What
the Heck Is a Trigger Point?
By Bryan Cobb, Advanced Remedial Massage Therapist
Bryan
Cobb, Advanced Remedial Massage Therapist
Precision Touch Massage Therapy, Winnipeg MB
204 688 1777
What
is a Trigger Point?
Trigger
Points (TP's) are defined as a "hyper-irritable spot
within a taut band of skeletal muscle. The spot is painful
on compression and can evoke characteristic referred pain
and autonomic phenomena."1
TP's
are painful knots in the muscle tissue.
Put
into plain language, a TP is a painful knot in muscle tissue
that can refer pain to other areas of the body. You have probably
felt the characteristic achy pain and stiffness that TP's
produce, at some time in your life.
TP's
were first brought to the attention of the medical world by
Dr. Janet G. Travell. Dr. Travell, physician to President
John F. Kennedy, is the acknowledged Mother of Myofascial
Trigger Points. In fact, "Trigger Point massage, the
most effective modality used by massage therapists for the
relief of pain, is based almost entirely on Dr. Travell's
insights."2 Dr. Travell's partner in her
research was Dr. David G. Simons, a research scientist and
aerospace physician.
Trigger
Points are very common. In fact, Travell and Simons state
that TP's are responsible for, or associated with, 75% of
pain complaints or conditions.1 With this kind
of prevalence, it's no wonder that TP's are often referred
to as the "scourge of mankind".
Trigger
Points can produce a wide variety of pain complaints. Some
of the most common are migraine headaches, back pain, and
pain and tingling into the extremities. They are usually responsible
for most cases of achy deep pain that is hard to localize.
A
TP will refer pain in a predictable pattern, based on its
location in a given muscle. Also, since these spots are bundles
of contracted muscle fibres, they can cause stiffness and
a decreased range of motion. Chronic conditions with many
TP's can also cause general fatigue and malaise, as well as
muscle weakness.
TP's
(black dots) can refer pain to other areas (red)
Trigger
Points are remarkably easy to get, but the most common causes
are
-
Sudden overload of a muscle
- Poor
posture
- Chronic
frozen posture (e.g., from a desk job), and
- Repetitive
strain
Once
in place, a TP can remain there for the remainder of your
life unless an intervention takes place.
Trigger
Points Not Well Known
With
thousands of people dealing with chronic pain, and with TP's
being responsible for -- or associated with -- a high percentage
of chronic pain, it is very disappointing to find that a large
portion of doctors and other health care practitioners don't
know about TP's and their symptoms.
Scientific
research on TP's dates back to the 1700's. There are numerous
medical texts and papers written on the subject. But, it still
has been largely overlooked by the health care field. This
has led to needless frustration and suffering, as well as
thousands of lost work hours and a poorer quality of life.
How Are Trigger Points Treated?
As
nasty and troublesome as TP's are, the treatment for them
is surely straightforward. A skilled practitioner will assess
the individual's pain complaint to determine the most likely
location of the TP's and then apply one of several therapeutic
modalities, the most effective of which is a massage technique
called "ischemic compression".
Basically,
the therapist will apply a firm, steady pressure to the TP,
strong enough to reproduce the symptoms. The pressure will
remain until the tissue softens and then the pressure will
increase appropriately until the next barrier is felt. This
pressure is continued until the referral pain has subsided
and the TP is released. (Note: a full release of TP's could
take several sessions.)
Other
effective modalities include dry needling (needle placed into
the belly of the TP) or wet needling (injection into the TP).
The use of moist heat and stretching prove effective, as well.
The
best practitioners for TP release are Massage Therapists,
Physiotherapists, and Athletic Therapists. An educated individual
can also apply ischemic compression to themselves, but should
start out seeing on of the above therapists to become familiar
with the modality and how to apply pressure safely.
1
Simons, D.G., Travell, D.G., & Simons, L.S. Travell and
Simons' Myofascial Pain and Dysfunction: the Trigger Point
Manual.
Vol. 1. 2nd ed. Lippincott, Williams, and Wilkins, 1999.
2http://www.muscletherapyworks.com/MTW%20Biography%20T%20&%20S%2001.htm
©
2008 Cris LaBossiere Rhino Fitness
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