Wednesday 3rd November, 2021

Your complete guide to (myofascial) trigger points

Trigger point introduction
In this article we'll show you what a trigger point is, how common they are, how you can find them, the effects they have on your body, and most importantly how they are treated.

If you look up "what are (myofascial) trigger points" you’ll likely find something like a discrete hype-irritable focal spot located in a taut band of muscle. That’s perfect for defining a term in a scientific journal, but not much else.

Instead, in this article I’ll show you what they are using plain English and simple diagrams, plus share with you useful information such as what causes them, how common they are, how you can find them, the effects they have on your body, and most importantly how they are treated.
What trigger points are
The effects trigger points have on your body
What causes trigger points
How common are they
How do you know if you have trigger points
The treatment of trigger points
Professionals
References

What are trigger points

Trigger point: positive feedback loop

Basically, trigger points are parts of muscles that have gone into spasm or "cramped" forming a lump, creating a chain of events known as a positive feedback loop (as shown in this diagram). This causes them to "lock on" and continue to grow (1–5)⁠.

A positive feedback loop is similar to when a microphone is placed in front of a loud speaker and you get a loud squeal until it is switched off. In the next section we’ll look at each part of that feedback loop. These are very important because they help:

  • show how and why trigger points form
  • what they do to your body, and
  • how they are treated

The parts of the feedback loop that cause trigger points to form and grow

Trigger points: abnormal nerve signals
Abnormal nerve signals cause part of the muscle to "cramp" forming a lump

Spasming or cramping part of your muscle

The first part of the feedback loop is abnormal nerve signals that cause part of the muscle to cramp or spasm. These are like a smaller version of a muscle cramp, and can be caused by things such as an injury, overloading your muscle, or even having your muscle tight all the time.

Trigger points cause muscles to shorten and tighten

Muscle tightness

Like when a body builder contracts their muscles, when part of the muscle cramps it expands and shortens. The shortening causes that part of the muscle becomes tight.

Tight contracted muscle fibres put pressure on blood vessels, reducing blood flow

Restricted blood flow

The tightened and expanded muscle fibres press on the blood vessels, blocking them. The muscle, and in particular around the tender lump, are deprived of oxygen and nutrients, and suffer a build up of waste products.

Increasing spasm

The lack of nutrients and build up of toxic wastes creates a toxic region, which stimulates further spasm. This completes the feedback loop. The more spasm the more the chain of events causes more spasm.

The effects trigger points have on your body

As you’ve now seen trigger points are parts of your muscle that have gone into spasm. As a result your muscle will tighten and not be getting adequate blood supply. Lets have a look at what this can do to your body. They are arguably the biggest cause of musculoskeletal pain such as back, neck and shoulder pain. However, even before doing this they cause a lot of very bad things to happen to your body.

When aggravated trigger points can cause pain without being pressed upon

Pain

The most recognised problem caused by trigger points is pain. Charts like that pictured show where the various trigger points refer pain to. As this picture also shows, in the early stages trigger points only shoot pain when a therapist presses upon them. Eventually though they can worsen and refer pain without being pressed upon.

Active vs latent trigger points

For descriptive purposes trigger points are classified as either being “active” or “latent”. Active means that they are shooting pain, while latent means that they are only shoot pain when pressed upon. Of course these are the same trigger points, just in differing states of angriness. As you will see in the next section, even when not actively shooting pain trigger points can still badly affect your body.

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 (spasming). 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 (6).

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.

What causes trigger points

We’ve seen that it is the feedback mechanism that causes trigger points to develop. There are a great number of things that can cause or predispose the feedback, causing trigger points to develop. By far the two biggest causes are the repetitive use of muscles and prolonged tightness of muscles. It is important to not that prolonged muscle tightness can be caused by things such as postural issues, sitting at a computer, or even emotional stress

How common are trigger points?

With trigger points caused by so many common issues, and you often not knowing they are there unless a therapist presses upon them, it is not surprising that clinical trials have found almost every adult gets a great many. As an example, lets look at the results of two separate trails. In the first scientists checked the neck and shoulder muscles of adults who had no neck and shoulder pain. In the second the scientists checked the muscles of worker who were suffering neck and shoulder pain.

People with no pain

An investigation of pain free adults found that nearly 90% had trigger points in their shoulder muscles (7).

People with pain

An investigation of office workers and blue collar workers with pain in their neck and shoulder region were checked for trigger points in their neck, shoulder and arm muscles (8). The results were:

  • Blue collar workers: Ave. 16 trigger points
  • White collar workers: Ave. 17 trigger points.

How do you know if you have trigger points

The odds are you do have trigger points

As the trials just discussed show, if you are a pain free adult there is a high probability you have trigger points, and if you suffer musculoskeletal pain it is almost a certainty. However, lets look at how to find out for certain.

Professional help

There are excellent professionals who can help identify trigger points. These include Chiropractors, Osteopaths and suitably qualified therapist. As a warning, medical doctors will usually be unable to help. Trigger points do not show up in standard medical tests, and despite being a major cause of pain and rarely mentioned in medical journals (9,10)⁠.

General muscle examination
General muscle examination with flat fingers

How to find trigger points yourself

It is best to have a professional show you how to examine for trigger points so you learn the correct techniques and can be sure that what you find is a trigger point. However the basic examination technique is very simple. You start by using flat fingers and moderate pressure as shown to examine your muscles for tight or tender areas. If you find a tight or tender area use one or two fingers to examine deeper, looking for tight bands of muscle. Along these tight bands of muscle you may find a tender harder part (lump) that may shoot pain when it is pressed upon. These lumps are likely trigger points.

The treatment of trigger points

We have an excellent resource What is the best treatment for trigger points. This discusses how trigger points are treated, which are the most effective therapies, and most importantly gives some excellent home therapies. However, we’ll give a brief overview here.

Trigger point: positive feedback loop

Effective treatments

We understand trigger points are formed by the issues shown in this diagram forming a positive feedback loop. To break this loop an effective treatment needs to address one or more of these issues. It is for this reason that there so many different therapies used to treat trigger points and trigger point related pain. We have massage techniques, dry needling, lasers, stretch and freeze therapy, and the list goes on. As long as they address at least one issue they will have some effect (11-14).

Number of treatments

Clinical trials show that courses of 3-12 sessions of therapy reduce pain but eliminate less than one third of trigger points (15-17). Therefore a very large number of treatments is necessary to eliminate trigger points properly. Please see our article Trigger point treatments: deactivate or eliminate for more detail.

Vibration: trigger point therapy
Vibration massage works on all the issues

Our choice of therapy

Vibration massage has been scientifically proven to address all the major issues of a trigger point. It disrupts spasm, relaxes muscles, increases blood flow, and the increased blood flow flushes the build up of wastes. For more details please see our article: The scientific effects of vibration massage with clinical applications.

Further, it takes no special skill or knowledge to apply vibration massage, so it is ideal for home use. Because of the large number of therapy applications needed effective treatment needs to include some home treatment, otherwise it becomes unaffordable and inconvenient.

Musculoskeletal conditions are complex. Always seek the guidance of a professional

You need more than just therapy

Musculoskeltal conditions are complex. As this diagram shows you usually need a lot more than just therapy. We recommend you consult a professional. However, as discussed trigger points usually need a large number of applications of therapy over time, which if done by the professional may prove inconvenient and expensive. We recommend you have a professional assess and manage your condition, plus provide the care that requires skill and training. This care can be supplemented buy self applied therapy at home. The use of vibration massage under the advice of your professional is an excellent and effective way to do this.

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. Jafri MS. Mechanisms of Myofascial Pain. Int Sch Res Not. 2014;2014:1–16.
  2. Zhuang XQ, Tan SS, Huang QM. Understanding of myofascial trigger points. Chin Med J (Engl). 2014;127(24):4271–7.
  3. Fernández-De-Las-Peñas C, Dommerholt J. Myofascial trigger points: Peripheral or central phenomenon? Curr Rheumatol Rep. 2014;16(1).
  4. Bron C, Dommerholt JD. Etiology of myofascial trigger points. Curr Pain Headache Rep. 2012;16(5):439–44.
  5. Shah J et al. Myofascial Trigger Points Then and Now: A Historical and Scientific Perspective. HHS Public Access. 2015;7(7):746–61.
  6. Ge HY, Arendt-Nielsen L, Madeleine P. Accelerated muscle fatigability of latent myofascial trigger points in humans. Pain Med (United States). 2012;13(7):957–64.
  7. Lucas KR, Polus BI, Rich PA. Latent myofascial trigger points: Their effects on muscle activation and movement efficiency. J Bodyw Mov Ther. 2004;8(3):160–6.
  8. Fernández-De-Las-Peñas C, Gröbli C, Ortega-Santiago R, Fischer CS, Boesch D, Froidevaux P, et al. Referred pain from myofascial trigger points in head, neck, shoulder, and arm muscles reproduces pain symptoms in blue-collar (Manual) and white-collar (Office) workers. Clin J Pain. 2012;28(6):511–8.
  9. Holmes RE, Barfield WR, Woolf SK. Clinical evaluation of nonarthritic shoulder pain: Diagnosis and treatment. Phys Sportsmed. 2015;43(3):262–8.
  10. Burbank KM, Stevenson JH, Czarnecki GR, Dorfman J. Chronic shoulder pain: Part I. Evaluation and diagnosis. Am Fam Physician. 2008;77(4):453–60.
  11. De Las Peñas CF, Sohrbeck Campo M, Fernández Carnero J, Miangolarra Page JC. Manual therapies in myofascial trigger point treatment: A systematic review. J Bodyw Mov Ther. 2005;9(1):27–34.
  12. Cagnie B, Castelein B, Pollie F, Steelant L, Verhoeyen H, Cools A. Evidence for the use of ischemic compression and dry needling in the management of trigger points of the upper trapezius in Patients with Neck Pain: A Systematic Review. Am J Phys Med Rehabil. 2015;94(7):573–83.
  13. Gattie E, Cleland JA, Snodgrass S. The effectiveness of trigger point dry needling for musculoskeletal conditions by physical therapists: A systematic review and meta-analysis. J Orthop Sports Phys Ther. 2017;47(3):133–49.
  14. Rickards LD. The effectiveness of non-invasive treatments for active myofascial trigger point pain : A systematic review of the literature. 2006;9:120–36.
  15. Gerber LH, Shah J, Rosenberger W, Armstrong K, Turo D, Otto P, et al. Dry Needling Alters Trigger Points in the Upper Trapezius Muscle and Reduces Pain in Subjects With Chronic Myofascial Pain. PM&R [Internet]. 2015;7(7):711–8. Available from: http://dx.doi.org/10.1016/j.pmrj.2015.01.020
  16. Bron C, Wensing M, Franssen JLM, Oostendorp RAB. Treatment of myofascial trigger points in common shoulder disorders by physical therapy: A randomized controlled trial BMC Musculoskelet Disord. 2007;8:1–8.
  17. Grieve R, Barnett S, Coghill N, Cramp F.Myofascial trigger point therapy for triceps surae dysfunction: A case series. Man Ther 2013;18:519–25.

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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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