Sunday 4th July, 2021

Do trigger points go away on their own?

Trigger points do not go away on their own. If rested or treated they may regress slightly to a state where they stop referring pain unless a therapist presses on them, but they will still be there. Further development or aggravation will cause them to refer pain again.

In this article we will discuss how trigger points form, what they do, and how you can get rid of them.

Trigger point
Trigger points develop slowly over time and will not go away on their own
Trigger point development cycle
Trigger points develop over time, then can eventually be "activated" to cause pain

How trigger points develop

Trigger points are those lumps in your muscles therapists find. As this diagram shows they start as a lump that is only noticed when a therapist presses upon it. At this stage a person usually will not know they are there. Over time the trigger point will continue to develop. It will reach the stage where it does not yet shoot pain, but is much larger and causes several adverse effects which we will cover later. Eventually it becomes that bit worse or is aggravated, then starts to refer pain without needing to be pressed upon. These pain referrals are responsible for a large percentage of musculoskeletal pain syndromes such as back, neck and shoulder pain (1–7)

Cycle of muscle tightness, restricted blood flow, and build up of waste products
Cycle of muscle tightness, restricted blood flow, and build up of waste products

Why do trigger points continue to develop

Scientist have found that trigger points continue to develop and grow because the conditions that develop create positive feedback, not unlike when one places a microphone in front of a loud speaker. Lets look at one part of this that can be easily understood without any technical knowledge. As the lump forms it causes the muscle to tighten, which restricts blood flow. Because of the restricted blood flow the muscle around the lump is deprived of oxygen and suffers a buildup of waste products. This makes the trigger point worse, so the muscle tightens further, restricting blood flow more. Scientists have found more to trigger points than this, but it shows why trigger points develop over time and won’t go away on their own accord (8–12)

Do trigger points go away when you rest?

If trigger points are not severe they may settle slightly and spontaneously stop referring pain. As this diagram shows though the trigger point is still there. At this point we will introduce two terms used to describe the behavior of trigger points: activation and deactivation.

De-activation of trigger points
De-activation: still there but not referring pain

Activation of trigger points

Activation of trigger points is when they go from only referring pain when pressed upon, to hurting without being pressed upon

Deactivation of trigger points

Deactivation of trigger points is when they go from hurting without being pressed upon, to only referring pain when pressed upon.

Simply, if trigger point pain goes after resting the trigger points are spontaneously deactivating. They may repeatedly activate and deactivate when exerting oneself then resting.

Chronic pain and fibromyalgia: the continued development of trigger points

If the trigger points continue to develop they will get to the stage where they no longer spontaneously deactivate with rest. The condition then becomes one of chronic (long term) continuous pain. Over time such chronic pain causes the nervous system to become sensitised, causing the development of fibromyalgia. This is the subject of a separate article.

Is trigger point therapy effective?

Trigger point therapy can be effective to an extent, but this can be highly misleading. As we discuss in our article Trigger point therapy: deactivate or eliminate, trigger point therapies are designed and tested to deactivate trigger points, which is just a technical way of saying to relieve the pain. Of course just as occurs when trigger points spontaneously deactivate when rested, the trigger points are still there and can easily re-activate.

The evidence: 12 sessions of trigger point therapy only eliminated 1/3 of trigger points

Bron trigger point data

This table shows the results of a trial where researchers used 12 weekly 45 minute therapy sessions for the shoulders alone, and still only 1/3 of trigger points were eliminated. Whether it is a course of treatment by a professional, or the latest relief technique from Youtube, very few trigger points are actually eliminated (3)⁠. At DrGraeme we think it is very misleading to be offering courses of treatment when they are only shown to deactivate the trigger points, so we share with you our strategy to eliminate trigger points properly.

Car warning lights
Medications do not treat trigger points: only hide their symptoms while the problem develops

Is medication effective in treating trigger points?

There is no medication that treats trigger points, only those that relieve the pain that they cause. Taking them may provide relief, but is analogous to covering up annoying warning lights in your car and continuing to drive. It is good for drug companies, but not for you.

Do trigger points still cause problems even when not referring pain

part from being just one step from referring pain again, muscles with trigger points become tight, lack blood flow, and are not able to function normally, which adversely effects posture and biomechanics. Even without referring pain, the consequences of these (known as latent trigger points) have been summed up as follows⁠ (7, 13). For more information please see our article Trigger point basics

  • restrict ranges of motion
  • cause muscle weakness
  • cause muscle fatigue
  • alter muscle activations (alter neurological control of movement)
  • induce muscle cramps, and
  • affect posture and joint function, creating further issues.

On top of that, scientists are now finding that latent trigger points still produce sub-threshold levels of pain that over time sensitises the nervous system. This is a major cause of issues such as fibromyalgia and migraines.(12)

How do you get rid of trigger points?

Our strategy that we’ve used in clinic to get rid of trigger points is as follows. Given that 12 sessions of therapy was shown to diminish trigger points and eliminate 1/3 of them, treatment should be continued after pain has gone to cause further diminishment and elimination. Because of the large number of treatments required the therapy used needs to be able to be self administered, or it will become way to expensive. Further, trigger points are usually part of more complex musculoskeletal conditions, There there are often issues that cause or perpetuate them. Because of this a professional who deals with trigger points should be consulted. Self applied therapy should supplement his or her overall management plan.

Our recommended trigger point treatment

We recommend that by far the most effect form of trigger point therapy you can use is applying a quality vibration massager. This is because it is highly effective and easy to self apply.

The scientifically proven effects of vibration massage
Summary of the scientifically proven effects of vibration massage

Vibration is highly effective

As mentioned earlier, trigger points are formed by a positive feedback look that involves tightness, reduced blood flow, and a build up of toxic waste products. Vibrations from the massager penetrate into the muscles and act upon all these issues, helping diminish the trigger point’s components and disrupt the feedback loop. Each application of therapy should reduce these a bit more. For more information about these effects please see our article The scientifically proven effects of vibration massage with clinical applications.

Vibration massage is very easy to use

Although we advise you to seek professional advice regarding where, when and how often to apply vibration massage, The application of trigger point therapy is basically very simple. You sit the massager on the muscle over the trigger point and let the vibrations penetrate. For more information on the application of vibration massager please see our instructions page.

Getting started treating your trigger points

To get started you will need to find a good professional who understands trigger points. If you go to our get a massager page then select your country you should find near the top a link to a list of clinics that may be able to help. Alternatively, you can find a qualified professional such as a Chiropractor, Osteopath or Physiotherapist and discuss this with him or her.

Getting a suitable vibration massager.

You will need an effective vibration massager. There is a lot of miss-information and ineffective machines available. I’ve linked some information below to help you choose, or you can use the safe option and get one of ours.
Video: How to choose a massager
Article: Percussion vs vibration massage
Video: Our highly effective vibration massager

Professional at desk
Professionals: click image to find out more and possibly trial vibration massage

Professionals

DrGraeme massagers were originally built by Dr Graeme for use in his clinic, and to prescribe to his patients for additional self use at home. Now these are used by colleagues and other professionals for similar purposes. If you are a professional and wish to know more about this therapy, or possibly get a sample massager to trial please check out our practitioner page.

References

  1. Chiarotto A, Clijsen R, Fernandez-de-las-Penas C, Barbero M. The prevalence of myofascial trigger points in spinal disorders: a systematic review and meta-analysis. Physiotherapy. 2015;
  2. Ge H, Wang Y, Fernández-de-las-peñas C, Graven-nielsen T, Danneskiold-samsøe B, Arendt-nielsen L. Reproduction of overall spontaneous pain pattern by manual stimulation of active myofascial trigger points in fibromyalgia patients. 2011;
  3. Bron C, De Gast A, Dommerholt J, Stegenga B, Wensing M, Oostendorp RAB. Treatment of myofascial trigger points in patients with chronic shoulder pain: A randomized, controlled trial. BMC Med. 2011;9.
  4. Hidalgo-Lozano A, Fernández-De-Las-Peñas C, Alonso-Blanco C, Ge HY, Arendt-Nielsen L, Arroyo-Morales M. Muscle trigger points and pressure pain hyperalgesia in the shoulder muscles in patients with unilateral shoulder impingement: A blinded, controlled study. Exp Brain Res. 2010;
  5. Castaldo M, Ge HY, Chiarotto A, Villafane JH, Arendt-Nielsen L. Myofascial trigger points in patients with whiplash-associated disorders and mechanical neck pain. Pain Med (United States). 2014;15(5):842–9.
  6. Fuentes-Márquez P, Carmen Valenza M, Cabrera-Martos I, Ríos-Sanchez A, Ocon-Hernández O. Trigger points, pressure pain hyperalgesia, and mechanosensitivity of neural tissue in women with chronic pelvic pain. Pain Med (United States). 2019;20(1):5–13.
  7. Celik D, Mutlu EK. Clinical implication of latent myofascial trigger point topical collection on myofascial pain. Curr Pain Headache Rep. 2013;17(8).
  8. Jafri MS. Mechanisms of Myofascial Pain. Int Sch Res Not. 2014;2014:1–16.
  9. Zhuang XQ, Tan SS, Huang QM. Understanding of myofascial trigger points. Chin Med J (Engl). 2014;127(24):4271–7.
  10. Bron C, Dommerholt JD. Etiology of myofascial trigger points. Curr Pain Headache Rep. 2012;16(5):439–44.
  11. Malekshahi F, Aryamanesh F, Fallahi S. The effects of massage therapy on sleep quality of patients with end-stage renal disease undergoing hemodialysis. Sleep Hypn. 2018;20(2):91–5.
  12. Shah J et al. Myofascial Trigger Points Then and Now: A Historical and Scientific Perspective. HHS Public Access. 2015;7(7):746–61.
  13. Celik D, Yeldan P. The relationship between latent trigger point and muscle strength in healthy subjects: A double-blind study. J Back Musculoskelet Rehabil. 2011;24(4):251–6.

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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



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