Trigger Point Therapy

What are trigger points?  Trigger points are tight bands and knots within a muscle or other soft tissue structure which have been held in spasm for some time. After a period of time they become less pliable (fibrous) and the localized blood circulation is compromised (ischaemic). They cause pain and other neuromuscular systems in predictable patterns which have been charted over the years. Trigger points can occur due to a number of factors – postural, mechanical, nutritional, metabolic, trauma, for example. Research by Travell and Simons (leading pioneers of trigger point therapy) has shown that trigger points are the primary cause of pain 75% of the time and are at least a part of nearly every pain problem. So it’s important that your therapist knows about them, and understands them.

What are the symptoms of trigger points?   The signature symptom with trigger points is referred pain. This is really confusing for the person in pain as well as inexperienced therapists and is the reason why some conventional treatments for pain so often fail. It’s a mistake to assume that the problem is at the place that hurts!

Trigger points cause

  • headaches,
  • neck and jaw pain,
  • low back pain, tennis elbow,
  • carpal tunnel syndrome.
They can cause problems in joints which can be mistaken for
  • arthritis
  • tendonitis
  • bursitis
  • ligament injury.
Trigger points also cause symptoms as widespread and diverse as
  • dizziness,
  • earaches,
  • sinusitis,
  • nausea,
  • heartburn,
  • genital pain,
  • numbness in the hands and feet.

How does your therapist know where and what they are?   A therapist who is trained and experienced in this advanced soft tissue technique will be able to identify trigger points by palpating the muscle as well as taking a careful history of your pain and symptoms. However, choose your therapist carefully as effective trigger point treatment relies more on the instinct and sensitivity of the therapist as he or she works with the patient, than on any amount of science or theory. It is for this reason that many people end up only 80% better after a course of treatment - because the muscle has not been completely released from trigger points.

How are trigger points treated effectively?  To treat trigger points effectively there are three main stages –

  • Deactivating – usually by applying precise direct pressure. This may well produce very effective and fairly immediate pain relief.
  • Stretching. Unless the affected muscle and localised muscle fibres are effectively passively stretched the treatment of the trigger points will be short lived and less effective
  • Self treatment – taking control of your own pain and symptoms is the best possible outcome in treatment trigger points. Regular scheduled massage treatments will be important for this, along with regular self treatment of trigger points and stretching. 

How often will I need treatment?    Your pain condition and individual circumstances will be unique to you. However Ros initially recommends a commitment to six treatments in trigger point work -

  • two or three treatments a week apart and review progress at each treatment
  • two or three more treatments at that interval, or –
  • move onto an intermediate stage of two treatments at two weeks apart again with review at each treatment.
  • Then a four week interval is recommended for two treatments
  • Thereafter a “maintenance” treatment is recommended at an interval that suits your circumstance – 4, 5, 6, or 8 weeks apart.
©Rosslyn Alternatives March 2011
References
Hunter G, 1998. 'Specific soft tissue mobilisation in the management of soft tissue dysfunction.' Manual Therapy 3(1) 2-11
Holey E, Cook E, 2003 “Evidence- based Therapeutic Massage – A practical guide for therapists’
Davies C, 2004 “The Trigger Point Therapy Workbook”
Finando D, Finando S, ‘Trigger Point Therapy for Myofascial Pain’
Niel-Asher S, ‘The Concise Book of Trigger Points’