Trigger Point Therapy 

Anne Wasielewski 

What is a trigger point?

A trigger point is an area of tenderness in a muscle. There are two basic types of trigger points: active and latent. Active trigger points cause general muscular pain and will refer pain and tenderness to another area of the body when pressure is applied. Latent trigger points only exhibit pain when compressed; they do not refer pain, and may or may not radiate pain around the point. Tight bands in muscles will usually contain trigger points and are responsible for muscle shortening and causing impaired mobility and pain. 

Possible causes of trigger points:

	acute overload, overwork, fatigue, direct trauma
	skeletal asymmetry such as short leg or pelvic imbalances
	other trigger points causing new points to occur
	arthritic joints
	visceral diseases such as ulcers, renal colic, myocardial infarction, gall stones,  kidney problems and irritable bowel syndrome
	B-6, magnesium, vitamin C, folic acid deficiencies
	hypoglycemia
	chronic infection from a viral or bacterial disease
	food allergies or intolerances (wheat and dairy products should be checked first.)
	toxicity due to exposure to organic chemicals or heavy metals

When a muscle or group of muscles incurs injury, it automatically contracts around the painful site to support and protect the area. If pain is resolved quickly, the muscles can relax. If pain persists, muscles can become habitually contracted. Sometimes contractions press on nerves causing tingling, numbness, and more pain. A contracted muscle can’t hold much blood. Blood transports oxygen and nutrients to the muscles and carries away waste products. When a muscle is deprived of healthy circulation, it doesn’t receive enough oxygen and nutrients, and waste products accumulate. This can result in fatigue and soreness. It can also irritate nerves in the area, causing pain to spread beyond the congested area.

What is trigger point therapy?

Trigger point therapy is a technique designed to relax tight muscles, increase blood circulation to the affected area, and deactivate trigger points. Deactivation of trigger points is done by using direct compression on the area to break down the condensed tissue. Other massage techniques are used afterwards to bring blood to the area, helping to flush the toxins out of the tissues.

Trigger point techniques include the use of finger tips, elbows, and a compression tool. The amount of pressure used varies and is determined by the patient's tolerance. In addition to trigger point therapy, this treatment approach may be referred to as myofascial release, neuromuscular therapy, myotherapy, and deep tissue massage, among many other terms. All of these and related disciplines typically involve deep, sustained pressure directly on trigger points. Such pressure usually causes the muscle to relax, making it possible to stretch and eventually exercise back to pain-free fitness and health.

History

In Western medicine, documented research on trigger points dates back to 1841. However, most references give credit to Janet Travell, M.D., for the most extensive clinical research on myofascial trigger point therapy.  She co-authored several books with David Simons, M.D., including their two-volume text, Myofascial Pain and Dysfunction, and The Trigger Point Manual. Travell and Simons continue to promote research about trigger points and to update their works as more research and information surfaces. Most people consider these books the definitive reference on trigger point therapy. This system of non-invasive techniques is widely used today by professional athletes, massage and physical therapists.

Benefits

Trigger point therapy is effective in eliminating 95% of all physical pain associated with muscular discomfort and is a proven technique used for the relief of soft-tissue pain and dysfunction, such as sharp pain, dull aches, muscle spasms, tingling, pins and needles, hot or cold. Trigger point therapy also reduces pain from repetitive strain injuries (carpal tunnel syndrome), head, back, neck pain, sciatica, accident trauma, and sports injuries, as well as fibromyalgia (pain in muscles, ligaments, and tendons) and related conditions. Trigger point therapy helps patients suffering from multiple sclerosis by reducing the swelling they experience. In addition, athletes who undergo trigger point therapy often experience enhanced physical performance. Most patients see excellent results, including restored mobility, function, and reduced pain.

Treatment

The therapist should start by observing the patient's movements and posture. He or she might look for poor posture, muscle strain, pain and discomfort that increases guarding, and increased pain in other muscle groups. Trigger points cause muscle shortening with secondary weakness and decreased range of motion that can be observed. To facilitate the identification of trigger points, the patient should be as relaxed as possible. Trigger points may develop anywhere in the body, but are most commonly found at the sites of the greatest mechanical and postural stress.

Hints for locating trigger points:

	look for changes in thickness of tissue, resistance to gliding strokes, lumps or strings
	edema
	pain or tenderness
	temperature changes (the area is usually colder and the skin color paler)
	muscle shortening with weakness
	occasionally increased perspiration in reference zone
	hypertonicity
	ischemia
	client "jumps" when pressure applied to trigger point

Once a trigger point has been found, the therapist deactivates the trigger points by applying slow sustained pressure to the trigger points for a short time (between about 7 to 10 seconds per point.)  The amount of pressure depends on the client’s pain threshold, with the therapist ideally working at a “7” out of “10” range. Initially, the trigger point may be very tender, but gradually this decreases and as the pain fades, the muscle begins to relax. A slow breathing technique by the patient helps ease the discomfort and releases the trigger point more quickly.

Communication between the client and therapist is crucial for proper treatment and assessment of referral pain. It is common to hit the same trigger points several times during a session if those points do not release immediately. Other techniques may be used also to enhance the release of trigger points, such as ice stroking, ischemic compression, stripping, and proprioceptive neuromuscular facilitation (PNF). The muscles are then stroked gently to complete the relaxation process. The client will feel instant relief once a trigger point is released.

Goal:

The major goals of trigger point therapy are to reduce spasm and induce new blood flow into the affected area. The spasms are partly maintained by nervous system feedback (pain-spasm-pain) cycles. Spasms also physically reduce blood flow to the trigger point area (ischemia), reducing oxygen supplied to the tissues and increasing the spasm, which can be momentarily painful but is greatly relieving. Trigger point is a pain-relief technique to alleviate muscle spasms and cramping.

Response to treatment varies. Some clients experience superficial soreness following therapy. Warm baths, showers, stretching and rest are helpful in reducing soreness. Some clients also experience fatigue as the chronically tight musculature is allowed to relax and return to its normal length. Other clients experience an increase in energy.

Minimizing stress, pacing your activities and listening to your body are very important in healing. Your individual rate of improvement depends upon your general health, weight, level of fitness, underlying physical conditions and compliance to the treatment program.

Anne Wasielewski is a Nationally Certified, Licensed Massage Therapist and a current member of the American Massage Therapy Association. She can be reached at Angelic Touch, (907) 227-3976