I have had the great fortune to collaborate with many excellent certified athletic trainers during my years working with collegiate and professional athletes. Over time, these trainers knew when to refer to me, and they understood which conditions respond favorably to soft-tissue therapy. This is why my experience with a new trainer a few weeks ago was so startling.

During a momentary break from seeing athletes in rapid succession, the trainer popped in.

“Everything going well?” he asked. “The players really seem to like this, which is probably a good thing. Sometimes, athletes just need to be placated.”

“Placating?” I thought to myself. “Is that what I am doing?” I was too stunned to respond at that moment, but I knew I couldn’t let the comment pass without addressing it. Gathering up my things, after I finished with the athletes, I happened to run into the trainer on my way out.

“If you have a second, I’d like to share with you the methodology behind what I am doing with the players. Let’s imagine that an athlete has pain in the anterior shoulder, for instance.”

“Like my left shoulder?” the trainer asked with interest.

“Really?” I replied. “I’m curious, if I strength test your left anterior deltoid relative to your other shoulder, is the left deltoid weaker?”

“You can test it, but I can tell you right now it is significantly weaker than the right deltoid. I have been doing strengthening exercises, but it doesn’t get stronger and the pain seems to increase after exercise.”

Just to double check, I did resistive testing on the left anterior deltoid and found it significantly weaker than the right. The left deltoid also had mild pain during contraction as well.

“Are you familiar with trigger points?” I asked the trainer.

“Sure,” he said. “They are points that refer pain to other parts of the body.”

“That’s true, but only part of the story,” I answered. “It is more accurate to say that trigger points refer sensation, rather than pain. Sometimes trigger points mimic nerve entrapment, a feeling of itching, or even nausea. More commonly, trigger points can create motor inhibition in areas of referral, making muscles in the area of referral test weak. This phenomenon is called motor inhibition, and is much more common than most therapists realize.

“As an example, the common referral area for the infraspinatus happens to be the anterior deltoid. It is possible that an infraspinatus trigger point can create a deep ache in the anterior deltoid, but another possibility is that the infraspinatus can create motor inhibition of the anterior deltoid, decreasing its strength. Let me show you.”

Using my thumb to examine his infraspinatus, I happened to land on exactly the right spot. Pressing on the tiny nodule I felt in his infraspinatus, he felt an immediate deep aching in the front of his shoulder. Judging by his reaction, the spot was exquisitely tender.

“Wow, that is crazy,” he exclaimed. “It feels like you are digging into the anterior deltoid and you aren’t even touching it! That’s wild. If I had my eyes closed, I’d swear you were pressing on the front of my shoulder. Man, is that tender!”

I probably should have let it go, but I couldn’t resist responding to his earlier comment. Keeping the pressure on the point of his infraspinatus, I posed another question.

“Just curious—how placated do you feel right now?”

As I released pressure on the trigger point, the knowing look on his face said it all.

“Welcome to the mysterious world of trigger points and referred sensation,” I said. “Wild, isn’t it? Now, let’s check something. Hold out your left arm and let’s strength test the anterior deltoid again.”

This time, his left deltoid was significantly stronger, testing approximately the same strength as his right side. What weeks of targeted strengthening exercises could not improve was corrected in less than one minute.

“That is amazing,” he said. “I would have never believed it, but the strength difference is astounding.”

“That is what I am doing with the players,” I said. “It may not be exciting to watch, but there is a complicated methodology behind these treatments. My job is to address areas of restriction and motor-inhibited weakness, both of which may decrease performance and be the product of trigger-point referral. Ultimately, my job is to maximize the effectiveness of your work with players, making targeted exercise more effective. With your left shoulder, you should see a progressive increase in strength over the next week or two.”

 “I still find it amazing that a tiny spot in one muscle can make another muscle weak,” he mused.

“So do I,” I concurred.

Douglas Nelson is the founder and principal instructor for Precision Neuromuscular Therapy Seminars and president of the 16-therapist clinic BodyWork Associates in Champaign, Illinois. His clinic, seminars, and research endeavors explore the science behind this work. Visit www.nmtmidwest.com or email him at doug@nmtmidwest.com.