Trigger point therapy has become a generally accepted form of treatment in medicine, physical therapy and massage over the last few years. 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.
An active trigger point is quiescent with regard to referred pain but is tender on palpation. Given the right emotional or physical events, the trigger point may become active.
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.
The massage therapist is able to distinguish trigger points by physical examination. The characteristics to look for are:
· Local tenderness on compression,
· Taut band,
· The jump sign and/or referred pain (pain felt at a distance from the site). The jump sign usually manifests when the massage therapist presses on a trigger point producing a wince, an “ouch” response to the pain, and with a pulling away from the therapist’s thumb.
To ‘erase’ the trigger point once found, the therapist applies steady pressure, well within the client’s tolerance for pain, for up to 60 seconds. Some sources suggest holding pressure against the points for as little as 7 – 10 seconds (For those who may be ill or frail). The pressure should be increased on the point as the treatment continues, in other words, more pressure at the end of the time than at the beginning. After all the trigger points in a muscle have had ischaemic pressure applied, the muscles should then be gradually stretched.
Since trigger points in certain muscles refer pain in predictable patterns, it is best to memorise the most common patterns. This saves considerable time and effort on the therapist’s part.
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.
Please feel free to ask our staff anything about trigger point therapy and how it could help you.
Durations Of Pain
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 Of Trigger Points
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.
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.
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.
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.
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.
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.
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.
Referred (Trigger-Point) Pain: Pain that arises in a trigger point, but is felt at a distance, often entirely remote from its source.
Referred (Trigger-Point) Phenomena: Sensory, motor and autonomic phenomena, such as pain, tenderness, increased motor unit activity (spasm), vasoconstriction, vasodilation, and hypersecretion caused by a trigger point. This usually occurs at a distance from the trigger point.
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.
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. The finger draws back so as to roll the underlying fibres transversely under the finger.
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.
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.
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.
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.