Sunday 6th December, 2020

Trigger point basics

A plain language easy to understand guide to arguably the most common cause of musculoskeletal pain such as back, neck and shoulder pain.

Find out:

  • what trigger points are
  • what problems they cause
  • why trigger point pain keeps coming back
  • how they can be successfully treated

Introduction

Trigger points: the most common cause of pain

As readers will probably be aware musculoskeletal conditions such as back, neck and shoulder pain keep coming back. According to scientists (myofascial) trigger points are probably the most common cause of this pain. They are those lumps in muscles that shoot pain when masseurs press on them. As well as causing pain scientists have shown that these points have a host of secondary effects such as causing postural changes, "overuse injuries", muscle tears, joint problems, and even long term arthritic changes.

Overlooked and inadequately treated

Despite being so common, and having so many adverse affects, they do not show up in medical tests and cannot be treated by drugs or surgery. Because of this they are barely mentioned in medical journals, so your doctor may not even consider them. If they are considered, usually by other professionals, treatment is usually targeted at relieving their pain rather than eliminating the condition. The obvious problem with just treating the symptoms is that the pain keeps coming back, but importantly it means the trigger points continue to have their covert effects on posture, muscles and joints. Long term these effects lead to a host of secondary problems.

Being aware: the solution to the problem

We believe that the only way this situation will ever change is if you have a better understanding of the issues and consequences. That way you can ask better questions and seek more appropriate care. To help you do this this we've taken the information out of the scientific journals and put it into plain language and simple diagrams that are comprehensive, yet easy to understand.

What those lumps actually are

In this section we will look at what those painful lumps masseurs find actually are. This is important because it helps you understand what they do, and how they can be successfully treated.

Trigger points are part of the muscle locked into spasm

Abnormal nerve signals

Those lumps are actually part of the muscle that has locked into a continuous spasm or "cramp". They are continually stimulated to contract (tighten) by abnormal nerve signals. The nerve signals result from what is known as a positive neurological feedback loop, which is the same principle as the feedback squeal you get when you put a microphone next to a loud speaker.

Trigger points cause muscles to tighten and shorten

Muscle tightness

When part of the muscle tightens the whole muscle shortens and becomes tight.

Trigger points put pressure on blood vessels, reducing blood flow

Restricted blood flow

As seen with body builders, contracting (tightening) muscles caused the fibres to expand or bulge. Those tightened and expanded muscle fibres press on the blood vessels, blocking them. The muscle, and in particular the tender lump, are deprived of oxygen and nutrients, and suffer a build up of waste products.

Trigger points: The consequences

When aggravated trigger points can cause pain without being pressed upon

Pain

As anyone who has been to a masseur would understand, you may not be experiencing any pain but still have many trigger points that feel tender if pressed upon. However, if those trigger points are aggravated or allowed to worsen they can start shooting pain spontaneously, without being pressed upon. Scientists have found that these are probably the most common cause of all pain syndromes such as back, neck and shoulder pain. You may see charts like these in clinics showing some of the pain they cause.

Muscles with trigger points are not as strong, fatigue quickly and react slowly

Poor performance

Muscles containing trigger points suffer from poor blood flow, a build up of harmful waste products, and are already fatigued due to the part contantly contracting. Because of this a muscle containing a trigger point will not be as strong, and will and fatigue quickly. As well, scientists have found that muscles with trigger points are slower to respond to nerve signals from the brain.

Trigger point tightening causes muscle tears, attachment pain and "overuse injuries"

Abnormal tightness: tears and attachments

Muscles with trigger points are constantly tight, and because part is trying to contract all the time it will resist stretching. For this reason, muscles containing trigger points are much more likely to tear. The abnormal tightness also creates extra tension where the muscles join to bone. Those sites of extra tension are more prone to injury or "over use syndromes" such as tennis elbow.

Trigger points tighten muscles: restricting movement and stretching

Abnormal tightness: restricts movements and stretching

The abnormal tightness in your muscles will also restrict movement generally. As anyone who has tried to stretch a muscle in spasm or cramping will understand, attempting to stretch a muscle containing a trigger point will meet with resistance, and maybe some pain.

Trigger point muscle tightness changes posture

Abnormal tightness: posture changes

Normal posture is maintained by having the tension in the muscles on each side. side (or front and back) in balance. An abnormally tight muscle with a trigger point will alter this balance, causing postural changes.

Trigger point posture changes alter joint alignment, causing increased wear and injury

Abnormal tightness: joint alignment

The abnormal posture that results from an imbalance will alter the alignment of joints, resulting in increased wear and an increased risk of injury.

The treatment of trigger points

Introduction

In this section we will give an overview of how trigger points are treated. We will first discuss how trigger point therapies work, then how these can be incorporated into a plan to eliminate your trigger points and keep yourself trigger point free. For further information please click on the image to the right for our research summary Trigger point treatment: deactivation or elimination.

How trigger point therapy works

So many different treatments?

There are are so many different therapies used to treat trigger points and trigger point related pain that it is confusing. We have massage techniques, dry needling, lasers, stretch and freeze therapy, and the list goes on. They are all different, yet are supposed to treat the same thing.

Lets look at the fundamentals

To make some sense of it all we look at the three key parts of a trigger point discussed above and listed below. Every form of trigger point therapy is designed to treat trigger points by addressing one or more of it's parts.

  • Abnormal nerve signal causes muscle to spasm
  • The whole muscle becomes tight
  • Blood flow is restricted, causing a lack of oxygen and nutrients, and a build up of waste products
Vibration massage is scientifically proven to address all three parts of a trigger point, and can be self applied for no ongoing cosr

Vibration massage is very effective

Vibrating massage is a very effective form of trigger point therapy because the vibrations penetrate deeply and have been scientifically proven to address all three parts of a trigger point. Further, vibration massage is one therapy that can easily be self applied. This is very important, because as will be discussed next trigger point therapy needs to be applied many times. For further information about the scientifically proven effects of vibration massage please our research summary The scientifically proven effects of vibration massage.

Trigger point treatment plan

Trigger point treatment two stage plan: 1) relieve pain, 2) eliminate remaining trigger point

The two stages of treatment

As can be seen in the diagram the treatment of painful trigger points is a two stage process. The first is to settle it down so it only shoots pain when a masseur presses upon it. At that stage the person is pain free. The second is the much longer process to when the lump and all it's adverse effects dissappear completely.

Trigger point treatment stopped when pain free: trigger point remains

What normally happens

Unfortunately, the diagram below shows what normally happens. After a few treatments pain has gone and the person feels good, so treatment is discontinued. However, the tender lump and all it's adverse effects will still be there. The obvious consequence of this is that you will be just one re-aggravation away from being in pain all over again. The less obvious consequence is that over time the adverse effects we've discussed will manefest into some or all of the problems listed below.

  • Muscle strains and tears
  • Muscle attachment or "overuse" injuries.
  • Postural pain syndromes
  • Joint injuries
  • Long term abnormal wear in joints ("arthritic or degenenerative" changes)

A better solution

Why the problem is not eliminated

This is a complex issue. Medical care tends to be symptom based, and there is generally a very poor understanding trigger points and their consequences. However, a big issue has to be the cost. Treatments such as dry needling, laser and manual trigger point therapies are all beneficial, but they usually need a professional to administer. The cost of having a large number of treatments can be horrendous.

When many treatments are needed the cost of therapy is a huge consideration

Overcoming the cost issue

The obvious way to ovecome this would be to have treatment that can be self applied. Sports people have tried to do this to some extent with the use of foam rollers, which is an attempt to emulate manaual massage. However, if you read our research summary on the use of foam rollers The use of foam rollers in sports you will see that even in clinical trial where users are screened for suitability, receive excellent instructions, and are well supervised the results are nothing to get excited about. By far the better option is the use of vibration massage. As previously discussed, it penetrates deeply to work on all three aspects of a trigger point, but more importantly, is much easier to use and doesn't require specialised massage skill to get professional quality results.

Prevention and maintenance vs pain

Hopefully it will be very obvious now that even before becoming painful trigger points are a very bad thing to have. Unfortnately according to the scientists though most adults have many and are completely unaware. By far the best solution is some sort of regular screening an maintenance. Some people do this with regular visits to a masseur. Sports clubs do it by having massuers work on their players regularly. The good news is that with a bit of professional advice and practice it becomes quite easy to find trigger points on oneself and use a vibration massager to treat them.

When pain syndromes exist always seek the help of a professional

Pain syndromes

If the trigger points have progressed and you have some sort of pain syndrome such as back, neck or shoulder pain please understand that these conditions can be complex. For example, they may be other issues, including those causing the trigger points to develop. There may also be some of the secondary effects of trigger points such as postural syndromes and joint issues. These often become entrenched and serious in their own right. Because of this we ask you to always follow the model in the diagram below. Obtain proper professional diagnosis and management, and have the trigger point therapy (such as using our massagers) as part of his or her management plan.

We are continually adding more information on research and uses. Subscribe below to have us email them to you "hot off the press".

Dr Graeme

About Dr Graeme

Several years ago Dr Graeme, a Chiropractor practicing in Victoria, Australia was looking for a serious hand held massager his patients could use at home to get the extra quality massage they needed. The ones he found in the shops and on-line for home use looked nice but were not serious, and... read more