TRIGGER POINTS AND KNOTS
What are trigger points and knots? Why do they cause us so many problems? And what can be done about them?
A (very) brief history
Trigger points have been the subject of study by a small number of doctors for several decades although this has not, as yet, become part of mainstream medicine. The term Myofascial Trigger Point was first coined by an America Physician, Janet G. Travell, in 1942, who treated John F. Kennedy's back pain and was the first female personal physician to an American President. She wrote many papers and books on the subject which are still arguably the most detailed and important work on myofascial pain and trigger points. Learn more about Janet Travell at JanetTravellMD.com.
What are trigger points?
Trigger points are described as hyper-irritable points within nodules in taut bands of muscle fibers, when pressed they can be, as Janet G. Travell said, "exquisitely painful". Compression of a trigger point may elicit local tenderness, referred pain, or local twitch response. A local twitch response is not the same as a muscle spasm because a muscle spasm refers to the entire muscle contracting whereas the local twitch response refers only to a small twitch - no contraction.
It is frequent for trigger points to radiate tenderness to local and broader areas sometimes distant from the actual location of the point itself. Patterns of associated pain areas have been identified that allow practitioners to associate pain in one location with the trigger point elsewhere in the body. It is still not fully understood why trigger points sometimes refer pain elsewhere, hopefully research in the near future will help explain this strange phenomena, at present it is thought that trigger points refer pain elsewhere in the body along nerve pathways.
Trigger points come in several different types, active/latent, key/satellites and primary/secondary. An active trigger point is one that is actively referring pain either locally or to another location, a latent trigger point is one that exists but isn't yet referring pain actively, but may do so when pressure or strain is applied. Latent trigger points can often cause poor muscle balance and co-ordination and restrict range of motion of the muscles and joints. There is some evidence to suggest that although latent trigger points don't usually cause us pain they are in actual fact more damaging as they cause longer lasting problems with muscle flexability and range of motion.
A key or primary trigger point will often cause or create satellite or secondary trigger points within muscles in its referal area. When this happens it is easy to have a cascading effect where one trigger point creates another and then that one creates another and so on. Often treatment of the secondary or satellite trigger point will only give temporary relief until the primary trigger point is treated and sometimes if the primary trigger point is treated then the satellite or secondary points will resolve themselves without the need for treatment. Basically finding the initial or primary trigger point is crucial to resolving the pain and discomfort.
Trigger points shouldn't be confused with the tendor spots experienced by someone with fibromyalgia. A trigger point will be painful when firm pressure is applied and will often refer pain to another area whilst a tendor spot will be painful even when only being touched lightly. Many people with fybromyalgia will experience both tendor spots and trigger points and will often experience relief from symptoms when having the trigger points treated.
Referred Pain
Pain referred from a trigger point is very real and can be as intense as from any other pain condition. The pain a trigger point causes is often felt as a deep ache but can also be pins-and-needles, a dull heavy sensation, a sharp pain or even a numbness. These sensations come from the fact that a trigger point can irritate nerve pathways and blood vessels as well as the actual pain associated with the trigger point referral area.
What activates trigger points?
Trigger points may be activated by any number of factors, including acute and chronic muscle overload, activation by other trigger points (key/satellite, primary/secondary), disease, psychological distress, direct trauma to the region, infections and health choices such as smoking.
Often it is when we are doing something we don't usually do, or spending to much time in an position such as driving or sitting at our desks, stressful situations add to this along with illness and poor health.
What causes trigger points?
There are many ideas about how a trigger point is caused, it was once believed that trigger points were scars or inflammation in the muscle, but this has been disproved when biopsies showed no abnormalities. Another idea is that trigger points are spasms or contractions of voluntary muscle possible caused by abnormalities at the neuromuscular junctions (where nerves controlling muscle connect to the muscle fibers), this idea is unlikely because the trigger points are often not in the location of neuromuscular junctions.
The two most credible answers are that:
- Trigger points are muscle spindles made over active by adrenalin stimulation, these are very short muscle fibers about 1 cm in length called intrafusal muscle fibers which are activated by adrenalin via the sympathetic nervous system.
- Trigger points are caused by an event of muscular overload causing a prolonged release of Ca2+ion from the sarcoplasmic reticulum (the storage unit for the muscle cell) which results in a sticking of the overloaded cells.
What can be done about trigger points?
There are several different approaches to treating trigger points, for chronic cases of myofascial trigger pain, injection of saline in to the muscle fibers involved is an option, this is quite sever but often very effective, only really applicable to chronic cases of myofascial pain syndrome. Another treatment is the acupuncture of trigger points, again this treatment can give excellent results but can be quite painful to receive and not every traditional acupuncturist is familiar with the application of dry needling for trigger points.
The least intrusive and arguably the best treatment for trigger points is massage. A practitioner trained in trigger point and myofascial therapy will be able to give far better results than the average massage therapist. Being able to locate, identify and use specific massage techniques aimed at de-activating and reducing trigger points. Often trigger point treatment can be slightly painful and sore during the treatment and for up to 24 hours afterwards but the relief gained over the long term can be considerable.
A good massage therapist will give you advice on techniques you can use yourself to help reduce the trigger points between treatments and how to maintain the work done during the treatment, often prescribing different stretches and exercises targeted at the area involved. You may find that some lifestyle changes are required to help de-activate the trigger points and keep them at bay.
Trigger point can cause a lot of pain and discomfort, often restricting movement. You don't have to put up with the pain from trigger points they are easily treated! Usually several treatments are required to really breakdown the trigger points, remember you have spent years creating them, but many people get huge relief from just the first treatment.
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