In Awe of Trigger Points
The more I study Trigger Point Therapy, the more I am in awe of Trigger Points (TPs). They are a very common cause of chronic pain and are often overlooked and undiagnosed.
Even though Massage Therapists might study the muscles in depth, they may overlook the source of their client’s pain. It is common to address an area of “chief complaint” in the body. But it may not be the source of your client’s pain, but an area of referred pain.
For instance, your client may complain of pain in their thumb. It is common to start rubbing away on their thenar eminence. It might feel good but what if the source of their pain originated from the Subclavius muscle. Your treatment would have little or no long term effect on their thumb pain. Or your client may be complaining about low back pain – a very common complaint. It would be easy to concentrate one’s efforts on the erector spinae. And why not? They are often tight and feel good when massaged. However, the source of your client’s pain could be a trigger point in the gluteus medius. Janet Travell referred to the gluteus medius muscle as the “Lumbago” muscle. Lumbago is a nonspecific term for dull, aching pain in the lumbar region. The gluts are a very common source of TPs with many paths of referral, often to the low back and area of the iliac crest.
Trigger Points are hyper-irritable areas in a muscle. They feel like a nodule or taut band. They are usually quite sensitive or tender to the touch. They typically refer to an area of pain that your client is familiar with. A TP in a muscle prevents the muscle from being fully stretched to its full range because of pain. It will restrict the muscle’s strength and endurance.
TPs can be caused by injury, stress, acute overload, fatigue, postural stress, or impact trauma. They can cause symptoms ranging from pain, radiating pain, numbing, tingling, cold or heat sensations and goose bumps. They can also cause other types of symptoms such as eye tearing, dry eye, blurred vision, headaches, stiff neck, or toothache. I have heard clients describe their pain as a “steel rod through my head”, a “hot poker in my ear”, and “deep pain through my eyeball”.
Referrals can mimic the symptoms of atypical facial neuralgia, carpal tunnel syndrome, tooth infection, and sciatica.
Key TPs can be responsible for the activity of satellite TPs. For instance, a hyper irritated active TP in the SCM muscle may cause satellite TPs to form in the Temporalis, Lateral Pterygoid, and Masseter muscles. The affect of Trigger Points can be far reaching, debilitating and not very well understood by Western medicine.
It would benefit any and all massage therapists and manual therapists that work with clients with pain to learn about TPs. The study of TPs has been made easier by the work of Janet Travell and David Simons. Their book Myofascial Pain and Dysfunction: The Trigger Point Manual published in 1983, mapped out the most common TPs and their common referral patterns. It is good to have at least one good reference guide in your office. Take a Neuromuscular Therapy class or a class specifically on Trigger Point Therapy. Purchase Travell’s book for an in-depth education about TPs – anatomy, causes, their neurology, common referral patterns, treatment, etc. You can also find quick reference guides such as flip charts and posters to help you in your exploration.
If you like technology, there are apps for the iPhone and iPad created by Real Bodywork. You can explore by the zone of pain that your client complains about or by the muscle. I often look up TPs while my client is preparing to get on the treatment table.
Knowledge of TPs can take your work to a new level. You will be able to bring ease to clients in pain. You will feel a level of mastery with your