For ischaemic compression steady pressure is applied to the painful trigger points, with the pressure being slowly increased over 30-60 seconds as the pain diminishes.

This good technique is almost as effective as cool and stretch. I found combining both methods, doing a session of ischaemic compression followed by a session of cool and stretch best.

I found this technique is also much better applied yourself. Professionals don't have the 'pain feedback' that you have, and often seem to let go too early. Doing it yourself you can apply the technique to your own satisfaction.

Using innovative methods to apply pressure

Finding a suitable implement to apply the pressure is important, especially if, like me at the time, your arms and hands are very sore. For TPs on my hands and arms I used a small plastic bottle with a smooth pointed lid (5-10 mm diameter - make sure it doesn't have corners or sharp bits)

For my hands and arms I would position the bottle end over the TP then lean my chin on the top to apply pressure, thereby freeing my hands and arms from having to hold it.

For the back a good one is to find a suitable door handle, or clothes hook on the wall. Carefully position yourself and lean back against it. Wear some thick clothing to help cushion your skin if the door handle/clothes hook is a bit sharp.

For the shoulders, find some piece of architecture that you can stand under and push up against, where a thin piece or outcrop can apply relatively sharp pressure to the TP.

Alternatively, of course, you can get a friend / spouse to apply pressure for you under your instructions, using whatever they find convenient (knuckles, fingers, elbow).

Doing it right

If you are doing it right it will hurt, alot. (When I started the pain was bad enough to make me sweat and feel sick). However the pain should gradually begin to subside. To begin with it won't completely go. But later, (after perhaps many months), at the end of the 60 seconds the area should feel numb.

It is necessary, I found, to apply considerable pressure. This pressure might seem too much. To check try applying the pressure to another area that is not tender, when you are pushing too much you will begin to feel a different sort of pain from the TP pain. Though there may be some discomfort, it seems to take alot of pressure to produce this pain on most body areas.

Deep Tissue massage involves hard digging and kneading of the area on and directly around the TP, attempting to break up the knot that forms around the TP.

I found that deep massage on very painful TPs did not help, and could make them worse. At this stage other techniques were more appropriate, although light, non-painful massage can be relaxing, and perhaps indirectly help relax the TP. Deep massage is good later on when the TPs are mild. See next section for further comments on massage.

These are important in regaining range of movement and flexibility, and can help with deactivating the TPs. It is important to do the stretch gently and hold it, for perhaps several minutes (at least 30 secs), whilst trying to relax. At first I would stretch quite hard, thinking the harder I pushed the better the stretch would work. However, I found out after a while that this often made the TP worse instead.

There are hundreds of possible stretches. I built up a regime from books, handouts given to me by treatment professionals and made some up. This regime included several stretches for each affected area (neck, shoulders, back, forearms, hands) and I would carry it out several times a day. I found it important to concentrate on doing the stretch properly each time, it was easy to get lazy and go through the motions. I have found that the difference in effects between a stretch done properly and with concentration and one done with little attention is considerable. If not done well they have no effect.

Correcting any muscle imbalances

Many of the problems of OOS can be exacerbated by postural and muscle imbalances. I was a good example of this. I had done a lot of swimming for many years, which had built up my pectoral and shoulder muscles. I had done stretches after swimming, but usually only stretched the back and trapezius muscles, these were the ones that felt most like they needed stretching. This added to hours spent hunched over a desk, or leaning forward at a computer caused me to develop posture with rounded, lifted shoulders, head forward and down, chin out. This posture greatly exacerbated my shoulder and neck pain, and correcting was obviously important. A physio I saw early on tried to get me to change by pulling my shoulders back, and my chin in. However, although this helped the TPs in my neck I found it very uncomfortable. After persevering in following her advice for many months I eventually developed TPs in my back (trapezius) as well, great. I now believe that such posture correction is impossible without directly trying to correct the muscle imbalances involved, by stretching and strengthening (see later section). I thus did alot of chest/pectoral stretches and neck stretches, trying to lengthen these muscles so as to allow my body to sit comfortably in a correct posture.

Nerve stretches may also have an effect upon the TPs. I used nerve stretches alot, though think they have more to do with other types of pain (caused by nerve tension, etc). I have thus discussed nerve stretches later under Neuropathic pain.

I visited a Chinese acupuncturist, who helped me greatly. I was seeing him twice a week and he would treat me alternately with Acupressure and Acupuncture. The acupressure was akin to a combination of ischaemic compression and deep tissue massage, though not always applied directly to the TP, or painful area. He used very strong treatment for me, occasionally causing minor bruising on my arms / back. However, the treatment had very beneficial results. He would explain it as breaking down the muscle and areas that were causing the problems, forcing them to reheal properly. He said that the treatment should not be done too much, and encouraged me to do exercise to encourage the healing.

Acupuncture by itself sometimes offered good pain relief, however, the effects always appeared to be short term. More beneficial appeared to be electrical stimulation applied to the acupuncture needles, usually applied between my wrist/hands and top of forearm, or neck / shoulder. The current was applied at approx. 1-2 pulses per second for 20-40 mins. This treatment appeared to help in reducing the sensitivity of my trigger points, and would also seem to settle my system. It was particularly good for neuropath pain (see later), and later on I duplicated the treatment to some degree using a TENS unit.

The electrical stimulation used was usually quite strong, once again, often painful. However, I viewed the pain as a healing pain, and looked forward to the improvements it brought. Usually the pain would subside after 5-10 mins, and often the Acupuncturist would then turn up the stimulation a bit more.

I should perhaps make the comment here that pain from recovery techniques was, I found, very common. The pain was often quite strong, but very often appeared necessary to gain good relief and recovery. It is obviously not correct to say that the more it hurts the better it works. Pain is not the aim, but I found that one should not be scared of it, and should not think that pain being felt during treatment is going to make things worse or is an indication of more damage being done. (although sometimes it can be worse for the immediate short term - 1-4 days)

This, more general technique, was done for me variously by a physiotherapist, osteopath, and massage therapists. I would, on past experience, not (in general) recommend physios for such treatment, they seem to be much less hands on people, and have less experience at physical treatments. I found it very important to follow advice about doing gentle stretches after the treatments. One very good Osteopath, whom I saw twice a week for many months, would use a systematic regime, massaging along each muscle, then stretching it for me. He would cover all the muscles in the area, not just those immediately sore. Once again deep strong massage was needed.

Ultrasound was used quite a number of times, on my hands, wrists and forearms. However, I don't really remember it appearing to have much of an effect. I'm told it is meant to help break down scar tissue, however, I always experienced much better results from the other methods described above. For my treatment, at least, ultrasound was at the bottom of the list of helpful treatments.