Nearly 20 years ago, Janet Travell and David Simons, the two leading pioneers of management of myofascial pain, described a simple myofascial-pain self-treatment approach, particularly when interscapular areas are involved. They advised putting two tennis balls into a sock, and placing this onto the floor (ideally carpeted), in a way that allows the person to lie back onto them — so inducing a compressive force that is almost entirely under the control of the individual.

If this direct pressure is uncomfortable, more weight could be taken on the forearms, and less on the sensitive areas. The advice was to have kept the balls in a freezer, before use, so that they are very cold, adding cryotherapy pain-relief to the process.

A few minutes of such treatment, no more than once a day, should effectively reduce myofascial pain — remembering that the underlying causes and aggravating features, of the dysfunction — whether involving poor posture, or due to overuse should be addressed in order to avoid recurrence.

Travell and Simons advised that: "Whenever the patient hits a "hot spot" or a painful trigger point, he or she can maintain that position and control the pressure by starting gently and gradually increasing body-weight pressure on the tennis-balls, until the trigger point releases."

My own approach to use of this method, for paraspinal muscle tension or pain, were described in my book, "Maintaining Body balance, Flexibility & Stability." A: Place two tennis balls into a sock. B: Place the balls on a carpeted floor. C: Lie so that your spinous processes rest between the balls, and the balls press into the tense muscles alongside the spine. ¹

Cautions for Self-Applied Treatments

It is often found to be useful to move gently, so that the balls roll up and down the paraspinal muscles, for a minute or two. There are several important cautions regarding self- applied treatments of any sort, including trigger point deactivation. If you offer advice for home care/self-treatment it's important for the individual to be advised that:

1. Pain relief should seldom be an end in itself — so underlying causes should always be considered and addressed.
2. It is important to follow the guidelines you provide, and in particular, to avoid over-treatment.
3. It is unwise to self-treat too many trigger points at any one time, potentially overloading repair and adaptation potentials — one or two per day is a safe number.

Thoracic mobilization using tennis balls

Recently a more general thoracic mobilization variation of the use of the "two tennis balls" has been described and validated by research. In 2012 a two-stage method, for self-mobilization of the thoracic area, was described by Johnson & Grindstaff.²

Stage 1: Paraspinal Muscle Release

The individual lies back onto the two tennis balls, that have been confined in something such as a sock — so that the balls press lightly (and painlessly) into the stiffest paraspinal soft-tissues, with the spinous process resting in the groove between the balls.

The arms should be crossed over the chest, as the person slowly raises the head-and-shoulders off of the floor, for a count of three seconds, before lowering back down to allow the balls to press into the tense tissues for a few seconds. It is suggested that — once daily — this process should be repeated up to 15 times.

Then, following a few minutes of rest, the sequence should be repeated once more. Different levels of paraspinal stiffness can be treated, in the same way, by placing the balls appropriately. Slow deep breathing should accompany the exercise, and no pain should be experienced.

Stage 2: Supine Arm Circles

The tennis balls should be placed on one side or the other — in tense tissues, lateral, or inferior, to the scapula, so that the two balls are parallel to the thoracic spine. The arm on the side being treated should be raised so that the shoulder is flexed to 90 degrees, with the arm straight.

The arm should be moved in slowly increasing circles, clockwise, for about 30 seconds, and then anti-clockwise for the same length of time. After resting for a minute or so, the process should be repeated — before the other side is self-mobilized in the same way. Slow deep breathing should accompany the exercise, and no pain should be experienced.

Validation of the usefulness of these methods was reported in 2015, by Jung et al., who observed that when the protocol, as described above, was used by people with thoracic restrictions, there was a marked difference in thoracic mobility (as evidenced by a significant increase in the degree of chest expansion) between those who performed the exercises (three times weekly for six weeks), compared with those who did not.

References

1. Chaitow L. Maintaining Body Balance, Flexibility & Stability. Cambridge: Elsevier, 2004; pp. 114.
2. Johnson K, Grindstaff T. "Thoracic region self-mobilization: a clinical suggestion." International Journal of Sports Physical Therapy, 2012; 7(2):252-256.
3. Jung J, et al. "The effect of thoracic region self-mobilization on chest expansion and pulmonary function." Journal of physical therapy science, 2015; 27(9):2779-2781.
4. Travell J, Simons D. Myofascial Pain and Dysfunction: The Trigger Point Manual Volume 1: Upper Half of Body, 2nd Edition. Philadelphia: Lippincott Williams & Wilkins, 1999; pp. 295.