Brachialis Trigger Points and Referred Pain Patterns

Before reading about trigger points and pain from the brachialis muscle, you may want to find out more basic information about the muscle.

As a primary elbow flexor along with the familiar biceps, the brachialis can be overworked by the same types of activities that overwork the biceps brachii, and perhaps even more so.

Brachialis Trigger Point Causes and Symptoms

Anything that requires repeated and/or sustained bending of the elbow, especially under load, and overwork the brachialis. Carrying groceries, using handheld power tools for long periods, repeatedly picking up children, carrying a purse or bag hanging on the forearm, fingering a guitar or violin with the forearm supinated, etc. Sustained computer work or driving may also aggravate the muscle. ¹Simons, David G., Janet G. Travell, Lois S. Simons, and Janet G. Travell. Travell & Simons’ Myofascial Pain and Dysfunction: The Trigger Point Manual. Baltimore: Williams & Wilkins, 1999. 660-665.,²Davies, Clair. The Trigger Point Therapy Workbook: Your Self-treatment Guide for Pain Relief. Oakland, CA: New Harbinger Publications, 2004. 113.

When exercising with elbow flexion, such as with barbell or dumbbell curls or with chinups/pullups, “doing too much too soon” can overwork or strain the muscle. Avoid excessive use reverse curls, which are weighed curls with the hand pronated (palms facing down or almost down), so as not to over-burden the brachialis (although it is perfectly okay to do this moderately, just not exclusively).

Neither the biceps or brachialis is activated when the arm is carrying a load in a fully extended position, and gravity is pulling the load straight down, so strain to the muscle through carrying exercises or deadlift exercises is only likely if unintentional elbow flexion is done, or the forearm is suddenly and violently extended. Although the ruptures of the proximal or distal biceps tendon are somewhat common, rupture of a brachialis tendon is rare. ³Doyle, James R., and Michael J. Botte. Surgical Anatomy of the Hand and Upper Extremity. Philadelphia: Lippincott Williams & Wilkins, 2003. 102-103.,⁴Simons, David G., Janet G. Travell, Lois S. Simons, and Janet G. Travell. Travell & Simons’ Myofascial Pain and Dysfunction: The Trigger Point Manual. Baltimore: Williams & Wilkins, 1999. 660-665.

Although most of the same activities that set up trigger points in the biceps brachii can also set up trigger points in the brachialis, the symptoms are quite different. Most of the referred pain from trigger points in the brachialis is in the volar part of the carpometacarpal joint of the thumb (opposite the palm at base of thumb) and also to the web of the thumb in that area. This pain may be felt at rest or also with use of the thumb. There may also be a diffuse tenderness in the thumb. Since the brachialis is capable of entrapping the superficial sensory branch of the radial nerve, there may be dysesthesia, tingling, and numbness in this area of the thumb. The pain and tenderness in the thumb, and the entrapment symptoms may be caused by trigger points in different areas of the muscle. ⁵Simons, David G., Janet G. Travell, Lois S. Simons, and Janet G. Travell. Travell & Simons’ Myofascial Pain and Dysfunction: The Trigger Point Manual. Baltimore: Williams & Wilkins, 1999. 660-665.,⁶Ferguson, Lucy Whyte., and Robert Gerwin. Clinical Mastery in the Treatment of Myofascial Pain. Philadelphia: Lippincott Williams & Wilkins, 2005. 174.

Oboe, clarinet, and sometimes saxophone players experience chronic thumb pain and numbness, usually on the right hand, which can easily be mistaken for a thumb problem since the thumb is certainly used a lot as a buttress for fingering the instrument while supporting the weight of the instrument. But the real problem may be that the brachialis has to stay contracted continuously while playing the instrument, and the symptoms in the thumb are caused by trigger points in the muscle. ⁷Simons, David G., Janet G. Travell, Lois S. Simons, and Janet G. Travell. Travell & Simons’ Myofascial Pain and Dysfunction: The Trigger Point Manual. Baltimore: Williams & Wilkins, 1999. 660-665.,⁸Davies, Clair. The Trigger Point Therapy Workbook: Your Self-treatment Guide for Pain Relief. Oakland, CA: New Harbinger Publications, 2004. 113.

The trigger points that occur more distally (closer to the elbow) may refer some pain to the crook of the elbow. The trigger points that occur further up, closer to the deltoid insertion refer spillover pain mostly upwards toward the deltoid. This does not affect movement at the shoulder. ⁹Simons, David G., Janet G. Travell, Lois S. Simons, and Janet G. Travell. Travell & Simons’ Myofascial Pain and Dysfunction: The Trigger Point Manual. Baltimore: Williams & Wilkins, 1999. 660-665.

Brachialis Trigger Point Self Release

The figure below shows the locations and referred pain patterns of brachialis TrP’s. To avoid these or to avoid aggravating existing TrP’s, try not to overwork the muscle, as described above. Also, when the elbow must be continually flexed as when working with tools or playing an instrument such as woodwind or guitar, put down the instrument at every opportunity and allow the arm to hang freely and relax, so as to rest the muscle and help return it to its resting length. Do not hold a purse on the forearm with the elbow bent, instead hold it in the fingers with the arm dangling or with the strap over the opposite shoulder. Remember that corrective actions and avoidance are really the same things, but for correction, you must be more diligent. ¹⁰Simons, David G., Janet G. Travell, Lois S. Simons, and Janet G. Travell. Travell & Simons’ Myofascial Pain and Dysfunction: The Trigger Point Manual. Baltimore: Williams & Wilkins, 1999. 660-665.,¹¹Davies, Clair. The Trigger Point Therapy Workbook: Your Self-treatment Guide for Pain Relief. Oakland, CA: New Harbinger Publications, 2004. 113.

The brachialis can be stretched by supporting the back of the upper arm, as on the arm of a chair, with the arm stretched out in front of you and the palm turned up. Push down on the wrist to gently stretch the muscle. Do this several times a day. ¹²Simons, David G., Janet G. Travell, Lois S. Simons, and Janet G. Travell. Travell & Simons’ Myofascial Pain and Dysfunction: The Trigger Point Manual. Baltimore: Williams & Wilkins, 1999. 660-665.

There may be a trigger point closer to the elbow and another a bit further away, but both are fairly close to the elbow. Remember, the muscle does not even stretch all the way to the shoulder joint. Although the brachialis lies under the biceps, it can be palpated and self-massaged by pushing aside the biceps. Using the fingers or knuckles, starting just above the crease of the elbow, push the biceps toward the body (medially) and massage the brachialis underneath against the humerus bone. To facilitate this, sit in a chair and lean forward so that you can rest your elbow on your thigh, to support the arm while massaging the muscle. Feel for trigger points starting at the elbow crease and working your way up. The trigger point that occurs in the upper position may be the one causing entrapment of the radial nerve if you are experiencing entrapment symptoms. Expect associated trigger points in the biceps brachii, brachioradialis, and/or supinator teres. ¹³Davies, Clair. The Trigger Point Therapy Workbook: Your Self-treatment Guide for Pain Relief. Oakland, CA: New Harbinger Publications, 2004. 113.