People talk about having “Trigger Points” in their muscles, which gives them a lot of pain, and talk about having “Trigger Point Therapy” to help resolve it. But what are trigger points, and what do Trigger Point Therapists do?
Please note – there is not much evidence-based research published to support the theory of trigger points. Most practitioners may point to clinical experience, and the publications referenced here are mostly by clinicians reporting and trying to explain their experience in the field. I have referenced some work that questions the existence of trigger points in muscle, but the they don’t challenge the treatment.
A contraversial subject – If anyone has a research grant spare, there is much still to be discovered!
What is a Trigger Point?
For a variety of reasons, when we strain muscles and fascia, either through impact or through a build up of chronic stress, the muscles go into spasm (ref 1). This spasm can restrict blood flow and cause pain, as well as restricting mobility (ref 2).
Alternatively, it is thought muscles can be in tension for so long that they lack the energy to release, and form tight “knots” or “trigger points”. These feel like little hard bumps in the muscle and are thought responsible for debilitating pain, often in neck & shoulders, referring to other parts of the body (ref 3).
In their famous “Trigger Point Manual” 2nd edition, Travell and Simons define a Trigger Point as:
“A hyperirritable spot in skeletal muscle that is associated with a hypersensitive palpable nodule in a taut band. The spot is painful on compression and can give rise to characteristic referred pain, referred tenderness, motor dysfunction and autonomic phenomena.”
What is not a Trigger Point?
Trigger Points should not be confused with Fibromyalgia, which is a painful systemic condition, but it seems many patients with fibromyalgia have significant trigger point discomfort, however. Treatment should be conservative, to prevent an irritation of the underlying condition.(ref 7 pp187-188)
Trigger Points are not fibrous adhesions. Inflammation is a necessary part of the healing process, bringing nourishment into the area, and reducing flow away, reducing the spread of infection. If neglected, and allowed to become chronic, however, it can lead to restrictive adhesions and thickening and shortening of connective tissue. This can lead to feelings of restriction and pain in muscles also. These are not trigger points, but your therapist should be aware of those also, and modify the treatment accordingly (ref 4).
Trigger points are not nerve damage, where pain may refer along the nerve pathway. Your therapist should be aware of these different referral patterns, to ensure appropriate treatment.
There are some views that suggest Trigger Points are none of these things (refs 5 & 6), although they do not dispute that some people find “Trigger Point Therapy” to help with their condition.
What is “Trigger Point Therapy” (sometimes called Neuromuscular Therapy)?
Neuromuscular Therapy – sometimes called Trigger Point Therapy – involves releasing Trigger Points in muscles & fascia, and encouraging flexibility in muscle and connective tissue.
Intermittent pressure is applied to each of these Trigger Points, until the sensation diminishes. It is assumed a release of tension relieves pain and increases mobility. It is thought greater blood flow may allow the healing process to resume.
Stretching the muscle and fascia afterwards helps to consolidate the relaxation, and you will be shown some stretches to practice after the session.
Different therapists recommend variations of this protocol (ref 8). Martin Kingston employs the protocol recommended by Leon Chaitow. (Ref 7 pp. 193-210)
Trigger points can be the cause of a lot of pain, but they may be evidence of some other dysfunction, which should be addressed or the trigger point will reappear in later times of stress.
Your London Neuromuscular therapist should conduct a postural or gait assessment to evaluate which areas to address. Martin likes to involve the patient in this, to regain awareness of imbalances.
Trigger Point Therapy can be researched easily on the web, and it is gaining ground as a key modality for the repair of soft tissues.
1. Travell, Janet G & Simons, David (1983), Myofascial Pain and Dysfunction: The Trigger Point Manual, Baltimore: Williams & Wilkins
2. Rattray, Fiona & Ludwig, Linda (2000), “Clinical Massage Therapy” pp. 193-196, Ontario: Talus Incorporated
3. Travell, Janet G & Simons, David (1999), Myofascial Pain and Dysfunction: The Trigger Point Manual, Vol 1. Upper half of body, 2nd Edition Baltimore: Williams & Wilkins
4. Hertling, Darlene & Kessler, Randolph (2006), Management of Common Musculoskeletal Disorders – Physical Therapy Principles and Methods, 4th Edition, p 11, Philadelphia: Lippincott Williams & Wilkins
5. Jacobs, Diane (2011) “Why I don’t buy the idea that “trigger points” are in muscle” HumanAntiGravitySuit Blog Monday July 4, 2011 from http://humanantigravitysuit.blogspot.co.uk/2011/07/why-i-dont-buy-idea-that-trigger-points.html accessed April 9 2012
6. Quintner, John L. and Cohen, Milton L. (date unknown ) “REFERRED PAIN OF PERIPHERAL NERVE ORIGIN: AN ALTERNATIVE TO THE “MYOFASCIAL PAIN” CONSTRUCT” Accessed April 09 2012 from the Pain Education website http://www.pain-education.com/referred-pain.html
7. Chaitow, Leon & DeLany Judith Walker(2002), Clinical Application of Neuromuscular Techniques – Volume 2 The Lower Body, Philadelphia Elsevier
8. Davies, Clair (2001) The Trigger Point Therapy Workbook, your self-treatment guide for pain relief. New Harbinger publications as referenced by Dr Diana Cross (date unknown) in “Information about Trigger Points and their Treatment” Accessed April 09 2012 from the Pain Education website http://www.pain-education.com/trigger-points.html