TRIGGER POINTS

What Is Trigger Point Therapy?


Muscle tightness, achiness, and pain are one of the most common reasons a persons seeks massage therapy. And trigger points are the most common cause of this type of malady that is known as myofascial pain and dysfunction. A skilled trigger point therapist can target the exact spot in the muscle(s) by feeling for these nodules and applying strategic massage techniques to get it to soften and resolve.

When a muscle and its related connective tissue malfunction, it can result in a knotted up area of tension that is known as a trigger point. It feels to the client like an achy, tight, sore area of the body, or even like it could be in the bones. Trigger points usually form in the muscle tissue fibers when the fibers cease to normally function. So the whole muscle can still function and move, say, the arm or leg to some degree, but it can be inhibited and usually tightly restricted feeling and painful.  This is usually the result of overburdening the muscle either acutely, or chronically over time. Then just one wrong move and the pain starts, or the client just wakes up one day with the pain. Car accidents or other trauma can result in muscles knotted by trigger points that can remain that way for years. So what exactly is a trigger point?


Defining  a Trigger Point (TrP)

 

A trigger point is : A skeletal muscle nodule located in the endplate zone of the muscle. The nodule contains clusters of numerous microscopic, electrically active loci of contraction knots. These knots are  associated with taut bands that extend to the attachment sites at each end of the muscle.

 

This can typically be felt by the therapist as a palpable tighter or harder area in the muscle.


An Active Trigger Point Commonly Causes:

 

          LOCALIZED TENDERNESS : Localized tenderness where the nodule feels sore when palpated.

 

          REFERRED PAIN SENSATION : A referred pain sensation where spontaneously or at the  

          application of pressure it can elicit a characteristic  referred pain  pattern  for that muscle. This is

          sensation that radiates away from the actual location of the trigger point.

 

          LIMITED FULL STRETCH RANGE OF MOTION: Because the muscle fibers are already under 

          substantial tension due to the taut bands, any attempt to stretch the muscle either actively or   

          passively produces severe pain. Some muscles experience more restriction of stretch than others.

 

          PAINFUL CONTRACTION : When an attempt is made to contract the muscle, particularly when it is 

          in a shortened position, the contraction against fixed resistance will cause pain.

 

          MUSCLE WEAKNESS : Compared to normal muscle, a muscle with a TrP will lack strength and

          endurance and will fatigue more easily. It also has been said that a muscle with a TrP cannot be  

          conditioned to be stronger or gain endurance.


The Energy Crisis Hypothesis

 

It is believed that trigger points form because a vicious  electrobiochemical dysfunctional loop is generated in the endplate of the muscle fiber.  This perpetuates a crisis where the cell starves for oxygen and glucose and therefore for energy in the form of ATP. 

 

This means that somewhere along the line the muscle sarcomeres begin to malfunction, and “lock up”.  They lack the energy to unlock and as the dysfunction in the muscle continues, it creates more irritating chemicals, more tight guarding of the muscle, and more strangulation  of the tiny blood vessels that feed the muscle. More fibers begin to lock up in “contraction knots” until it forms a palpable nodule and the muscle becomes more progressively dysfunctional. 


Trigger Point therapy can effectively release this palpable nodule, and therefore restore proper function of that muscle. This can also result in pain relief of the referral pain sensation and torquing of the related bony joint. Trigger Point therapy utilizes scientific reasoning, clinical experience, and new concepts from research about how the nervous system,muscle function, and fascia interrelate. It is believed to act at the molecular level to fix an energy crisis that occurs in the muscle cell.  Theoretically, it is logical that compression that is only deep enough to engage the barrier of equal resistance from the muscle would cause a direct “microstretch” to the nodule area without causing additional ischemia or lack of blood flow, because the pressure is moderate and only sustained for 5 to 15 seconds. At the relief of compression of  the “microstretch” , more space is now made temporarily. This space now allows the arterial blood pressure to “micropump” fresh blood into the nodule.   Because the pressure on the nodule is kept under the threshold that causes neurological guarding, the muscle can stay relatively relaxed.  This series of compressions continues the “micropump” process until the cell has enough oxygen and glucose  to function and the sarcomeres unlock and the crisis is broken. This strategic combination  is important for the ultimate sarcomere release that is felt by the therapist as a “melting” of the muscle nodule.  Once the sarcomeres release, the palpable nodule is no longer present in the tissue.