Ischemic Compression for Trigger Points

Ischemic compression is a generic manual release technique in trigger point therapy. The technique begins by palpating the tissue to locate the taut band (trigger point), while the patient is asked to report if any referred pain is felt. When a trigger point if found, steady and deep manual pressure is applied directly to the point. The pressure is held for 5 to 10 seconds and then released for 2 to 3 seconds. It is repeated 3 to 4 times in the session. Each time the pressure is reapplied, it becomes stronger. The compression is repeated until the local or referred pain is diminished, or until two minutes have passed. There are no rubbing, stroking, or stripping movements used.

Note: There are many different manual techniques used to treat trigger points or other soft tissue problems. Some of these have “brand names” and are being developed as an entrepreneurial technique by a certain person or organization, while others have names based simply on anatomic or physiologic descriptions, hence the term generic, used above.

This method was promoted by Raymond L. Nimmo, a pioneer in chiropracty, and others, and is sometimes known as the Nimmo technique, especially in the chiropractic field. It and many variations are used by massage therapists and physical therapists where it may be called myotherapy or neuromuscular therapy. Travell and Simmons have since advocated a gentler compression method, called Trigger Point Pressure Release. 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.

Clinical Application of Neuromuscular Techniques, Volume 1: The Upper Body

 

The term ischemic compression most likely developed as a result of the blanching effect on the skin during the treatment, which is followed by the skin immediately reddening once the pressure is released. During this time, the tissues become hyperemic, meaning there is an increase in blood flow to the area and the tissues become engorged. It was thought that this resulted in “washing out” the muscles tissue of inflammatory exudates which relieved pain. There has been no research to support this theory. Although the Trigger Point Pressure Release method advocated by Travell and Simmons is similar, it is recommended to avoid ischemia and the technique is more complex.

The authors described an apparent contradiction to using deep pressure in already ischemic tissues: The blood flow would be reduced even more. Therefore, in the second edition of their book, they recommended a lighter compression applied until restricting tissue tension is met, and then a gentle stretching of the affected tissues.

Another suggested alternative to ischemic pressure is integrated neuromuscular inhibition technique or INIT, which uses on off and on pressure instead of continuous pressure. Here, firm pressure is still used, but only held for 5 seconds, then released for 2 to 3 seconds, and repeated until a change in palpation is felt or the patient reports a change in the perception of pain.

Sources   [ + ]

1. Simons, 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.