Trigger Point Overview

(Information taken from, The Trigger Point Therapy Workbook, by Clair Davies)

About muscles

Muscles are made of many long fibers placed together side by side.  Each of these fibers consists of short segments which each have a capacity to stretch or contract.  When a section of these fibers contracts and will not release because of overstimulation, it is called a trigger point.

Click to enlarge.

The trigger point causes the rest of the fiber segments to be stretched to capacity.  It becomes a tight band. 

Normally the regular contracting and releasing of these little segments circulates blood in the capillaries that supply them (the segments) with their nutrients.  When they hold this contraction, blood flow is stopped to that area, there is not an oxygen supply, and waste products are not pushed out. 

The trigger point then sends out pain signals until the trigger point is put in a position of rest again. 

What do trigger points do and why do I care? 

Trigger points can cause pain, stiffness and weakness, often at another place in the body than where they are located.  When you know where your referred pain is coming from, you can then do something about it.  For example, if you have pain in your knee, and you keep icing and rubbing your knee, but the pain is actually coming from a trigger point high in your thigh, all of your hard work will not pay off.  But, if you work the trigger point in your thigh, you will be able to take care of that pain.   

Where are trigger points normally found? 

Trigger points most often occur in the belly of a muscle. 
This can be easy to find in some muscles and harder to find in others.  Some muscles have all the fibers running parallel to the muscle and so it is easy to find the trigger point.  Other muscles have fibers running diagonally across the muscle, or the muscle may be interrupted by tendon tissue.  Then we get multiple bellies and multiple possible sites for trigger points. 

How can trigger points refer pain somewhere else?  What's with that? 

There are different theories as to exactly how the pain is referred and at this writing the scientists do not know for sure the how because there is still so much to learn about the nervous system.  But they do know that the referral pattern is basically the same in all people.  A lot of referred pain occurs in joints. 

I have noticed that the referral pain is often at an attachment point of the muscle.  Many muscles connect in several places, and many are attached to more than one bone.  

Pain, numbness and swelling can also be caused because the offending trigger point is impinging on a blood vessel or nerve farther up the line.  An example of this is the piriformis muscle and its effect on the sciatic nerve.  When the trigger point contracts, the muscle becomes shorter and thicker, it pushes on the sciatic nerve, causing pain, numbness, etc. 

How can I release trigger points? 

Trigger points will not release unless they are made to release by one of three methods.  The first two involve an experienced doctor using either refrigerant spray or needles.  The third way is to massage the contracted area to help the trigger point to release.  This is also called performing a "microstretch" since one is attempting to stretch just one small part of the muscle, not the whole thing. 

What is the procedure? 

When you find a trigger point, massage with a pressure that "hurts good." 
Massage in one direction only. 
Use short strokes, maybe about an inch long. 
Go no faster than one stroke per second. 
Use 6 to 12 strokes per trigger point. 
Come back to the trigger point several times a day. 

Over how long a time period should I keep working the trigger point? 

Continue to work the trigger point, several times a day, until it no longer hurts when you press on it. 
Healthy muscles do not hurt when you press on them. 

What is the difference between an active trigger point and a latent trigger point? 

An active trigger point is a trigger point that is currently causing pain or some other symptom (swelling, for example) somewhere. 
A latent trigger point is a trigger point that hurts when it is pressed, but is not currently causing any symptoms.  It may not take much to activate it, though, so the goal is to massage regularly until it is gone. 

Wouldn't it be better to massage it hard until the trigger point is gone, instead of having to come back to it frequently? 

If you massage too hard or too long, you can actually make the trigger point worse.  And you can cause a lot of bruising, which may keep you from coming back to the site until the bruises are gone.  The goal is to do a little at a time, and let the body do the healing.  

What causes trigger points? 

Trigger points can be caused by accidents, falls, injuries, surgeries, childbirth, physical abnormalities, disease, vitamin deficiencies, repetitive strain, overworking a muscle, not enough activity, poor posture, and chronic tension from stress. 

Trigger points can also be caused by other trigger points.  
They can refer pain to another area which eventually develops trigger points. 
They can disable one muscle, which causes the other muscles to compensate, and subsequently to develop trigger points. 

If you disable a trigger point but continue to overwork your muscles in one of these ways, your trigger points will come right back.  So, it is important to also examine your activities and make adjustments if necessary. 

What can I do to reduce the amount of trigger points I get? 

Mix up your activities during the day.  Try not to use one muscle group for too long.  Spend 20 minutes doing one thing and then turn to a different activity that uses a different set of muscles if you can.  Resist the urge to "push through" and finish something even though you are exhausted.  Sit down and take a break, or if you are sitting (like at a computer), get up and walk around.  Give those muscles a chance to return to a relaxed state.  (Any time that you saved pushing through will be paid back with interest later when you are not able to do very much because of pain or stiffness.) 

Check for trigger points before an activity like running, gardening, deep cleaning, or anything that involves repeated use of a set of muscles.  Work them before and after the activity. 

Don't slouch.  (This is a hard one, but I have noticed that once you deactivate the offending trigger points, it is actually easier to sit up straight.)  Check the height of the chair that you sit in.  Do you have to point your feet to reach the floor, or do you have to cross your legs to keep your balance?  You may need some kind of low footrest.  Are seats too short for you?  Are your knees always much higher than your waist level?  You will want to stretch them out occasionally. 

Be aware of your tension.  Notice if your shoulders are hiked up.  When you feel them up, relax them.  Neck, chest, and abdominal muscles also tend to tense up when we are stressed, so watch for this and work on relaxing those muscles. 

What kind of success can I expect with trigger point therapy? 

If you have had pain for a long time, it may take a while to deactivate your trigger points because you probably have a lot of them.  And it may be an ongoing thing.  Sometimes, damage has been done at the attachment points because of the chronic tension.  With new pain, sometimes you can get rid of it right away.  There is almost always an immediate lessening of the pain when you work the correct trigger points. Usually, if it is not helping, it is because the wrong trigger point is being worked, or one of the trigger points contributing to the problem has not been worked.  (Often, there is more than one trigger point contributing to the problem.) 

I personally have reduced my pain by about 75 percent, and I have regained mobility that I have not had for several years. 

Trigger point therapy also has the added benefit of reducing tension. 

Be sure to

Drink lots of water after doing trigger point therapy.  You are releasing toxins into the blood stream. 

Use tools whenever possible to save your hands; otherwise, you'll develop more trigger points to deal with.