Trigger Point Therapy

Trigger Point therapy or trigger point massage as it’s also known is a very powerful, deep soft tissue treatment that can help clear up your painful muscle knots and unresolved aches and pains throughout your body 

Working on these tender points  is one of the most effective ways of treating the pain and discomfort of painful muscle knots. Here is an article on the treatment, causes, prevention and definition of a myofascial trigger points. At Pain and Performance in Glasgow, I’ve been successfully treating people with Triggerpoints for over 20 years,

Table of Contents

What Is A Trigger Point?

Trigger points are just one of  a series of muscle “knots”. A trigger point, or to give it its full name a Myofascial Trigger Point (MFTP) has been defined as “a highly irritable, localized spot of exquisite tenderness in a nodule, in a palpable band of taught skeletal muscle.”

What a trigger point actually is, is a section of the muscle that is contracted. This is not the whole muscle, but a small focal point of the muscles that are ‘on’ or ‘active’, which means they are stuck in a contracted state. This makes them very difficult to release or relax, and in some people, they can stay contracted for years, sometimes decades, if left untreated

These focal painful points have been described as tiny lumps, little peas, or even large lumps. Trigger points can often be felt beneath the surface embedded within a muscle. If, when they’re pressed, they refer pain to other places, this is a good indication that this is a trigger point and is part of their criteria.

To check if your type of knot is a trigger point, 4 distinguishing features are needed.

These criteria allow you to test for trigger points.

Criteria for Trigger Points

  • Palpable nodules
  • Within a taught band of muscles
  • That’s exquisitely painful when pressed
  • Refers pain into a recognized distribution.

Definition of a trigger point "A highly irritable, localized spot of exquisite tenderness in a nodule, in a palpable band of taught skeletal muscle."

Travell and Simons', Myofascial pain and Disfunction

Other types of muscle knot

If your muscle knot doesn’t have all these features, then it probably isn’t a trigger point, as there are different types of knots in and around muscles with different characteristics.

As I said before, there are other types of muscle knot. So tender points is a name that is sometimes used, but tender areas also exist in acupuncture,

There’s a 70% correlation between trigger points and acupuncture points. There are also ashi points in Chinese medicine, which are points that similarly to trigger points give very sharp pain when pressed but don’t have other trigger point features.

There are other points that will be more familiar to osteopaths, with Chapman’s Reflexes. There are also the tender points associated with the Jones points of strain/counter-strain.

In Ayurvedic Medicine, there’s the Marma point.

As we can see, there are lots of forms of regional medicine that have the idea or concept of painful muscle points.

Even though there is a lot of support for the idea of the muscle knots or Trigger points some sources query the existence of them, but as a series of research papers demonstrated, this was probably due to poor training with misclassification bias of muscle knots in the first paper giving poor results. Unfortunately, the first paper is often cited more than the second.

Regardless of the research if you are unfortunate to have a trigger point and you have had it pressed, you will know this isn’t your imagination and that there is something there. The problem comes because some people do not follow the right criteria, and this has led to some therapists saying that they don’t exist

Causes of Trigger Points

Theories Behind Trigger Points.

The science of trigger points has given us 4 theories to their causes.

These four theories are:

  • Motor endplate theory.
  • Energy crisis theory.
  • Radiculopathic theory.
  • Polymodal theory, sometimes called PMRs.

Postural Causes for Trigger Points

The way we use our body is one of the biggest causes. A large number of trigger points are thought to be posturally related. So potentially people who frequently are;

  • Standing or sitting with your head forward or
  • Rounded shoulders
  • Classic telephone posture, the head to one side
  • Sometimes the malpositions we make due to work
  • Standing slouched, and
  • Sitting slouched or slumped as well.
  • Have a look at computer screen ergonomics.
  • Think about crossed leg sitting and habitual postures you take.
  • Look at how you drive.
  • The way you lift and carry
  • And sometimes scoliosis.

While these potential causes aren’t enough to do it on their own, this together with other activities or lack of activities is likely to either predispose you or help maintain trigger points

Treatment of Trigger Points

There are various ways of treating a trigger point. I’ve outlined some of the possible ways to treat and manage trigger points below

Heat

Heat is often a good home management option. It aims to relax muscles, decrease tension and increase blood flow, but because it doesn’t get to the cause of the problem I’d call it pain management rather than treatment. Ways to increase heat, change blood flow and maybe release tension in the area include;

  • Hot Water Bottle or Microwavable Wheat Bag,
  • Sauna,
  • Hot Tub,
  • Heat Lamp

 

Some will obliviously be easier to find and use at home, but because of the temporary nature, I wouldn’t invest too much money in this. Although going to a sports centre or gym and exercising and finishing off with a sauna may work well as part of long term management

 
 

Contrast Bathing (hot & cold)

This aims to change the circulation of blood through and around your trigger point. I find that this is a useful home treatment for temporary relief. It’s possible that the change in temperature doesn’t get deep enough, quickly enough to generate the gradient needed to treat longer term.

Dry Needling and Acupuncture.

This is a really useful technique and one that I used to use more. The reason I stopped was that it hurt so much and potential risk. There’s sometimes trouble placing the needle directly within the trigger point which leads to repeated probing of the area. It is the stabbing with the repeated probing that changes blood flow through the area that, in my opinion. is the reason for its success. The trouble with needling is, it isn’t risk-free and there are other safer ways of treating. Due to potential risks, this is not to be attempted unless you have had good face to face training from an accredited training provider…some guy on YouTube that isn’t good enough.

Trigger Point Injection

Trigger point injection therapy or “Wet” Needling to differentiate it from dry needling. This uses a pretty standard hypodermic needle. This is where you are injecting a substance into or around the trigger point. This should be done under ultrasound guidance for the best effect. It can be very hard to find someone to do this. The same warning as dry needling applies

Trigger Point Therapy or Massage

Trigger point massage is often called Trigger Point Therapy. This is probably the easiest and safest method for treating. This involves pressing into the trigger point using an optimal pressure then moving the finger applying pressure around. Sometimes massage tools are used instead of pressing with a finger or thumb

Spray and Stretch

This is probably the best method for treating Children.

Of all the choices I believe that the safest treatment method for Triggerpoints, using pressure, with a manual trigger point massage.

What is trigger point therapy effective at treating?

The most common complaints treated effectively are;

  • Back pain, especially low back pain
  • Neck and shoulder pain
  • Tension and Migraine Headaches
  • Whiplash type injuries and associated problems
  • Acute Sports injuries – including muscle, ligament and tendon damage
  • Achilles problems
  • Tennis & Golfers elbow
  • Pain in the ears, jaw or face

Prevention of Trigger Points

Just as important as your Trigger point massage is advice. The advice if followed will help shorten the duration of treatment, and potentially some new trigger points occurring and old trigger points returning.

The advice that I will give to my patients to help you manage your own symptoms will include but won’t be limited to:

  • Think about moving more. although this may sometimes be to, move differently or very occasionally move less
  • I’ll also be thinking, How can I help you move more? Would you benefit from treatment in a different part of your body to take the strain away from the painful bit?
  • Can we get you to stretch? Sometimes stretching and relaxation, again, can help move through the muscle, get things moving and get things settling down
  • Strengthening. Sometimes weaker, tighter muscles just could do with some work to get them stronger, to get them longer, and do this as part of an overall training pattern. .

Prevention may be having a look at what maintaining and predisposing factors there are. Some are harder to change, but like ageing, I can find ways of making your body work better to compensate for the changes of the ageing processes.

  • Ageing
  • Posture
  • Obesity
  • Dietary problems
  • Scar tissue, potentially post-surgical
  • Sports, Hobbies, habits, repetitive movements

can cause and maintain trigger points, various stress and strain patterns from life can also do this, certain metabolic disorders, some diseases or illnesses, vitamin deficiencies and illnesses, congenital bony abnormalities, sometimes the type of muscle fibre, they’re more likely to happen in some types of muscle fibre, psychological factors.

Also, the chronicity of trigger points. So if we think about the postural factors having psychological triggers, then a habitual, “depressed”, slouched posture, can contribute to starting the trigger point and maintaining the trigger point.

Advice to follow to reduce Triggerpoints

So for example, when I look at your driving position a simple checklist could be similar to this

How do you drive?

Do you drive with your arms stretched out in front of you
Are your shoulders raised high?

If yes and vehicle dependent, can you raise the seat or lower the steering wheel?
Maybe bring the wheel closer to you, or the seat closer to the steering wheel.

Is your head and neck extended or stretch forward?
what changes can you make to get nearer to a “normal” posture?

Do you slump in the seat? why?

Could moving the seat change this?

How long do you drive for?
can you get out and have a little walk. Maybe swing your arms or stretch. Some employers will have someone specifically to assess driving positions or can sometimes get someone in.

This sort of advice and checklist can be applied to most of the predisposing and maintaining factors of triggerpoints. This should come from your practitioner/therapist. I’d ask if it doesn’t, then why not?

Trigger points can be a very painful and debilitating problem that can trouble you for extended periods of time. The advice and self-management here can help you live with it, but If you find you need further help please book an appointment with me Daniel Gerber at Pain and Performance in Glasgow.