Trigger Points Explained
Trigger Point Symptoms & Referred Pain Patterns
Pain is a complex symptom experienced differently and individually. However, referred pain is the defining symptom of a myofascial trigger point.
You may be used to the idea of referred pain of visceral origin: an example of this is heart pain. A myocardial infarct (heart attack) is often not experienced as crushing chest pain, but as pain in the left arm and hand, and in the left jaw. This type of pain is well documented, and known to originate from the embryological dermomyotome; in this case, the heart tissue, jaw tissue, and arm tissues all develop from the same dermomyotome.
Referred pain from a myofascial trigger point is somewhat different. It is a distinct and discrete pattern or map of pain. This map is consistent, and has no racial or gender differences, because stimulating an active trigger point generates the pain.
Patients describe referred pain in this map as having a deep and aching quality; movement may sometimes exacerbate symptoms, making the pain sharper. An example of this might be a headache. The patient often describes a pattern of pain, or ache, which can sometimes be aggravated and made sharper by moving the head and neck. The intensity of pain will vary according to the following factors (this list is not exhaustive):
Location (attachment points are more sensitive)
- Degree of trigger point irritability
- Active or latent trigger points
- Primary or satellite trigger points
- Site of trigger point (some areas are more sensitive)
- Associated tissue damage
- Location/host tissue stiffness or flexibility Ageing
- Chronicity of trigger point
What is trigger point therapy?
Most of us will suffer from stiff, achy muscles, and numerous musculoskeletal pain conditions that are caused by "knots". Trigger point therapy uses a variety of techniques to "deactivate" these painful knots and make them dissapear. Trigger point therapy is generally simple to perform, both at home by yourself, with a partner, or by working with a trained therapist.
For most musculoskeletal conditions, a combination of trigger point therapy together with some simple lifestyle changes will produce very fast and lasting results.
So, what happens when you treat (massage) a trigger point? Well, by doing so you:
numb and reduce the pain
- lessen the pain feedback pathways
- interrupt the pattern of pain and spasm
- stretch out tight muscles, which will indirectly affect other tissues
- open out the plastic-wrap-like myofascial bag that surrounds your muscles
- stimulate the blood supply helping to remove debris and toxins from the area
- encourage the release of powerful pain-killing endorphins
Pressing on trigger points:
numbs and reduces pain in the treated area and in the area of the percieved pain;
attenuates the pain feedback pathways;
breaks the vicious cycle of pain and spasm;
stretches tight structures, which will have an indirect effect on other tissues;
opens out the plastic-wrap-like myofascial bag surrounding, investing, and supporting the muscles;
stimulates the blood supply, to clear away debris and toxins;
- increases the release of powerful pain-killing agents called endorphins;
affects the autonomic/automatic nervous system.
How do you know it is a trigger point?
You are looking for:
Stiffness in the affected/host muscle
Spot tenderness (exquisite pain)
A palpable taut nodule or band
Presence of referred pain
Reproduction of the symptoms (accurate)
Possible loss of skin elasticity in the region of the trigger point
The affected area may be moister or warmer (or colder) than the surrounding tissues, and may feel a little like sandpaper.
What bits of your hands should you feel them with?
- Finger pads: remember to cut your fingernails (shorter is better).
- Flat fingers: use the fingertips to slide around the skin across muscle fibers (see fig. a)
- Pincer: pinch or grip the belly of the muscle between the thumb and the other fingers, rolling muscle fibers back and forth. (see fig. b)
- Flat-hand palpation: useful in the abdominal region (viscera).
- Elbow: allows a stronger and shorter lever, which can be a distinct advantage (not always practical, and can be difficult to get used to).
If you plan to treat yourself at home through self-help, hands-on treatments, you should schedule no more than one session a day, with a three or four day gap in-between. If you are using balls, rollers or pressure tools on the other hand, then you can usually increase the frequency of treatment up to up to six times a day (based on a 10-15 minute treatment session).
If you are receiving treatment from therapist, you should also expect "home-work". Your therapist will provide you with a suitable treatment plan for you to follow between visits.
About You and Your Pain
Over 25% of adults suffer from musculoskeletal disorders (MSD's), and this number is growing exponentially as we live longer, work longer, and adapt to changing lifestyles such as increased use of mobile and tech devices.
Whilst most MSD's will heal over time without treatment, the process is usually slow and debilitating. In some cases, a lack of early intervention and treatment can lead to more serious symptoms, and temporary or permanent disability.
Sadly, the majority of MSD sufferers will take little or no remedial action, most often because the costs of manual therapy can be prohibitive.
The good news is that the vast majority of MSD's can be effectively treated, especially when action is taken early.
Self-Help or Therapist?
The best option is always both! All good therapists will encourage and help you to help yourself, by providing you with simple techniques to help you understand your body, and help speed up the healing process between treatments.
For those of you who are unable to visit a therapist, NAT self-help programs are available here.
To find a trigger point professional in your area click here