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Muscle guarding, Delayed Onset Muscle Soreness and Trigger points

Discussion in 'Pain Management' started by Josephine, Aug 20, 2018.

  1. Josephine

    Josephine FORUM ADMIN, NURSE DIRECTOR Administrator
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    Most post-op pain is caused by guarding which is why it's never a good idea to take pain meds in order to tolerate PT. Guarding happens when the muscle - which, believe it or not, has a memory - goes into spasm when you are doing things, or having things done to you, which it knows it won't like. So it goes into spasm to prevent that movement being done. Adjacent muscles can join in this defensive behaviour. But if you force the movement anyway, you risk spraining or even actually tearing the muscle. Hence why taking pain meds before PT can be harmful, even potentially dangerous.

    Further reading from Sage:
    Muscle tissue is quite a lot more interesting than we may think. It behaves in different ways, depending on its treatment and circumstances. Muscle tissue also changes as it ages, becoming more susceptible to dysfunction. But the changes aren’t always irreparable – with a little bit of knowledge, and some great massage technique, we can stay on top of them. So muscle guarding, delayed onset muscle soreness (DOMS) and trigger points are well worth knowing about.

    Muscle guarding
    Muscle guarding is when muscles can start to misbehave with the intent to protect your body after an injury or a period of chronic stress. Instead of staying relaxed, certain muscles will activate and contract involuntarily, causing the surrounding area to tighten up. This is a bit like muscle memory, the muscles will tighten up defensively, sometimes long after the original injury or stress has gone away.

    Muscle guarding can be an exasperating situation for the sufferer. For example, an athlete may have previously injured a gluteal muscle. Then, due to the trauma, the gluteus muscle may shut down while other muscles, for example, the psoas or ITB (ilio-tibial band), rev up to take control of the situation. When the patient performs a certain motion, instead of the glutes firing, the surrounding muscles go into spasm in order to ‘guard’ the area.

    Like with trigger points, muscle guarding can be treated effectively with massage. From a massage therapist’s perspective muscle guarding may manifest as an obviously stiff, awkward feeling in the joint or limb movement – like the muscles are resisting movement imposed from the outside.

    With careful observation and listening to the patient, they can gain an understanding of the original source of the trauma and the ongoing issue. Gentle massage and pressure can then be applied to relax the muscles and loosen areas of tightness so that muscles that have been chronically contracted can return to a normal and pain-free function.

    Delayed Onset Muscle Soreness (DOMS)
    As the name suggests, delayed onset muscle soreness does not appear straight away. It is not simply sore muscles after exercise. Delayed onset muscle soreness presents itself as intense muscle soreness and weakness, causing the muscles to feel like they can’t coordinate properly. DOMS may start to occur a few hours after exercise but is usually at its worst a couple of days after an exercise activity.

    The clearest example of eccentric contraction is with 'assisted' (forced) knee flexion or squats especially squat to standing.

    Scientist can’t get to the bottom of what actually causes delayed onset muscle soreness, nor do people know how to treat it. OTC pain meds like Tylenol (in appropriate doses of 1,000mg) may ease the pain but will not help the muscle weakness or the recovery time. You just have to wait it out.

    Trigger points
    A familiar term amongst many, technically speaking, trigger points are a bunch of extremely contracted muscle cells called ‘sarcomeres’. These are like tiny little micro-muscles, bundles of protein fibres that are the basic component of most muscle tissue. Sometimes you get an area where these sarcomeres spasm or tighten up causing what we commonly refer to as a trigger point.

    So are all tight muscles trigger points? No. Sometimes the entire muscle will go into spasm, in other words, all the fibres contract. With a trigger point, there is a localised tender area and in some cases, the area can be very sensitive and painful for a massage therapist to work on.

    Trigger points are caused by tissue irritation, too much activity, overstretching or even chills. Having an experienced massage therapist perform trigger point therapy effectively can give you profoundly positive results, restoring ease of muscle movement and relaxing the surrounding muscles.

    Acknowledgement: SAGE Institute of Massage, Australia
     
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