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Trigger Points, Nasty Little Things

Trigger points
Most people have heard of trigger points. However, there seems to be much confusion about
what they are, what they do, and why they are important. Trigger point therapy is a bit
experimental. It’s not a miracle cure for chronic pain, either. However, it DOES work and it can
be extremely effective in removing pain and dysfunction from your body.
What are Trigger Points?
Dr’s Travell and Simons defined a myofascial trigger point as “hyperirritable spot in a
skeletal muscle”
. The spot is painful on compression and can give rise to characteristic referred
pain, referred tenderness, motor dysfunction and autonomic phenomena.


Let’s simplify all of this. The muscle “knots” that nag at you aren’t really “knots.” Despite how
it may feel, there’s not actually a tangle or twist in your muscle. More likely, those “knots” are
trigger points; small parts of muscle tissue that are in spasm.


Think of a handful of uncooked spaghetti noodles. Let’s say that each noodle is a muscle fiber
and, all put together, they make up the entire muscle. If the entire muscle spasms, we call that a
“Charlie Horse.” I’m sure we are all painfully aware of those! Now, if just one of those noodles
(muscle fibers), in the entire handful of noodly-muscle, were stuck in a contracted state, we’d say
that that portion of the contracted noodle (fiber) was a trigger point. Make sense?

So, this contracted muscle fiber becomes a highly tender area in the muscle or connective tissue
(fascia) that is painful when compressed. In addition, pressing on this trigger point can cause
pain in other, seemingly random, parts of the body. This is called “referred pain.” Trigger points
also love to create a radiating pain throughout the muscle and connective tissue causing
something called “myofascial pain syndrome.” Trigger points are nasty little buggers!


And then, as if the pain weren’t enough, trigger points can cause weakness, fatigue, and, often, a
loss of coordination of involved muscles. This can lead many to believe that they need to
strengthen the weakened muscles. However, if the trigger points aren’t first released,
strengthening exercises can force the surrounding muscles to do all of the work, instead of the
muscle with the trigger point! This then causes more weakening of the muscle containing trigger
point and over-works the other muscles, possibly causing more trigger points in THOSE
muscles. It’s a can of worms, I tell ya.


Types of Trigger Points
To make things even more complicated, there are more than one type of trigger point and each
has it’s own special little way of torturing you. Ugh…There are “active” and “latent” trigger
points. An active trigger point refers pain or tingling-like sensations to other parts of the body
and they can also limit your range of motion. A latent trigger point doesn’t cause pain but will
cause a decrease in your range of motion and weakness in the affected muscle.


Furthermore, there are also primary or “central” trigger points that form where nerve endings
that cause the muscle to contract, attach to the muscle fiber. These are generally in the middle of
the muscle fiber. If the trigger point is found at the muscle’s attachment point, it’s called an
“attachment trigger point” and these points also cause referred pain and can further make a mess
of things by creating “satellite” trigger points. Again, UGH!


A satellite trigger point forms in a different muscle in the referral zone of the primary trigger
point. This satellite trigger point may be formed because the muscle is overloaded due to the
muscle with the primary trigger point being weakend and not pulling it’s own weight in your
body. For example, a primary trigger point in your upper back may cause a satellite trigger point
in your neck. If the primary is released, the satellite will often resolve itself.


When Trigger Points Go Bad


The “X’s” mark the trigger points and the blue marks the referral zones
You still with me? I told you this trigger point stuff was a can of worms. Most people have a few
trigger points here and there. They are a pain but you can live with them and they are usually
worked out in time or with a nice massage. However, some have many and this becomes a
syndrome called “Myofascial Pain Syndrome.” Aack! What’s that?!?!
Myofascial Pain Syndrome
Myo-muscle
Fascial-connective tissue
Pain– OUCH!
Syndrome– a bit unknown
This is a painful condition and it’s best to see a practitioner who’s experienced in Trigger Point
Therapy. Most of the time trigger points can be released with manual therapy but sometimes, dry
needling or trigger point injections through a licensed practitioner is the only way to eradicate
the little buggers.


How do Trigger Points Form?
Why Me?


I get asked this all of the time. People want to know what the heck happened to them and what
are they doing wrong. Nothing, really. We live in and use our bodies. It happens and is just part
of life.


Trigger points can develop gradually and with over use. They can form after sudden trauma or
injury. Nutritional problems, sleep issues, organ dysfunction, disease, chronic infection and
emotional factors can also contribute to the formation of trigger points. Dont think that you can
escape trigger points by stopping all activty, plopping down on your couch and binging on
Netflix for days, either. Inactivity and poor posture can create them, too! You are a lucky
person, indeed, if you can avoid trigger points. So, don’t beat yourself up. Welcome to the
human condition. The good news is that you now have a pretty good idea as to what’s going on
with all of this pain you are feeling AND you happen to know a darn good trigger point therapist
to help you out, too. (Wink. Wink.)


What can you expect when recieving Trigger Point therapy with me?
Will it Hurt?


To be perfectly honest…it’s uncomfortable. Trigger points can be mean and nasty. Some hardly
hurt and some make you swear. Although I’m often amused at the colorful stuff that comes out of
your mouths, I promise, I do NOT enjoy causing you pain and will try every technique possible
to avoid hurting you. In fact, muscles in pain tend to tense up, so causing you pain will hinder the
technique working correctly. If it hurts too much, you will start to tense your muscles and undo
all of my hard work. That’s just a waste of everyone’s time and I don’t want to have to wear
shin-guards when you next walk past me.


53709085 – trigger point physical therapy
How Are They Treated?


Every trigger point is different and each requires a different technique to help it release. During
trigger point therapy, I put on my detective hat and start looking for clues to explain your pain. I
locate the trigger point(s) by pressing on the muscle tissue with a finger (palpation) or by picking
up the muscle fibers in a pincer grip. Light to moderate pressure is applied for up to 30 seconds. I
also use a more gentle technique that apples a light stroking of the point 10-15 times and then I
leave it alone for awhile to think about it’s naughty behavior. When I come back, I’ll check in
with the point to see if it has learned it’s lesson and disappated. If it has, great.

If not, I’ll do one more treatment and likely send you home with a bit of homework, requesting
that you continue to work the point in the same manner. The longer pain goes untreated, the
greater the number of muscles are affected and more pain is caused in new areas. As the
problem gets bigger, there’s a greater likelihood that the pain will become a chronic problem.
This vicious cycle continues until there’s outside intervention. The sooner you treat trigger
points, the less likely pain will become a permanent problem. So, while trigger point therapy can
be less than comfortable, it is a necessity and the point of it is RELIEF!


Fun stuff to check out
Self Care

  • Trigger Point Performance Therapy online store. There are some great self-care tools to
    be found here!
  • Real Body Trigger Point apps I love this app and often refer to it when introducing my
    clients to trigger point pain patterns.
  • THE Trigger Point Workbook. This is a must have book for anyone looking to take
    control of their pain and show their trigger points who’s boss!
    By Erin Brummett, LMT, MMP~Founder and Medical Massage Therapist
    Reference
    1.Simon, D.G., Travell, J., & Simons, L.S. (1999). Myofascial pain and dysfunction: The trigger
    point manual: Volume. 1. The Upper Half of Body. Baltimore, MD: Lippincott Williams &
    Wilki, PainScience.comPaul Ingraham&?Tim Taylor, MD

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