In recent years trigger point therapy has become a generally accepted form of treatment in medicine, physical therapy and massage. While medical doctors rely on injection and physical therapists on spray and stretch with vapocoolants, massage therapists are able to work in a highly effective manner using thumbs, elbows, and braced fingers to create an ischaemic compression.
A trigger point is a hyper – irritated area in muscle that, when compressed is locally tender and creates referred pain. Trigger points can occur in muscles, ligaments, skin fascia and periosteum.
Duration:
Acute: Of recent onset (hours, days or a few weeks).
Chronic: Long standing (months or years), but NOT necessarily irreversible. Symptoms may be mild or severe.
Types:
Active Myofascial Trigger Point focuses of hyperirritability in a muscle or its fascia that is symptomatic with respect to pain; it causes a pattern of referred pain at rest and/or on motion that is specific for that muscle.
Associated Myofascial Trigger Point: A myofascial trigger point in one muscle that develops in response to compensatory overload, shortened position, or referred phenomena caused by trigger point activity in another muscle. Satellite and secondary trigger points are types of associated trigger points.
Referred (Trigger-Point) Pain: Pain that arises in a trigger point, but is felt at a distance, often entirely remote from its source. The pattern of referred pain is reproducibly related to its site of origin. The distribution or referred trigger-point pain rarely coincides with the entire distribution of a peripheral nerve or dermatone segment.
Referred (Trigger-Point) Phenomena: Sensory, motor and autonomic phenomena, such as pain, tenderness, increased motor unit activity (spasm), vasoconstriction, vasodilatation, and hypersecretion caused by a trigger point, which usually occur at a distance from the trigger point.
Latent Myofascial Trigger Point: A focus of hyperirritability in muscle or its fascia that is clinically quiescent with respect to spontaneous pain; it is painful only when palpated. A latent trigger point may have all other clinical characteristics of an active trigger point, from which it is to be distinguished.
Local Twitch Response: Transient contraction of a group of muscle fibres (usually a palpable band) that contains a trigger point. The contraction of the fibres is in response to stimulation (usually by snapping palpation or needling) of a trigger point, or sometimes of a nearby trigger point. A local twitch response erroneously has been called a jump sign.
Jump Sign: A general involuntary pain response of the patient, who winces, may cry out, and may withdraw in response to pressure applied on a trigger point. At one time, we erroneously used this term to describe the local twitch response of muscle fibres to trigger point stimulation.
Myofascial Trigger Point: A hyperirritable spot, usually within a taut band of skeletal muscle or in the muscle’s fascia. The spot is painful on compression and can give rise to characteristic referred pain, tenderness and autonomic phenomena. A myofascial trigger point is to be distinguished from cutaneous, ligamentous, periosteal, and nonmuscular fascial trigger points. Types include active, latent, primary, associated, satellite and secondary.
Satellite Myofascial Trigger Point: A focus of hyperirritability in muscle or its fascia that became active because the muscle was located within the zone or reference of another active trigger point. To be distinguished from a secondary trigger point.
Primary Myofascial Trigger Point: A hyperirritable focus within a taut band of skeletal muscle. The hyperirritability was activated by acute or chronic overload (mechanical strain) of the muscle in which it occurs, and was not activated as the result of trigger-point activity in another muscle in the body. To be distinguished from secondary and satellite trigger points.
Secondary Myofascial Trigger Point: A focus of hyperirritability in muscle or its fascia that became active because its muscle was overloaded by a synergistic substituting for, or as an agonist countering the forces of, the muscle that contained the primary trigger point. To be distinguished from a satellite trigger point.
Myotatic Unit: A group of agonist and antagonist muscles, which function together as a unit because they share common spinal reflex responses. The agonist muscles may act together in series, or in parallel.
Palpable Band (Taut Band, or Nodule): The group of taut muscle fibres that is associated with a myofascial trigger point and is identifiable by tactile examination of the muscle. An evoked contraction of the muscle fibres in this band produces the local twitch response.
Trigger Point (Trigger Zone, Trigger Spot, Trigger Area): A focus of hyperirritability in a tissue that, when compressed, is locally tender and, if sufficiently hypersensitive, gives rise to referred pain and tenderness, and sometimes to referred autonomic phenomena and distortion of proprioception. Types include myofascial, cutaneous, fascial, ligamentous and periosteal trigger points.
Treatment:
Ischaemic Compression: (also Acupressure, Myotherapy, Shiatzu, “Thumb” Therapy): Application of progressively stronger, painful pressure on a trigger point for the purpose of eliminating the trigger point’s tenderness and hyperirritability. This action blanches the compressed tissues, which usually become hyperaemic (flushed) on release of the pressure.
Pincer Palpation: Examination of a part by holding it in a pincer grasp between the thumb and fingers. Groups of muscle fibres and rolled between the tips of the digits to detect taut bands of fibres, to identify trigger points in the muscle, and to elicit local twitch responses. To be distinguished from flat palpation and snapping palpation.
Snapping Palpation: A fingertip is placed on the tender spot in a taut band of muscle at right angles to the direction of the band and suddenly presses down while drawing the finger back so as to roll the underlying fibres transversely under the finger. The motion is similar to that used to pluck a guitar string, except that firm contact with the skin in maintained. To most effectively elicit a local twitch response, the band is palpated and snapped transversely at the trigger point, with the muscle at a neutral length or slightly longer. To be distinguished from flat palpation and pincer palpation.
Trigger points are believed to be caused by overuse of a muscle, physical traumas (sports injury, car accident, fall etc.), alcohol or drug abuse, difficult (forceps) birth, long term emotional stress, dietary deficiencies and a host of other causes.
Outline Approach
- Find the trigger point through palpation or referral pattern, pain being the primary indicator (tingling, burning, numbness or thermal sensations may also be felt by the client)
- Press against the point for 60 seconds, always within the clients tolerance
- Increase the pressure gradually during the 60 seconds
- Stretch the muscle after all trigger points have been worked
NOTE: Trigger points can be very individual to the respective client. When applying them move around the ‘point’ to locate the area of greatest referral/pain. Change the angle of applied pressure. Look and think.
