Functional rehabilitation
As practitioners we are continually dealing with dysfunctional musculoskeletal systems. Typically dysfunction develops and is perpetuated... Read Article
In this article I’ll show you what trigger points are are using plain English and simple diagrams. We'll also 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 the best way to treat them.
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
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:
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.
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.
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.
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.
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.
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.
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 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).
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.
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.
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.
The abnormal posture that results from an imbalance will alter the alignment of joints, resulting in increased wear and an increased risk of injury.
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
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.
An investigation of pain free adults found that nearly 90% had trigger points in their shoulder muscles (7).
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:
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.
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).
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.
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.
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).
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 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.
For how to choose an quality massager that will do a great job and that you will be extremely happy with please see our article How to choose a massager, or you can go straight and check out our economical, easy to use professional standard machines: the General Purpose Massager or our Ultimate Quad Head Massager.
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.
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.
We are continually adding more information on research and uses. Subscribe below to have us email them to you "hot off the press".
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
As practitioners we are continually dealing with dysfunctional musculoskeletal systems. Typically dysfunction develops and is perpetuated... Read Article
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