Trigger Point Therapy

What are trigger points?

  A trigger point is essentially a painful tiny knot in the fibers of a muscle. All of the muscles in your body are made up of bundles of fibers. The contraction of these fibers shortens your muscles and pulls on the bones of your body. The coordinated actions of muscles pulling on your bones is what makes it possible for you to walk, talk, cough, etc.

  When a muscle receives a nerve impulse, it contracts. When the nerve impulse goes away, the muscle stays contracted unless something pulls it back to its resting length. That's very important to realize; unless something pulls on a muscle, it stays contracted.
For reasons that are not precisely known, a single fiber of a muscle may stay contracted when the rest of the muscle has been pulled back to its resting length, and the result is a trigger point.

  Trigger points can cause headaches, neck and jaw pain, low back pain, tennis elbow, and carpal tunnel syndrome. They are often the source of pain in joints, such as the shoulder, wrist, hip, knee, and ankle. In addition to pain, the effects of trigger points can include limited range of motion, muscle weakness, and numbness or tingling.

  There are two types of trigger points, active and latent. All trigger points cause pain when pressed; however, “active” trigger points frequently refer pain to other areas of the body. This explains why the pain you are experiencing in your head may actually be coming from a trigger point in your shoulder, or the pain in your lower back may originate from the deep muscles in your hip. A “latent” trigger point will still feel like a lump or knot, but only produces pain when pressed upon, and won't give the same referral pain as an active point.

  Some of the causes of trigger points are stress, both external stresses and postural stresses, such as poor posture, prolonged isometric contraction (working at the keyboard), and strain to the muscle. Trigger points are also thought to be caused by poor nutrition, such as vitamin B, C or folic acid deficiency, hypothyroidism and depression and anxiety.

  Trigger points will keep the muscles tight, restricting blood flow and compressing nerves, causing a vicious pain/spasm cycle in the muscles. This may result in decreased flexibility, limiting movement and encouraging bad postural patterns that may continue the cycle for years.

  If this sounds to you a bit like voodoo, rest assured that trigger point therapy is firmly based in Western Science. Trigger point therapy evolved from the work of Dr. Janet Travell. Beginning in the 1940's, Dr. Travell conducted research on trigger points and referred pain. Her success led her to the post of White House physician for her successful treatment of John Kennedy. Dr. Travell's research, along with that of her colleague Dr. David Simons, has been published in the two volume set Myofascial Pain and Dysfunction: The Trigger Point Manual.

  Travell and Simon were able to map where trigger points occur on most people. They were also able to map the areas of the body where pain is referred by each trigger point. The result is an accurate and repeatable guidebook that has proved its usefulness for countless patients. Dr. Travell and Dr. Simon developed a treatment regimen for trigger points that required injecting each point with a painkiller, followed by passive stretching and the use of cooling spray. Bonnie Pruden, an exercise and fitness guru, was the first to discover that trigger points can be "released" simply by pressing on them.

  Massage therapy, specifically trigger point therapy, is one of the best methods to help you get relief from the pain that trigger points bring.  Pressing on a trigger point hurts. In some cases pressing on a trigger point can hurt so much that it brings tears to your eyes and you jump up off the table. But pressing on a trigger point can also release it, eliminating the pain and muscle tension that it caused.

  Some people are reluctant to have trigger point therapy done, but the important thing to realize is that if done correctly, it will be a “good” pain. Your massage therapist will be able to incorporate trigger point therapy into your session, so that by relaxing the muscles and attachments first, it is easier to access the trigger point, and the degree of pain may be somewhat lessened. Used correctly, trigger point therapy can be a great tool in helping to reduce pain, and gain greater range of motion, as well as reduce chronic pain.

What to expect from a trigger point therapy session:

  Dealing with trigger points is a collaborative process. A good therapist can locate and release your trigger points, but will need your help to be most effective.

  On your first visit your therapist may ask you a lot of questions about your medical history, particularly if you have had any accidents or surgeries; your occupation, recreational activities and other pastimes; and your current stress level.

  The reasons for these questions are to help your therapist determine what may have caused your chronic muscular pain and to safely find and release your trigger points. Chronic muscular pain can be brought on by stress. The stress may be emotional, physical, or a combination of both. Knowing about your stresses helps your therapist develop a plan of action.

  Your therapist will begin by performing a seeking massage to locate your areas of muscular tension. Although your therapist will be able to feel many of the taught bands that accompany trigger points, you will be asked to provide feedback. As your therapist palpates your body, you will be asked if the area is tender, and in many cases how you would rate the pain at a specific spot. Communication is very important. If you can help guide your therapist to the source of your pain, your therapist will be more effective in releasing the pain.

  Your therapist will apply pressure to trigger points as they are located. This will most likely be painful, and in many cases the pain will "refer" to other parts of your body. Be sure to tell your therapist as soon as you feel any pain or discomfort; The pain is an indication that the therapist has found the right spot. The good news is that the pain should begin to fade as the therapist works the spot, and the result should be a release of your chronic pain.

  Trigger point pain can be quite intense; many have described it as exquisite tenderness. If the pain becomes too intense, tell your therapist immediately to "back off" or stop. You are always in control. You are the best judge of the proper amount of pressure that your therapist should apply.

  Unfortunately, trigger point therapy is not a silver bullet, and a single session will probably not dispel your chronic muscular pain. Your pain developed over time, and it will take time to reverse the process. Most people need about five sessions to feel better, but if you suffer from fibromyalagia or other myofascial pain syndromes, you may need regular treatments over a much longer period of time. Your therapist should be able to tell within a few sessions whether or not you will benefit from further sessions. If you do not respond to the therapy, your therapist will recommend treatment from other health care professionals.