Trigger Point Therapy
A major source of pain for many people are a certain type of muscle lesion called trigger points. Trigger points can cause pain that is referred away from the actual site and commonly go undiagnosed for long periods of time.
Trigger point therapy is a type of manual therapy that is commonly performed by physiotherapists, chiropractors, and other practitioners of physical medicine. It is a technique which aims to reduce pain while improving function and has experienced excellent results for many conditions like headaches, jaw pain, and many other muscular pain syndromes. To understand what trigger point therapy is and how it may help with these conditions, it is important to understand what exactly qualifies as a trigger point.
What Is A Trigger Point?
Many people refer to trigger points as "muscle knots", which are tight nodules or bands that are felt inside of muscle tissue. In order to be qualified as a trigger point these tight bands (muscle knots) must also have a few distinct features, including the following (1):
Must produce pain in the spot of the tight band
Must produce "referral" pain (pain away from the original tight band)
Palpation (pressing on) the band will produce a snapping twitch (local twitch response)
Trigger points should not be confused with "tender points", which are only areas of localized pain that do not produce referral pain away from the original site. Tender points are commonly seen in fibromyalgia and myofascial pain syndrome and they may commonly overlap with trigger points, so an experienced practitioner may be needed to differentiate between trigger points and tender points (1).
THERE ARE TWO DIFFERENT TYPES OF TRIGGER POINTS THAT MAY DEVELOP - LATENT AND ACTIVE.
Latent trigger points are those that only cause pain when they are palpated. Patients with latent trigger points may only become aware of them when pressure is directly applied over the specific site. Latent trigger points are the first stage of trigger points and may become "active" over time with poor posture, poor biomechanics, excessive stress, lack of exercise, or other detrimental stimuli.
Active trigger points are those that cause pain even when they are not being touched. These are the type of trigger points that commonly lead to patients seeking care and many times are the source of unknown pain syndromes that have not been diagnosed for extended periods of time. For example, a certain type of headache may be caused by referral pain from an active trigger point in the neck which has caused years of unknown pain until the patient seeks care from a qualified practitioner who eventually discovers this problem. Active trigger points respond to various treatment methods and stop causing symptoms by becoming latent again (2).
Trigger points are most commonly found throughout muscles that are used to support posture and the weight of the body. Trigger points may also be found anywhere on the body and can cause a wide variety of symptoms, but most often trigger points are found in the neck, shoulders, and around the hips. Here is an example to get a better idea of where some trigger points are commonly located, and where they may refer pain:
X shows the spot of the actual trigger point, while the pain referral is marked in red.
How Are Trigger Points Treated?
The treatment for trigger points may depend on a variety of factors including location, patient tolerance, physician preference, and severity. Among many techniques, the most common treatments that manual therapy practitioners like chiropractors and physiotherapists use are manual release, spray and stretch, and trigger point needling.
Manual release involves the practitioner using their hands to press on the trigger point in order to get it to "release" and stop causing symptoms. A skilled practitioner may also use different stretches and movements while doing this to provide further benefit.
Spray and stretch is a technique that involves the practitioner stretching the target muscle while spraying the area with a topical anesthetic. The goal of this is to numb the area to the stretch in order to block a reflex that would usually resist the stretch, allowing the muscle to be stretched back to normal length (1). This technique is not as common as it used to be, but still may be used in the treatment of trigger points and muscle spasm.
Dry needling or trigger point injections have become very popular lately as a way to treat trigger point pain. Similar to acupuncture, a tiny needle is inserted into the trigger point to improve the pain and inactivate it. Studies have shown that for reducing pain, only inserting the needle is just as effective as injecting an anesthetic (1). Like acupuncture, this technique is usually not painful and may provide great relief for those with muscle pain due to trigger points.
What Can Trigger Point Therapy Help With?
Studies have shown trigger points to help improve many types of muscle-related pain. Common conditions that are caused by trigger points and trigger point therapy may help with include Headaches (3, 4), Migraines (5), TMJ Pain, Eye Symptoms, Tinnitus, and any other area of prolonged muscle pain that often mimics injury (1).
Many people who have trigger point referral pain do not realize the cause and the pain has become their new "normal". Many times symptoms of trigger points also do not match typical patterns of muscle pain and may be mistaken for something else. In order to relieve these symptoms it is important to find a skilled practitioner that can diagnose the source of the pain and determine the optimal treatment plan. If the source is trigger point referral, post-treatment lifestyle changes like diet, exercise, and proper posture may also be necessary to prevent their recurrence.