• TECHNIQUE: Specific sustained pressure on a local area where there is radiating pain or referring pain.
 
• BENEFIT: Ability to change muscle length and relax corresponding muscles that have been locked by adhesions.
 
The purpose of ischemic compression is to deliberately increase the blockage of blood to an area so that, upon release, there will be a resurgence of blood. This washes away waste products, supplies necessary oxygen and helps the affected tissue to heal. This increase of blood flow to the area is called a hyperemia. To apply ischemic compression to a trigger point, the relaxed muscle is stretched to the verge of discomfort. Initially, a thumb (or strong finger) is pressed directly on the Trigger Point to create tolerably painful (5 to 6 on a client pain scale of 10), sustained pressure. Treatment is useless if the patient tenses the muscles and so protects the Trigger Point from pressure. As the discomfort tends to abate, pressure is gradually increased by adding a thumb or finger from the other hand, as necessary, for reinforcement. This process is continued up to 1 min. with as much as 20 or 30 lb. of pressure. If Trigger Point tenderness persists, the procedure can be repeated, preferably after a hot pack and active range of motion." Travell, Janet, Myofascial Pain and Dysfunction, The Trigger point manual, v1.
 
Following treatment it is valuable to gently stretch the area to help the muscle "remember" its full length.
 
The first treatment should be conservative, lasting one or two minutes only, followed by a day of rest for the treated part. The treatment is resumed on alternate days until the pain abates and full usage is returned, usually within 3 to 10 sessions. Appropriate application of ice following treatment is recommended.
 
Trigger points can develop in ischemic areas of soft tissues such as muscles, tendons, or ligaments. When a trigger point becomes stimulated or stressed, it will cause a referred sensation that is usually remote from the trigger site. For example, if a trigger point develops in a neck muscle and becomes active because of injury, poor posture, repetitive motion or stress, it will commonly cause referred sensation into certain areas of the head (headaches) or cause upper back, shoulder, or arm pain. The trigger site can also refer other sensations such as numbness, tingling or burning. Another example involves active trigger points that develop in low back or hip muscles that can cause hip and leg sensations that are very similar to sciatic pain. Trigger point therapy is very useful to help alleviate pain of all kinds.
 
Muscle Energy Techniques (MET)-  Therapist assisted techniques that help to lengthen soft tissues or re-position a joint. For example, the therapist may first have a person contract a muscle or muscle group against the therapists resistance, then assist the person in stretching the same muscles. This sequence will be repeated until the desired length of the muscle or muscle group is reached.

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Works Cited
Braun, Mary Beth., and Stephanie J. Simonson. Introduction to Massage Therapy. Philadelphia: Lippincott Williams & Wilkins, 2005. Print.
Knaster, Mirka. Discovering the Body's Wisdom. Bantam 1996 NCTMB website