Trigger Point Therapy

Trigger points are hyper-irritable spots in skeletal muscles that are associated with palpable nodules in taut bands of muscle fibers. The palpable nodules are said to be small contraction knots and a common cause of pain. Compression of a trigger point may elicit local tenderness, referred pain, or local twitch response.

Drs. Travell and Simon state that around 75% of pain clinic patients have a trigger point as the sole source of their pain. Trigger points can cause carpal tunnel syndrome, bursitis, tendonitis, angina pectoris, sciatic symptoms and many other pain problems. Arthritis is often cited as the cause for pain even though pain is not always concomitant with arthritis. The real culprit may be a trigger point, normally activated by a certain activity involving the muscles used in the motion, by chronically bad posture, bad mechanics, repetitive motion, structural deficiencies such as a lower limb length inequality or a small hemi pelvis, or nutritional deficiencies. Trigger points, or hyper-irritability focal spots in muscle can strongly affect the central nervous system and its functions. Myofascial pain is associated with muscle tenderness that arises from trigger points, focal points of tenderness, a few millimeters in diameter, found at multiple sites in a muscle and the fascia of muscle tissue. Biopsy tests found that trigger points were hyperirritable and electrically active muscle spindles in general muscle tissue. Studies estimate that in 75-95 per cent of cases, myofascial pain is a primary cause of regional pain.

Activation of trigger points may be caused by a number of factors, including acute or chronic muscle overload, activation by other trigger points (key/satellite, primary/secondary), disease, psycho-emotional disorders, homeostatic imbalances, direct trauma to the region, radiculopathy, infections and health choices such as smoking.

Trigger points can appear in many myofascial structures including muscles, tendons, ligaments, skin, joint capsule, periosteum, and scar tissue. When present in muscles there is often pain and weakness in the associated structures. These pain patterns in muscles follow specific nerve pathways and have been readily mapped to allow for identification of the causative pain factor. Many trigger points have pain patterns that overlap, and some create reciprocal cyclic relationships that need to be treated extensively to remove them.

The misdiagnosis of pain is the most important issue taken up by Travell and Simons. Referred pain from trigger points mimics the symptoms of a very long list of common maladies; but physicians, in weighing all the possible causes for a given condition, have rarely even conceived of there being a myofascial source. The study of trigger points has not historically been part of medical education. Travell and Simons hold that myofascial trigger points cause most of the common everyday pain and that ignorance of that basic concept could inevitably lead to false diagnoses and the ultimate failure to deal effectively with pain.

One of the effective methods of treating trigger points is through manual therapy. With the skill of the therapist holding or pressing the trigger point until it responds is very important. If trigger points are pressed too short a time, they may activate or remain active; if pressed too long or hard, they may be irritated or the muscle may be bruised, resulting in pain in the area treated. Releasing trigger points not only treats the cause of the problem but will also remove the referred pain from areas that can be affected by the trigger point.