What is Trigger Point Therapy?

Trigger point therapy is a soft tissue technique that works to release painful, tension in muscles and fascia that you would usually experience as a knot in the muscle. There are many different approaches to trigger point therapy including soft tissue work, deep tissue massage, dry needling and ischemic pressure.

What is a trigger point?

A trigger point is basically a really sore point in a muscle when you push on it or what most people would call a knot. You know that bit of the muscle when you are rubbing your tight shoulders that just doesn't feel right and really hurts? When a trigger point is very sensitive it can cause pain without being pressed on and this is a major cause of muscular pain that most people suffer from.

According to the leading researchers on trigger points and the doctor that coined the term “myofascial trigger point” a trigger point is a “hypersensitive nodule within a taut band of tissue that can refer pain”

There are 3 types of trigger points being active trigger points, latent trigger points and satellite trigger points.

Active trigger Points

Active trigger points are defined as causing pain when no pressure is placed on them. So this means they are painful even if you aren’t massaging them. This is one of the most common causes of Myofascial pain and can be experienced anywhere in the body. Common examples of active trigger points are headaches, neck pain, back pain including sciatica, knee pain and so on.

As in the picture above the X marks the spot where you press and the red area is the referral pain pattern. This is helpful in diagnosing where the trigger point is.

Latent Trigger Points

A Latent trigger point is a point you press on that causes pain and often refers pain to another area. These points are seen as the precursor to active trigger points. If you have latent trigger points that get worse through further strain then they can become active trigger points and that is when you usually feel pain and need someone to help you get out of the pain.

Satellite Trigger Points

A satellite trigger point is the area where the pain is referred to. For example if you were getting pain in your shoulder and you found that the trigger point was in your shoulder referring to the elbow, the elbow points would be the satellite trigger points. So you would also work on these elbow points as they will be involved as well. This is why it is important to work on more than just the area that is painful.

History of Trigger Points

Trigger points were first described by Dr Janet Travell, the personal rheumatologist to President John F. Kennedy, in 1942. In 1960 she teamed up with Dr David Simons and continued to research and work on trigger points. In 1982 they wrote the “bible” on trigger points, “Myofascial pain and dysfunction. The Trigger Point manual” volumes 1 and 2. Which are hefty tomes to trigger points.

How is a trigger point diagnosed?

There are 4 main criteria to diagnose a trigger point.

1. A taut band within the muscle fibre

2. An area that is sensitive to pressure within that taut band of tissue

3. The point refers pain or sensation to another area ie: you press on the trapezius muscle and you feel it radiate into the head, causing a headache.

4. A twitch response in the muscle that is pressed on or dry needled.

Symptoms of a Trigger Point

So how do you know it is a trigger point and not a bone or nerve. There are some common symptoms you will get that can differentiate trigger point pain.

• the nodule or band you are pressing on is in a muscle and not on the bone or nerve.

• The point you press on refers pain. This is not like nerve pain as when you press on a nerve it is like an electric shock or pins and needles. A trigger point referral isn’t like this. It is more of a dull pain that radiates.

• You have muscle pain that won't go away and even gets worse when you move or exercise.

• You have chronic muscle pain.

What causes a Trigger Point?

There are a few ideas that have been shown to cause trigger points.

• lack of nutrients in the tissue including oxygen. When the blood supply to parts of the muscle is reduced it can cause these nodules in the tissue that then cause pain.

• Overuse of a muscle through exercise, posture, working at a computer all day without breaks can cause the muscle fibres to become chronically contracted which over time causes pain.

• Injury such as a strain to the muscle/fascia. When this heals it may leave trigger points.

What is referral pain?

There are a few ideas that suggest that the referral pain you experience is happening in the brain. It is like “crosstalk” you get in electrical cables that are close to each other. This can happen in the brain where areas of sensation in the brain are close to each other. For instance is the trigger point is in the glutes and refers down the leg the area of the leg is close to that area in the brain and that is why you feel it there.

Some simpler ideas are that the muscle may attach to the area you feel the referral, which is common and may be transmitted through the fascia or nerves.

Methods of Trigger Point Therapy

There are a number of ways you can release a trigger point. The most common way is using sustained pressure with fingers, thumb, elbow or a massage ball or tool. Dry needling is also a form of trigger point therapy that is becoming more widespread as its effectiveness is being seen.

Manual therapy for Trigger Points: this usually involves a sustained pressure on the trigger point until it releases. If you find the nodule within the taut band of tissue you hold pressure on it until the pressure starts to reduce. This may take from 30 seconds to a few minutes. If the trigger point is really chronic then it may take multiple sessions to release this pain. You can try this will a ball to help to release the trigger point. This method is also known as ischemic pressure with the idea to get the blood flow away and then when you let go the blood flow rushes back in, drawing all of the new nutrients to the area.

Myofascial Dry Needling: This method has become an increasingly common way to release trigger points. An acupuncture needle is inserted into the trigger point of the muscle to elicit a twitch response in the muscle. By twitching the muscle the needle is getting the muscle to contract and relax which can help the body to “let go” of this contraction of muscle tissue. Dry needling also helps the nervous system to become desensitized to the pain which will help you to feel no pain or reduced pain after the treatment. Dry needling also helps to get more blood flow into the muscle that helps attract more nutrients to the area.

All practitioners at Muscle Therapy Australia are highly trained in Trigger Point Therapy and include trigger point therapy in their treatment and assessment. If you are suffering from pain, especially chronic pain, there is a high likelihood that you have myofascial trigger points and would benefit from an assessment and treatment.

As always feel free to get in touch if you have any questions or comments.