What is a Trigger Point?
A trigger point is a hyper-irritable spot in muscle tissue that is associated with a highly sensitive taut band in the same tissue. The taut band can feel like and is often referred to as a “knot”. This “knot” is essentially a contracted cluster of some of the fibers of the effected muscle and within that cluster lies a palpable nodule which is the actual trigger point.
Trigger point therapy is a method for treating muscle pain caused by trigger points. Dr. Janet G. Travell (1901-1997) is generally recognized as the leading pioneer of trigger point therapy (the direct massage pressure method is described further down).
A trigger point should not be confused with a muscle spasm. When you have a spasm, the entire muscle is involved in a painful contraction. A trigger point on the other hand only involves a small part of the muscle. In spite of this, it can cause dysfunction in the entire muscle and associated joint. A trigger point can be the source of acute muscle pain and tends to feel like a dull and aching pain. This pain can be reproduced when you or your massage therapist presses directly on the trigger point with a moderate pressure that normally wouldn’t hurt.
Trigger points have the ability to refer pain or other sensations to another area of the body in predictable patterns. Referred pain is a feature of the body’s pain system and is not exclusive to trigger points so a practitioner will use client history intake and orthopedic assessments to gather information and determine if trigger point treatment is an appropriate strategy. In addition to pain, trigger points can also cause muscle weakness – like a dead and heavy feeling – and refer sensations like tingling, numbness, and prevent full range of motion at a joint it affects.
Active vs Latent Trigger Points
Trigger points are categorized into two states, active and latent. An active trigger point is causing an acute pain complaint – and eventually chronic pain if left untreated over time. When your massage therapist finds the trigger point by pressing on a specific spot on a muscle, it will reproduce the pain you are already familiar with. Active trigger points should be treated sooner rather than later. If left untreated they can contribute to the formation of secondary trigger points which are self-perpetuating unless correctly treated.
A latent trigger point can have all the same characteristics of an active trigger point however they are only painful or produce other symptoms when you press on it. With latent trigger points, you won’t have an acute pain complaint but they may contribute to the feeling of muscle tightness and joint stiffness. Latent trigger points can become active if the muscle(s) which harbor them are over exerted – for example: excessive activity from exercise, sports, yard work or other forms of repetitive strain.
What causes Trigger Points and are they common?
Trauma from accidents, repeated physical stress, or changes in posture seem to be common causes of trigger point formation and according to Dr. Travel, a common cause of muscular tension and pain.
In the book “Myofascial Pain and Dysfunction: The Trigger Point Manual”, Travell and Simons believe that trigger points are the primary cause of pain and that many doctors may still be uniformed about them (though this is changing). Misdiagnoses of pain along with ineffective treatment results in unnecessary cost to the consumer financially as well as to their quality of life. Travell and Simons list in their book 24 examples of mistaken diagnosis, which can be made if the physician is unaware of myofascial trigger points. While Janet Travel first coined the term “trigger point” in 1942, what are today considered their characteristics have been written about for more than 150 years.
Pain can be a very complicated picture to sort out as patterns overlap and there are many different causes. Myofascial trigger points can be the sole cause of an individuals’ pain or they can be co-factored with other causes. Travell and Simons quote studies suggesting that trigger points are a component of up to 93% of the pain seen in pain clinics, and the sole cause of such pain as much as 85% of the time. Trigger points can develop in any of the 200 pairs of muscles in the human body. They can last as long as life and can even survive after death, detectable until rigormortis sets in. Trigger point pain affects everyone, young and old, all walks of life, and all occupations.
Trigger Point Release Using Direct Massage Pressure
According to Travel and Simons, deep stroking massage applied directly to the trigger point is safe and effective. Massage therapists trained in trigger point or neuromuscular therapy are skilled at finding and treating trigger points to help reduce the pain and restriction they cause. Massage treatment for trigger point pain is very specific and focused. General massage will not do. If you massage just the area where you feel pain, the odds are that it won’t work. The muscle harboring the trigger point must be correctly identified. Clues can be found in the pain pattern and with muscle testing. Then the trigger point must be located within that muscle.
The therapist scans a muscle for a taut band of fibers where the trigger point can be found. A moderate pressure is applied directly on top of the trigger. The client will know this is the right spot because he/she will feel their exact pain complaint intensify.
After a few rounds of direct massage deactivates and releases the trigger point, light stretching along with active range of motion is applied to the involved muscle(s) and associated joint. The gentle exercise helps to restore proper muscle length and increase local circulation to the area which was effected by trigger point pain.
Though the massage pressure will be cautiously moderate, it may still be somewhat uncomfortable to experience. Tolerance for pain and discomfort varies among individuals. Your massage therapist will remain in constant communication with you in order to maintain a tolerable treatment pressure.
Addressing perpetuating factors
Along with direct massage to the trigger points, it is important that perpetuating factors are addressed as well. There are several factors that can perpetuate pain and trigger points which massage and bodywork can address such as postural stresses, ischemia (lack of blood flow to the tissues), nerve compression or entrapment. Other factors include nutritional deficiencies of vitamins or minerals, food sensitivities, hydration status, allergies, and stimulants like caffeine which can play a role in muscular health.
Emotional and mental health factors can also influence your physical health for better or worse. This is an important factor and is often under appreciated. An individual carrying an excessive load of emotional stress without a method or outlet for releasing it can experience various states of dis-ease which down the line can lead to more serious states. Seeking guidance from a skilled practitioner in nutrition or mental health can be the key factor to solving a complex and chronic pain problem.
Client education and self care
Your massage therapist can teach you specific self-help strategies to help you maintain your wellness. This will allow the client to continue their own mini-treatments between scheduled sessions or to attempt a practical self treatment should the same symptoms arise again. You can learn how to identify the muscle(s), locate the trigger point, apply trigger point massage to the body using either your own hands or simple objects such as tennis ball or specially design tools for trigger point massage, and how to safely stretch the muscle and mobilize the joint following self massage. Finally, by understanding the factors they can cause and perpetuate muscle pain, you can stop the cycle before it starts.
Mitchell Diaz has been a practicing massage therapist since 2004.
Disclaimer: Massage therapy works great as a prevention strategy and can remedy many aches, pains, and stresses. However, it is no panacea and not an alternative for medical care when needed.