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 is 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. I know from some conversations that I've had with colleagues over the years that it is sometimes seen as too simplistic to be taken seriously. So bearing in mind that we use the technique almost daily in our clinics, we thought we'd bring up the subject in today's blog.
Studies have Confirmed Positive Results
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 methods” 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:
- Allergy to cold
- Raynaud’s syndrome
- Disorders of skin sensitivity
Simeon Asher demonstrates Spray & Stretch technique for the hamstrings
Spray and Stretch 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.
We use Spray and Stretch techniques daily in our clinics, and details of these techniques are included in the NAT Anatomy of Pain - Trigger Point Master Course.
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