SaveYourself.ca helps you solve pain problems

updated 10/17/09

Many patients are surprised to learn how their wrist pain is caused or at least signifiantly affected by their forearm muscles.

Many patients are surprised to learn how their wrist pain is caused or at least signifiantly affected by their forearm muscles.

Massage Therapy for Tennis Elbow and Wrist Pain

Perfect Spot No. 5, in the common extensor tendon of the forearm

by Paul Ingraham, Vancouver, Canada (qualifications)

Trigger points (muscle knots) are the world’s most common cause of aches and pains. The Perfect Spots series of articles teaches you how to self massage the most satisfying and therapeutically significant places on the human body to apply pressure. Each Perfect Spot article focuses on a specific location. For a complete, advanced tutorial that walks you through every possible self-treatment option for muscle pain, see Save Yourself from Trigger Points & Myofascial Pain Syndrome!

Just beyond your elbow, all the muscles on the back of your forearm converge into a single thick tendon, the common extensor tendon. At the point where the muscles converge, in the muscles that extend the wrist and fingers, lies one of the most inevitable myofascial trigger points (muscle knots) in modern civilization: Perfect Spot No. 5. It is constantly and greatly aggravated both by computer usage today and by the use of a pen in simpler times — and by the occasional tennis match, then and now.

Unlike trigger points in the back or the shoulders, where feelings of aching and stiffness are all-too-familiar, people are often unaware that there is anything wrong in their forearm until things get ugly. Unfortunately, instead of being diagnosed correctly, almost everyone who develops an active Spot No. 5 is diagnosed with either “tennis elbow” or a wrist problem, usually carpal tunnel syndrome. Note that not every Perfect Spot is a major cause of common problems in the area — I do not blindly assume that every muscle knot is clinically significant! But this one often is.

The unholy relationship between Perfect Spot No. 5, wrist pain and carpal tunnel syndrome

Virtually all wrist pain is either caused or significantly complicated by myofascial trigger points in the forearm musculature, especially the extensors of the wrist and fingers, and especially Perfect Spot No. 5.

(Of course, injuries are an exception, right? Sadly, no. The “cause or complicate” rule applies even with injuries: if you damage your wrist, tension in the forearm is going to be a factor in healing.)

Unless there is a clear injury, nearly all kinds of wrist pain, regardless of their true cause, are usually mistaken for carpal tunnel syndrome. Carpal tunnel syndrome is one of those conditions that enjoys such a grandiose reputation, such over-the-top “popularity,” that it is usually suspected and diagnosed no matter how wrong the symptoms are.  Something wrong with your wrist?  Must be carpal tunnel syndrome!

The One True Cause of most wrist pain, however, is Spot No. 5!

Even when Spot No.5 is not the actual cause of wrist pain, it is often such a significant complication that relieving it will virtually solve the problem. In fact, even in cases of actual carpal tunnel syndrome, where all the signs and symptoms really do fit with a diagnosis of carpal tunnel syndrome, treating trigger points in the forearm often resolves the problem — somehow, relieving them interrupts whatever vicious cycle it is that perpetuates carpal tunnel syndrome.

 Something wrong with your wrist?  Must be carpal tunnel syndrome!

Spot No. 5’s dramatic tennis elbow connection

Perfect Spot No. 5 is probably1 a major cause of or contributor to a “tennis elbow,” technically known as lateral epicondylitis, which commonly afflicts typists as well as racquet sports players. Just like “carpal tunnel syndrome” often isn’t really carpal tunnel syndrome, “tennis elbow” often isn’t really tennis elbow. Tennis elbow is regarded my most health care professionals as being a tendinitis of the common extensor tendon at the elbow — immediately to the “North” of Perfect Spot No. 5.

But tennis elbow is rarely if ever a case of true or “pure” tendinitis, because there isn’t actually much inflammation involved. In 1999, Boyer and Hastings wrote, “The term epicondylitis suggests an inflammatory cause; however, in all but one publication … no evidence of acute or chronic inflammation is found.”2

Instead, tennis elbow is entirely the result of either the pain of trigger points themselves, or due to the fact that muscle knots are pulling hard on the tendon. Regardless, the quickest path to relief in almost all cases of wrist and elbow pain is to massage Perfect Spot No. 5. Self-treating them is a low-cost, low-risk method of attempting treatment of tennis elbow. For more information about dealing with tennis elbow, see Save Yourself from Tennis Elbow!.

And a (strange) scalene muscle connection with Spot No. 5 and tennis elbow

Curiously, a muscle in the neck seems to have an unusually strong effect on Perfect Spot No. 5. Travell and Simons write, “Scalene muscle trigger points are frequently the key to [treatment of] forearm extensor digitorum trigger points.”3 If you need to help your forearm muscles, I recommend also treating your scalene muscles — see Massage Therapy for Neck Pain (and Much More).

How to find and treat Perfect Spot No. 5

The muscles on the back of your forearm lift your fingers and wrist. You can see them moving under the skin of your arm if you drum your fingers on a desk. In writing, typing, and mousing, these muscles must hold the wrist up and stable, and the fingers work constantly. In racquet sports, the forearm muscles particularly suffer because of the eccentric contraction required to stabilize the wrist on striking.4

Spot 5 is easy to find and treat yourself. Simply find the bony knob on the outside edge of your elbow. This is the point on which all the muscles on the back of your arm converge. Just beyond that point — below it, towards the wrist — you can easily find the thick common extensor tendon. Perfect Spot No. 5 is just a little further down.

Perfect Spot No. 5 is one of those Perfect Spots that is not alone in the area. You can find significant trigger points nearly anywhere in the muscles on the back of the forearm! Perfect Spot No. 5 is simply the best of the lot.

An easy way to self-treat this spot is to press it into a hard surface — the rounded edge of a counter top is about the right height and shape. It won’t take much experimentation for you to figure out exactly where to press! As always, go slow and easy at first to avoid aggravating it.


Further Reading

If you found this article useful, you may also be interested in some other articles I’ve published:

Notes

  1. The science is not in. It’s a reasonable theory, but hardly proven. Return to text.
  2. Boyer et al. Journal of Shoulder And Elbow Surgery. 1999. Return to text.
  3. Travell et al. Myofascial Pain and Dysfunction. 1999. Volume 1, p513. Return to text.

  4. An eccentric contraction is an interesting but routine type of muscular contraction that seems like a paradox: the muscle is contracting even as it is lengthening! Eccentric contraction is a bit mysterious, and is known to be harder on muscle, causing more soreness, as in your quadriceps after climbing down a mountain. For more information about eccentric contraction, see Eccentric Contraction: A peculiar phenomenon in muscle physiology.

    Return to text.

All The Perfect Spots for Trigger Point Massage

Choose your perfect spot!

Or, for general information and advanced tips about trigger point therapy, see Save Yourself from Trigger Points!

and …


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Are trigger points too good to be true?

Trigger point therapy often fails, but it often succeeds. Trigger points are not a “flaky” diagnosis. They are based on a lot of hard science. You can take photomicrographs of them, measure their electrical activity, take samples of their acidic and toxic tissue chemistry.

In addition to a decade of my own clinical experience, the Perfect Spots are based primarily on the research and writing of Drs. Janet Travell and David Simons, the pioneers of myofascial pain syndrome research. Dr. Travell died in 1997 after decades of tireless efforts to educate her medical colleagues about trigger points. Dr. Simons continues to publish. They produced “the Big Red Books,” a massive 2-volume text about trigger points, and recently Dr. Simons published Muscle Pain with Dr. Siegfried Mense.

The existence and importance of trigger points is not scientifically controversial, but it is obscure. The challenge is to get the word out. Doctors are generally uninformed about musculoskeletal health care — it simply isn’t on their radar. As Dr. Simons wrote, “Muscle is an orphan organ. No medical speciality claims it.