1. What is a trigger point?
2. Extensor Carpi Radialis Longus Massage
3. Extensor Digitorum Massage

Massage of the Extensor Carpi Radialis Longus Muscle

Action of the Extensor Carpi Radialis Longus Muscle The Extensor Carpi Radialis Longus (ECRL) bends the wrist toward the thumb side of the hand and also backwards. It also helps bend the elbow. These three actions are demonstrated in picture 1. You would for example use this action when throwing a Frisbee. When this or any muscle is worked hard, it develops trigger points. Common activities that work this muscle hard are key board typing, and computer mouse work (especially when the mouse is held too far to the side of the key board). A more complete list of activities that may cause trigger points and tennis elbow pain are shown in the panel below. (Show/Hide) List of activities that work the Extensor carpi radialis:- Typing Piano playing Computer mouse work Tennis and Golf Stirring paint or cookie doug h Screw driver work.

Picture 1: The wrist and arm action that works the Extensor carpi radialis longus muscle. The opposite hand is in position to feel the muscle go tense.

The trigger point in the extensor carpi radialis is about two inches away from the crease of the elbow. Locate it thus: Bend the elbow up and with the other hand hold the forearm close to the elbow (refer picture 1 above). Extend the wrist (fist moves away from you), and lower the outstretched thumb. (The muscle is now tense under your finger tips). Explore the tense muscle by pressing into it with the tip of the second finger. Trigger points in muscles are painful when pressed - you will have no trouble finding this one!

Diagram 1: Extensor carpi radialis longus trigger point and referred pain pattern (the drawings show the outer side of the forearm and hand). Left: The muscle together with its trigger point. Right: the trigger point location and its pain referral patterns. (From Clair Davies: The Trigger Point Therapy Workbook).

How to De-activate the Trigger Point in the Extensor Carpi Radialis Longus Muscle Relax the wrist and thumb, and press into the sore spot for 6 to 30 seconds. Work to the limit of your pain. Be patient. Repeat once if necessary (see picture 2). Follow up by stretching the muscle (see picture 3). How often? - Repeat twice weekly, or (if you keep the pressure light) as often as you feel you need it. Note: You could attempt to press on the ECRL trigger point with the elbow not bent, but in this position, the ECRL muscle just roles around the bone and hides under its neighbor, the Brachioradialis muscle.

Picture 2: The right arm is now relaxed, and the middle finger of the opposite hand is pressing on the trigger point that has just been located -it's painful, but the result will be worth it! Picture 3: Extensor Carpi Radialis Longus Stretch

Extensor Digitorum Massage

Trigger points in the extensor digitorum are also a major cause of tennis elbow pain. The extensor digitorum straightens (extends) the third, fourth, and fifth fingers. Trigger points in the extensor digitorum send pain to the outer elbow, and the second knuckle of the third and fourth fingers. When you make a fist or grasp something strongly, the finger extensors are called upon to help keep the wrist from bending when the fingers bend. The harder you grip something, the harder the finger extensors have to work. List of activities that work the Extensor carpi radialis hard:- Computer keyboarding Computer mouse work (make sure you take your hand off the mouse as often as you possibly can!) Gripping a tennis racket

Diagram 2: Extensor digitorum - trigger point and referred pain pattern (Source: The Trigger Point Therapy Workbook).

How to Locate the Trigger Points in the Extensor digitorum Muscle There are two trigger points in the Extensor digitorum muscle; both of which are associated with the hard working middle finger. (It is rare for the third and fourth fingers to be working hard enough to cause trouble in the extensor digitorum muscle). Here is how to locate them: First Trigger Point (see pictures 4 and 5)): Locate the first trigger point by pressing the fingers into the muscle about 2 inches away from the crease of the elbow, and waggling the middle finger. This action tenses and relaxes the ED muscle so you know where it is, and you can then search for the painful spot in the muscle. Second Trigger Point The instructions are the same as for the first trigger point, just place the fingers about 2 and three quarter inches away from from the crease of the elbow. How to De-activate the Trigger Points in the Extensor digitorum Muscle Press into the trigger point with the middle finger (the other fingers aid the middle finger by stabilizing the Extensor muscle) Six to 30 seconds at the pain level you can easily tolerate, and then repeat once if necessary. Follow up by stretching the muscle (see pictures 5 and 6). Repeat twice weekly, or (if you keep the pressure light) as often as you feel you need it. Summary You have now learnt to de-activate trigger points in two of the most common locations in the forearm. For many people, de-activating these trigger points will be enough to bring about relief to their trigger point induced tennis elbow problem. There are however many more trigger points that may be involved. Both in the forearm, and higher up the arm, shoulder and even the neck. This excellent book will help you: Trigger Point Book Recommendation Read what people have to say about this remarkable book! - Clair Davies: The Trigger Point Therapy Workbook.

Picture 4: By applying finger tips across the body of the Extensor digitorum muscle, we can minimise side role of the muscle and keep it securely under the pressure of the middle finger (note: next picture shows actual hand positioning to press on the trigger point)... Picture 5: Locate the muscle by waggling the middle finger, and then probe for and de-activate the sore spots with the middle finger. The first and third fingers are there to minimise the side roll of the extensor digitorum muscle . Picture 6: To stretch the extensor digitorum longus, make a fist and curl it downward with the help of the other hand.