This technique might be the single most effective non-invasive method for deactivating trigger points. So why isn’t it used more often?
Spray and Stretch is one of those strange trigger point treatment techniques that are extremely effective, but somehow under-used.
It could be because it’s simply not taught widely nowadays, or that it’s just somehow become unfashionable.
- Reduces migraine symptoms. …
- Numbs nerve irritation. …
- Helps treat mood disorders. …
- Reduces arthritic pain. …
- May help treat low-risk tumors. …
- May help prevent dementia and Alzheimer’s disease. …
- Treats atopic dermatitis and other skin conditions.
The spray and stretch technique, Cryotherapy is a learned modality that can quickly alleviate acute pain and restricted range of motion due to muscle trigger points. The application of a vapor coolant acts as a counterirritant to myofascial pain due to muscle spasms and trigger points.
Studies have Confirmed Positive Results
- Decreases pain sensation to allow the muscle to be stretched.
- Helps inactivate trigger points, relieve muscle spasms and reduce referred pain.
Hans Kraus (1941), who was the first to describe the technique of spray and stretch using ethyl chloride spray, used the technique for treating aches and sprains in circus performers.
Since then, a number of coolant techniques have been developed to treat almost all trigger points.
These often appear to have a myorelaxant effect within a few seconds of application. A number of studies have confirmed positive results.
In fact, a 1998 study (Simons) summarised this technique as the “single most effective non-invasive method” for deactivating trigger points.
Ethyl chloride spray is highly flammable, toxic, and is considerably colder than is necessary. It is volatile and has even accidentally killed several patients and doctors.
Vapocoolents, such as a Fluori-Methane spray, are a safer alternative, although being a fluorocarbon, it may affect the ozone layer.
The recommended product (and sorry no, we don’t sell it) is Gebauer’s “Spray and Stretch”, as it is nontoxic and nonflammable.
Machine-based products, such as Cryonics CRYO+, are also gaining popularity. These products are far more predictable and controllable.
The Physiological Basis for these Products is a Type of “Thermal Shock”
Research has indicated that these techniques work partly on the hypothalamus.
The rapid skin cooling challenges the autonomic reflex pathways and forces a local homeostatic response, which may have a therapeutic action.
A skin cooling of the skin by 2–5 degrees is enough to cause this reaction. The following beneficial effects have been suggested in a number of studies:
Spray and Stretch Contraindications
- Allergy to cold
- Raynaud’s syndrome
- Disorders of skin sensitivity
Spray and Stretch, Cryotherapy Technique
The basic spray and stretch technique is quite straightforward, as it does not require the same precise localization of trigger points as for needling or injection.
Instead, you need only locate and identify the affected host muscle to release its fibers. However, it is advisable first to locate the trigger point by palpation.
Doing this tends to help reassure the patient as to the efficacy of this “unusual” approach.
- Spray: This is a distraction for the more important second step. The spray is aimed out of the inverted bottle nozzle at 30 degrees to the skin in a fine jet over a distance of about 20–50 cm (aim at an area rather than a single spot).
- Stretch: This is the therapeutic component of the technique. While two to three sweeps of spray are applied to the affected/host muscle, the muscle is gently extended to its full stretch length.
When to Use Spray and Stretch
- Young children
- Needle-shy patient
- Immediately after trigger point injection
- Post-hemiplegic—stroke rehabilitation
- Immediately following major trauma, e.g. fracture or dislocation
- After whiplash injury
- In a patient with myofascial trigger points and hyperuricemia (excess uric acid)
- Chronic or inhibition-resistant trigger points
- Attachment trigger points
Spray and Stretch Tips
- Locating the central trigger point which causes a precise referred pain pattern is recommended, as it gives the patient a rationale for accepting treatment. Make sure the patient has recently eaten, as hypoglycemia aggravates trigger points.
- Provide a warmish surgery/room.
- Use a blanket to cover the body and areas not being cooled, as muscle warmth is more conducive to muscle relaxation.
- Remember to cover the eyes where appropriate.
- Do not aim at a single spot, as this can burn or cause urticaria.
- Do not force a stretch.
- If the patient is apprehensive, ask them to focus on their breathing.
- Test the range of motion before and after the spray and stretch technique. Make sure that the muscle to be treated is fully relaxed and support it where possible—treatment can be performed sitting, side-lying, prone, or supine.
- To achieve a full stretch, you should anchor one side of the muscle, and move the other (passively).
If you are not familiar with Spray and Stretch, we suggest giving it a try.
The chances are that you will be amazed at the results. It’s certainly not the only way to release trigger points, and it’s not the best option in all cases but, as stated above, it is fantastically effective in certain situations, especially when treating young children.
What is a Modern cryotherapy chamber?
Spray and Stretch Technique for Myofascial Pain
Many of you may recall the name of Janet Travell. She was President Kennedy’s personal physician. It was Dr. Travell that developed the spray and stretch technique used today for trigger point therapy. The term “trigger point” was coined in 1942 by Dr. Janet Travell to describe a clinical finding related to a discrete, irritable point in the skeletal muscle or fascia. Trigger Point Therapy is safe and effective in improving myofascial pain syndromes such as headaches from referred muscle dysfunction, tennis elbow, frozen shoulder, TMJ, fibromyalgia, and any muscle dysfunction that may be encountered through injury or overuse. Mainstream clinical research has shown that trigger points are often responsible for headaches, muscle weakness and pain, restricted range of motion, tearing, sweating, salivation, dizziness, and blurred vision. We have found that using a combination of the spray and stretch technique with acupuncture and chiropractic techniques has been able to help many acute and chronic disorders that may be recalcitrant to conventional medicine.
What Causes Trigger Points?
Normal, healthy muscles do not have trigger points. After experiencing trauma, such as a fall, car accident, joint sprain, or abnormal excessive exercise, the muscles can develop trigger points. Trigger points may also develop in muscles that are chronically overloaded by poor posture, especially while working, or repetitive muscle movements such as sitting at a computer all day. Structural discrepancies, like uneven legs and pelvic bones, may produce chronic mechanical stress that activates trigger points. This is why Travell prescribed left heel lifts for all of Kennedy’s shoes
How does the Spray and Stretch Technique Work?
As described by Dr. Travell, when spraying the skin surface the sudden drop in skin temperature is thought to produce temporary anesthesia allowing the muscle to be passively stretched to inactivate or break down trigger points in the muscles. The spray and stretch technique uses a vapor coolant as a counterirritant to myofascial pain due to muscle spasms and trigger points. Using the spray and stretch technique decreases the pain sensation and helps in relieving muscle spasms and referred pain. Thus the spray and stretch technique can help in alleviating acute pain and restricted range of motion due to muscle trigger points associated with myofascial pain syndromes.
Trigger points are tender and irritable spots located in muscles and tendons, that when activated, refer to painful sensations (including aching, throbbing, burning, and even itching) to distant areas of the body.
The hundreds of known trigger points are beyond the scope of this article but can be found in resources such as the monumental texts by Travell and Simons: […] The Trigger Point Manuals: Volumes 1 & 2 (which cover the upper and lower body respectively).
The most frequently used techniques to diminish trigger point activity include the following:
- Trigger point pressure release (also known as “ischemic compression”)
- Chilling techniques (including ice, and spray, and stretch)
- Dry or wet needling (acupuncture or trigger point injection)
- Muscle energy stretching techniques
- Superficial Moist heat (as from a hot pack)
- And a host of other techniques way beyond the scope of this article.
One of the authors (Keats) a massage therapist specializing in Neuromuscular Therapy, primarily uses the trigger point pressure release method as it has been shown in scientific research to be one of the most effective methods for deactivating noxious trigger points. However, performing this type of therapeutic modality requires a thorough knowledge of anatomy and a high level of palpatory skill in order to locate the trigger points.
- Rest. Allow your body to rest if you have muscle knots. …
- Stretch. …
- Exercise. …
- Hot and cold therapy. …
- Use a muscle rub. …
- Trigger point pressure release. …
- Physical therapy.
Please consult your healthcare provider with any questions or concerns you may have regarding your condition.
The information provided is for educational purposes only and is not intended as a diagnosis, treatment, or prescription of any kind. The decision to use, or not to use, any information is the sole responsibility of the reader. These statements are not expressions of legal opinion relative to the scope of practice, medical diagnosis, or medical advice, nor do they represent an endorsement of any product, company, or specific massage therapy technique, modality, or approach. All trademarks, registered trademarks, brand names, registered brand names, logos, and company logos referenced in this post are the property of their owners.
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