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Trigger Points…Nasty Little Things.

September 24, 2017 by Erin Brummett0

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?

Trigger point illustration
Small muscle fibers in a contracted state

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

Trigger point pain referal
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
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!

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Self Care

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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