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I discovered trigger points when a friend of mine who has fibromyalgia mentioned to me that she was in a lot of pain all the time, couldn’t walk well because her feet were sore and stiff, and was generally feeling weak and fatigued.
The problems she was experiencing were very similar to those caused by trigger points, which I’d been reading about in a Fibromyalgia and Chronic Myofascial Pain: A Survival Manual by Starlanyl and Copeland. When treated specifically for trigger points, my friend gained great relief. She can now walk normally, can move without pain, and has more energy.
There is a distinction between the ‘fibromyalgia tenderpoint,’ which is common to people with fibromyalgia and which is used to diagnose fibromyalgia, and the ‘trigger point,’ which is a problem common to everyone. Interestingly, people with fibromyalgia often have both tenderpoints and myofascial trigger points (MTrPs aka trigger point TrP). The main difference between the two is that tenderpoints do not have hard bumps or ropy bands in the muscles but TrPs do.
Starlyl and Copeland describe trigger points as:
A hyperirritable area of skeletal muscle. Trigger points exist in association with hypersensitive contraction nodules, which feel like rock-hard lumps in your muscle. You may be able to feel the taut ropy band of tense muscle fibers that extends from the TrP to the area where your muscles attach to other structures.
Hyperirritable means you’ll know you’ve found a TrP when you come across a spot that’s much more painful than the rest of the muscle. It’s common that you’ll jump in response to pressure on this point. And if it’s an active point it will sometimes refer pain to other areas of the body. This referral pattern can occur with or without pressure on the point.
Trigger points have been the focus of a lot of research, which has resulted in the development of trigger point pain referral pattern maps, helpful guides for locating TrPs based on pain patterns. Though research has also shown that it’s important to remember that each person’s patterns are unique to that person and may not be consistent with mapped patterns.
Here’s an example of TrP pain referral patterns. When I first began massaging, my jaw muscles on the left side suddenly hurt so much I could barely open my mouth. It was a bizarre and somewhat alarming occurrence. Releasing the TrPs in my jaw muscles only gave brief relief. Luckily, because I was deep in my studies of TrPs by that time, I realized a key trigger point in my upper shoulder muscle was causing satellite triggers in my jaw muscles. When the key trigger point in my shoulder was released the pain and stiffness in my jaw went away.
I find the pain referral characteristics of TrPs fascinating. ‘It hurts here, but the point to release it is way over there…’
Trigger points can lead to headaches, muscle pain, loss of range of motion, fatigue, osteoarthritis, muscle weakness, depression, sleep disturbances, visual disturbances, sinus problems, stiff neck, dizziness, loss of circulation, nausea, bladder troubles, back pain, ringing in the ears, and nerve impingement leading to numbness and tingling. I’d go on, but I think you get the idea.
You may wonder what factors can lead to TrPs in the first place? Travell & Simons’ book Travell & Simons’ Myofascial Pain and Dysfunction: The Trigger Point Manual Vol 1 gives a number of causes. Here are a few:
- Structural problems of the body. A short leg or pelvic imbalance can be the culprit.
- Postural stresses: a) Check your body posture. Do you slump while standing, sitting, relaxing? b) Do you lift objects from the floor in an unsafe way? c) Do you overload muscles or push through pain? d) Are your muscles in a shortened state often? An example is when driving long distances with the arms and shoulders raised high, causing upper shoulder muscles to shorten.
- Constriction of muscles. This can occur with the constant pressure of a belt, necktie, purse strap, bra strap, or even a chair that presses uncomfortably on the backs of the legs.
- Nutritional inadequacies. These can cause physiological changes in muscles.
- Metabolic and endocrine disorders. Hypoglycemia, gout, and low metabolism issues such as hypothyroidism can all factor into TrP development.
- Psychological factors. Includes hopelessness, depression, anxiety and tension.
- Chronic infection and infestation. These can be caused by viral disease, bacterial infection, and parasites.
- Visceral diseases. Ulcers, renal colic, myocardial infarction, gall stones, kidney problems, and irritable bowel syndrome can all contribute to TrPs. Because of the many potential health issues it is important to check for and resolve underlying issues that can lead to TrPs!
- Impaired sleep.
- Nerve impingement.
Just as there are many causes, there are also numerous methods for
releasing TrPs. Techniques that may be used clinically are cold spray with stretch, needling of TrPs with a hypodermic needle, and massage or pressure on TrPs. Masseurs and bodyworkers use various massage techniques along with consistent but not excessive pressure on a point anywhere from 3 to 30 seconds. And if you want to release your trigger points at home you can use your fingers, thumbs, knuckles, massage cane, or a tennis ball or rubber lacrosse ball to press gently on point for 3 to 30 seconds. You may need to apply pressure a number of times. Then gently massage the area. A gentle stretching routine is also a good idea.
The new therapy, Massage Cupping, a method that uses Chinese Medicine cups to release tight and knotty tissue, is an extremely effective and much less painful way for your massage therapist to release your trigger points.
Often when a TrP is released, it will stay released—unless the factors that caused it in the first place are still in place. This is another reason to determine the cause, so you don’t keep coming down with nasty little TrPs.
Trigger points are not a well-known phenomenon, yet they can really factor into many problems that plague our lives. Quite thankfully, once TrPs are recognized and underlying health problems are either treated or ruled out as causes, these little painful nodules are easy to deal with and simple to release.
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Photo Credit: Lars Sundström
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