SELF HELP 

General Hydrotherapy Self Care


Although these suggestions may not suit every client, they are general instructions to be taught to the client at the therapist’s discretion when appropriate. These activities are for the client to do at home between their trigger point treatments.  Clinical experience has found that when clients practice doing these things at home consistently, the benefits achieved by trigger point therapy is enhanced. In contrast, clients who do not practice these things may still achieve pain relief through trigger point therapy alone, but treatment sessions usually need to be more in number and frequency to achieve sustained deactivation. These clients have also been observed overall to regress more quickly after pain relief has been achieved.  In addition, clients can also have habits and activities that are detrimental to therapeutic goals and can cause benefits of therapy to regress. So it does seem to matter what a client does do and does not do in reference to  certain activities in their day to day lives that can give them some level of control over their myofascial pain.

 

 

 

Post Treatment Guidelines ( The First 48 Hours Post Treatment)

 

1. Ice Packs  (Hydrotherapy)

 

Particularly after the very first treatment to a particular body area’s trigger points, the area can become tender and sore post therapy. This is not usually felt immediately after therapy, but is similar to the effect of  post exercise soreness. The area can have a similar sore sensation and be tender to the touch. This is post therapeutic inflammation, probably due to the fact that the trigger point’s presence was already producing inflammatory chemicals and the treatment temporarily increases this process. This usually occurs the next day after treatment and can last for up to 48 hours after the treatment session. 

Because ice cold temperatures applied to soft tissues can decrease inflammation, this issue can be helped by the application of an ice pack to the area. Cold application to tissue also provides an analgesic effect. This means it temporarily blocks the pain sensation to the area. It also helps the client psychologically feel in charge of the pain when they can do something to relieve it. This helps the client to have a positive opinion of the therapy process, instead of thinking that the trigger point treatment only made the pain worse. 


First, the client is to understand that they are only to apply ice packs in the event that post treatment soreness occurs. There is no benefit to use ice if there is no soreness, and it may actually decrease the healing response time, as ice decreases blood flow to the area, if only temporarily. As with many issues in clinical practice, it is a compromise between two goals. The goal is to have the area heal as quickly as possible, but initially the pain relief provided by ice may over ride this overall goal. 

 

How To Apply Ice Packs

 

Ice packs are only to be used for the first 48 hours after trigger point therapy. After that, the soreness should resolve, and the goal is restoring normal function of the tissue as stated above.

The client should not attempt any movement that will cause stretching or strain to the muscle immediately after applying the ice treatment. The ice will stiffen the myofascial tissue, and until that tissue becomes warm and pliable again, it’s function is affected. 

The client  should not be apply the ice directly to the skin, but use a barrier in between such as a damp towel. Drugstore ice gel packs that already have a barrier are ideal. Apply the pack for about 5 minutes or less, as tolerated,  centered on the most sore area and then remove the pack for five minutes. This prevents injuring the tissue by freezing it, but still provides a numbing affect and cools the tissue down. This cycle  should be repeated three times with removal of the ice for five minutes in between so a treatment cycle would be like this:

Apply cold ice pack for 5 minutes max

Remove the ice and wait 5 minutes

Apply the ice pack for 5 more minutes max

Remove the ice pack for 5 minutes

Apply the ice pack for a final 5 minutes max

Remove the ice pack and rest the area until it is back to normal body temperature

This procedure can be repeated at equal intervals 2 to 3 times a day.

It is normal for the tissue to appear reddened for up to an hour afterwards. There may be an inability to tolerate the ice for only five minutes.  If an intolerable pain should occur,try using a gel pack that is melting slightly and is less cold. If this is tried and there is still intolerance to the cold,  immediately stop applying ice and discontinue hydrotherapy.

 

Contraindications for Ice Pack Hydrotherapy:

Open wounds or rashes 

Raynauld’s Syndrome

Poor circulation of the immediate area (such  diabetic complications)

Any sensory impairment to the area ( client may not feel if ice is too cold)

 


Resting The Muscle(s)

 

The client should be instructed to rest the affected functional group for 48 hours post therapy. So, for example, if trigger points were found in the hamstrings, the client should avoid any strenuous activity that could stimulate a reactivation of the trigger point. This would be hamstring curls or walking up hill for extended periods. The muscle needs some time to relearn the new resting length.Weight lifting especially is to be avoided.

In clinical practice, leisurely walking and swimming have been found to be beneficial to increase circulation without causing reactivation in all but the most severe dysfunction. Swimming also has the added benefit of cooling the tissue down.

 

Between Treatment Guidelines ( After 48 Hours Post Treatment Until the Next Session)

 

After 48 hours has past, post therapeutic inflammation should be gone and the muscle is now more adapted to it new resting length. The guidelines change at this point in time for the interval until the next treatment session, or indefinitely and can be discontinued if the dysfunction is resolved.

 

Moist Heat (Hydrotherapy)

 

Moist heat can help tight myofascial tissue to temporarily soften and become looser, so it takes the tension off of areas that are affected by articular torquing. It can also bring more blood flow to the muscles and is thought to prevent reactivation of trigger points. Note that the heat must be moist heat to penetrate into the muscle tissue.


Moist Heat Towel Compress


Moist heat can be applied several ways. Most clients do not have access to a hydrocollator pack, as used in clinical practice. However, an inexpensive way to apply moist heat is to soak and ring out a hand towel or dish towel in warm water,  keeping it fairly wet, but not dripping. Fold  the towel in half or quarters and place into the microwave on a microwave safe plate. Experiment with heating the towel so that it is steaming, but avoid cooking the fabric. Use tongs to lift the towel off the plate and place into another damp, room temperature towel. Then fold the damp towel over the other. Test the temperature of the compress and wait until the temperature feels tolerably warm but not burning.   Then place on the tight target area until the towel has cooled down, not more than 15 minutes. The towel should feel comfortable hot, but not burning. If it becomes too hot after a few minutes, remove the towel and wait for it to cool down a bit more. Clients who cannot use a microwave can place the towel into very hot water instead, then proceed to wring out the towel using thick rubber cleaning gloves, taking care not to burn their hands.  Another option is a store bought heating pad, but only if it allows moist heat application.


Warm Baths


Bathing in warm water of about 100 to 102 degrees between 15 to 20 minutes has beneficial effects to both internal circulation and the fascial tissue. When the fascial tissue is warmed with moist heat, its ground substance changes temporarily from a harder gel state to a more liquid  state. This enable the facial fibers to be stretched more easily and become softer and more pliable. A good analogy is how heat can change taffy from a stiff and hard solid to a stretchable, pliable substance. But this effect is only temporary. However, it is believed that when stretching or massage is applied to the tissue when in this state, more long lasting results can be achieved.  

Epsom salts are a form of magnesium sulfate. Magnesium is a mineral needed by the body that relaxes muscle. Because of this fact, it is beneficial to use epsom salts in the bath water because the magnesium can be absorbed through the skin during bathing and help relax tight muscles. Use about 2 cupfuls to  a standard sized bath tub. A 2:1 ratio of magnesium sulfate or magnesium chloride flakes (better absorbed and utilized, but harder to find locally) to baking soda added to the bath and completely dissolved can also be used. It is believed that a 2:1 ratio of magnesium salts to baking soda helps the magnesium to be better absorbed due to the ph level of the water being raised to a more alkaline level. 

 

Contraindications for Moist Heat


Do not use moist heat:

Less than 48 hours post trigger point treatment if there is post massage soreness. This could increase inflammation which you don’t want.

Over skin wounds, rashes, bruises, or burns (including sun burn) 

In cases of fever or systemic illness, or recent trauma injury

When there is inflammation (tissue feels hot,red, and/or sore). edema (swelling), redness, or phlebitis.

Sensory impairment (tingling, numbness, pins and needles, burning pain)

Clients should get their physicians permission to use warm baths in situations of hypertension, cardiac disease, or inflammatory diseases such as rheumatic diseases.

Moist heat need not be applied immediately after a hot bath, shower, steam bath, or sauna to avoid raising the temperature of the tissue for a prolonged period. More is not better.