What are trigger points?
Trigger points, also known as trigger sites or muscle knots, are hyperirritable spots or areas in skeletal muscle that are associated with nodules and tight zones in muscle fibres.

• Trigger points are small zones of contracted muscle knots and are a common cause of pain.
  
  
• Compression of a trigger point may cause sensations of  local tenderness, referred pain, or local twitch response.
  
  
• The trigger point model states that pain frequently radiates from these points of local tenderness to broader areas, sometimes distant from the trigger point itself.

• Trigger points exist all over the body, many hundreds of them, from your jaw to your heel, from your pectoralis minor to your peronius tertius. All of which can produce symptoms which are amenable to my approach, one of multiple techniques all blended into one.
  
  
• Trigger points have a number of qualities. They may be classified as potential, active or latent and primary or secondary.
  
  
• There are more than 100 potential trigger points in the lower upper limb and hands.
  
  
• These trigger points, when they become active or latent, show up in similar places in muscles in every person.
  An active trigger point is one that actively refers pain either locally or to another location.
  A latent trigger point is one that exists, but does not yet refer pain actively, but may do so when pressure or strain is applied to the myoskeletal structure containing the trigger point.
  
  
• The trigger points are generally located at the muscle origin, middle of the muscle, at the myotendinous junction
  ( where the contractile portion of a muscle becomes the non-contractile tendon portion ), in the middle of the tendon and final insertion points of the tendon.
  
  
• Great attention must be taken to the ranges of movement of the carpal bones of the wrist, for if they are lacking in their full range, symptoms will occur. This needs the ability to articulate and to manipulate the carpal bones. There are many of us who have such joint adhesions especailly of the scaphoid, lunate and hamate bones where they join with the forearm bones, the radius and ulna.
  
  
• Elbow joint problems can also be at the root of apparent RSI, these need to be manipulated as above. The radial head is a common site of irritation, often with the patient feels the pain elsewhere, further down the back of the forearm.
  
  
• For more detailed information on the subject of RSI please read my RSI article.

• Neuro-muscular technique has been around since humans first experienced pain in their muscles. It is a natural instinct to squeeze and rub a painful are of muscles. The Naturopaths of the late 19th century evolved the technique.
  
  
• Myotherapy was developed in the USA after the second world war. It is similar to trigger point therapy.
  
  
• Myo-articulation uses triggerpoints but also employs simultaneous stretching of the trigger points and areas in the muscles. The technique was developed by me over many years of practice and observation. It is profoundly more effective than trigger point therapy or myotherapy alone.

"I had tendinitis in both hands, after improper use of the muscles - playing difficult pieces in long practice sessions without breaks, without doing the necessary stretching exercises and without thinking about my body.

The problems were on and off for about 2 years until I decided to suspend my playing for a year, to take time to think and to cure the problem.

During this time I completely recovered with the great help of Paul. He not just cured effectively the problems with the muscles and the tendons (through a simple physiotherapy) but also gave me a very good knowledge which I still use to maintain myself in a good health and prevent injuries.

I sent some of my colleagues from the Royal Academy of Music to him, as he is a great specialist dealing with musician's injuries (his understanding is even deeper as he himself plays the guitar).

I am really grateful to Paul and will recommend him to anyone. There is hardly anything that is not completely curable from the musician's injuries! :-) "

Stanislav Hvartchilkov: classical guitarist

"Five years ago, at a very young age, I began to develop RSI type symptoms. At the time I was playing in teaching a lot of guitar, and the pain began in my fingers of my left hand. My natural reaction was to shift most of the burden onto my right hand when I was typing, and as a result the symptoms seemed to spread all the way up both of my arms.

I searched for a cure, was put on multiple types of painkillers and anti-inflammatories by several GPs, was treated by osteopaths and sports masseurs but nothing seemed to work. When starting a new job in London, I looked on the Internet for someone to take on management of my condition as I knew it would involve a lot of computer based work. I stumbled across Paul's webpage and he seemed to be more in tune with the symptoms associated with RSI than anyone else I had approached, so I decided to give him a try.

Since that first meeting, the results have been extraordinary. His depth of experience means that he was able to pinpoint the source of the problem and treat accordingly. Whilst I am not "cured", the regular treatments keep symptoms at bay and allow me to live and work with effectively no restrictions. His ultimate aim is to work with my body so that I will be able to manage my symptoms without his help, and if someone had told me that my condition would be in such good shape even six months ago, I would never have believed them".

Tom, 23, Strategy Consultant