering like others (especially young others) might. 

Another interesting fact in this case (like many others) is autoimmunity.  HEAD INJURES are intimately linked to people developing autoimmunity — often against their own brain.  Roger’s problems seemed to get far worse shortly after the ski-to-the-temple concussion he incurred.  While this kind of damage likely won’t show up on a BRAIN SCAN (CT), it’s not an uncommon problem, even though it seems to be little discussed in the mainstream.  And although the not-being-able-to-grow-hair-in-the-area-of-injury situation is intriguing, it’s not terribly uncommon and sometimes indicative of neurological injury. 

Having noticed a patch of psoriasis (an autoimmune disease) on his foot, autoimmunity was confirmed. Why is this potentially a big deal?  Autoimmunity is a huge problem even though is not a problem with the tissues, cells, enzymes, organs, etc, specifically being attacked.  It’s a problem with the immune system that’s doing the attacking.  THYROID PROBLEMS are a great example of this phenomenon. Even though about 80-90% of all thyroid problems are autoimmune (Hashimoto’s / Graves), people take their thyroid meds faithfully and think everything is under control.  Until they start developing other autoimmune diseases (HERE is a great example of numerous autoimmune diseases attacking in a pack — like hungry wolves).

Furthermore, even though we can sort of check for autoimmunity via the ANA Test (Anti-Nuclear Antibodies), it’s not the most accurate and it doesn’t tell us what’s being attacked.  Although we have put names on quite a number of autoimmune diseases, there are an almost infinite number of tissues, proteins, and enzymes that the body could and does sometimes choose to attack.  This is why when I see people with ADHESED FASCIA virtually everywhere, my first thought is that their problem is likely systemic (HERE) — quite possibly autoimmune.  A failure to address these problems systemically means you never really get to the root of the problem (temporary relief only). 

I bring the whole autoimmunity thing up so that Roger can pick some low-hanging fruit.  The easiest thing to address in a situation like this is diet.  Why is diet important in autoimmunity?  In a word; INFLAMMATION.  Your diet is either driving it or squelching it.  Controlling inflammation is the primary reason I recommend the PALEO DIET (or something similar) to my chronic patients. whether CHRONIC PAIN or chronic illness.  Not to mention, science has been talking about the relationship between GLUTEN AND AUTOIMMUNITY since the 1930’s.  Once you understand the whole Gluten, Autoimmunity, LEAKY GUT / LEAKY BRAIN connection, doing an ELIMINATION DIET starts making a lot of sense.  Especially knowing that Non-Celiac Gluten Sensitivity is mostly neurological as far as its symptoms are concerned (START SKIMMING POST TITLES).

Lest we leave without addressing Roger’s nervous system a bit deeper; because of his history and the fact that everything seems to be left-sided (right brain, left cerebellum) — including the weird hamstring tendon thing, I would suggest a visit to a FUNCTIONAL NEUROLOGIST.  While I know there are any number of capable individuals in his neck of the woods (none I know personally), if you can pull it off, the guy to see would be BRANDON BROCK.  Likewise, since Roger has had good results previously with Upper Cervical Technique, realize there are other techniques equally as effective as NUCCA — Blair, Sweat (Dr. Roy Sweat), Grostic, HIO, Kale, etc, etc.  And as always, if you have any questions about anything Roger, shoot me a line.  I am rooting for you and would love to see you well enough for me to school you on the basketball court!

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