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  Sunday 1st August, 2021
  Author: Dr Graeme Blennerhassett

Trigger point release explained

Osteopath performing trigger point release
Osteopath performing trigger point release
What is trigger point release

Trigger point release is a general term that describes procedures that relax tension and relieves pain in muscles that contain trigger points. It usually refers to manual techniques involving pressure and stretching muscles, but can also refer to other techniques such as the use of needles.

Trigger point release vs trigger point therapy

For practical purposes trigger point therapy and trigger point release are the same thing. They are both terms used to describe therapies that relax muscles with trigger points and relieve pain.

Trigger point releases/therapy do not rid the trigger points

The goal of trigger point release/therapy is usually to relieve and relax rather than to eliminate the underlying trigger point. This is obviously a serious omission. It appears to fix the problem, but with the trigger points still there further pain and muscle tightening are usually inevitable.

Unfortunately this fact is usually omitted when explaining therapy options. Because of this, in this article we'll:

What are trigger points

Trigger points are those tender lumps in your muscles that therapists find. Scientists have found that they are parts of the muscle that have spasmed or "cramped", forming the lump. As discussed in our article Trigger point basics these "lock on" and start to grow.

They start small and you only know they are there when a therapist presses upon them. However over time they can grow and eventually become aggravated and start shooting pain spontaneously without being pressed upon.

Trigger point: positive feedback loop

What the scientists have found

Scientists have found that this "locking on" is caused by what is called a positive feedback loop, as shown in this diagram. Simply:

  • the spasm causes muscle tightness
  • the tightness restricts blood flow
  • the restricted blood flow causes a build up of waste products, and
  • the build up waste products is toxic and causes more spasm.

This keeps going around in circles, causing the trigger point to continue to grow.

How does trigger point release (or therapy) work

Trigger point releases relax your muscles and reduce pain by disrupting the core positive feedback loop. This can be done at any of the stages. For example, massage will help relax the muscles, and increase blood flow which helps remove waste products.

Later we will discuss what the research says about the various common therapies, but it is critical to mention that the goal of most courses of therapy is to just diminish the feedback loop enough that it stops hurting. As you now understand, as long as it is still there though the trigger point will continue to grow. We will finish off by outlining effective therapy to actually eliminate the problem.

How trigger point releases (therapies) appear to fix the problem but don’t

The "de-activation" deception

Advovates of various therapies and releases claim to "de-activate" trigger points. To the un-informed this sounds like a fix or remedy, but it actually means to (temporarily) stop the trigger points hurting.

As explained in our article Trigger point therapy: de-activation or elimination even the scientists use this deception when they test trigger point therapies (1-3). When they do their clinical trial they will deliberately use the goal of de-activating the trigger points rather than eliminating them. By lowering the bar this way they appear to show that the therapy they are testing is useful when there is really no long term benefit. The way researchers do this so it is not noticed is to simply measure things like pain but fail to check or mention whether the trigger points are still there. As we will see later they certainly will be.

The consequence of just "de-activating" trigger points

After de-activation the pain will be reduced or gone, again creating the illusion that the problem is fixed. However:

  1. the pain will almost certainly return, and
  2. even when de-activated and not shooting pain trigger points still cause a host of problems.

What actually happens when trigger points are de-activated

In this section we will show you what actually happens when trigger points are de-activated, then proof that the trigger points will still be there.

Trigger point development cycle
How trigger points develop

As this diagram shows, trigger points start small and develop slowly, reaching a stage where are still not shooting pain, but are quite large and would shoot pain if pressed upon. In this condition it takes very little to aggravate them so they start shooting pain. This last step is called "activation".

De-activation of trigger points
What trigger point release does

Trigger point release (therapies) do as the large blue arrow in the diagram shows. That is revert the trigger point back to how it was just before it started to shoot pain. You feel better and tension in the muscle releases, but of course the trigger point is still there and will re-activate when aggravated.

Residual trigger points after treatment
Proof that trigger points are still there

As mentioned, generally the researchers doing the trials on the various trigger point therapies (conveniently) don't check or mention whether the trigger points are still there. However, one very important trial did. The chart pictured gives the results. In summary, the world's best PhD. trigger point scientists did a very extensive 12 week treatment program, using a combination of therapies. After that 2/3 of the trigger points were still there (4).

If the best in the business can do a huge amount of therapy and only eliminate 1/3 of the trigger points the release someone shows you on YouTube or even 6-10 therapy applications by a respected professional it will barely make a dent in your trigger point numbers.

What the research says about common therapies

In the section below we summarise the the findings of several scientific reviews of individual trigger point therapies (2,3,5–9)⁠⁠. Keep in mind that the clinical trials these are based on would have taken success to be pain relief rather than trigger point elimination. In summary:

  • there appears to be little difference between the effectiveness of the three common therapies
  • they would all need a large number of applications to even reach the low goal of (temporary) pain relief.
Trigger point dry needling
Trigger point dry needling

Dry needling

Most trials show that dry needling provides some short term pain relief and improved function. The risks and potential to cause pain are obvious. The mode of how needles work is still speculation. Where dry needling had been compared with laser the laser has given slightly better results.

Laser
Laser therapy

Laser

Trial results for laser have been marginally better than those for dry needling, but still only temporary relief. Scientists attribute it’s effect to increasing micro-circulation, improving oxygenation and helping remove waste products. However, this is something that can easily be achieved, if not better, by any competent massage therapist.

Major concern

The big concern with laser is the sheer number of applications of therapy sessions needed for only temporary benefits. For example one trial (10)⁠ used 10 daily applications of laser on patients with upper back and neck pain to get a reduction in pain and tenderness for three weeks. Further, according to one review (1)⁠ applications of laser should be given from 2-3 times a week though to 5 times a week, with a total of 30 applications of therapy for long term cases. Keep in mind this is just to achieve deactivation, not to eliminate the problem. Assuming each laser consultation costs $50 and takes an hour out of your day that’s $1,500 and 30 hours of your life just for some temporary pain relief, leaving you to front up again next time the problem is aggravated.

Manual trigger point therapy
Manual trigger point therapy

Manual therapies

There are various types of manual therapies that involve pressure, massage and stretching of muscles. The trial results for them tend to be similar to those of laser and dry needling. However, according to one review (2)⁠ one study did show residual benefit after six months.

Further issue: trigger points cause problems even when not referring pain

As discussed in our article The complete guide to (myofascial) trigger points even when not shooting pain trigger points have the following adverse effects. This applies whether they are still developing and not yet activated, or have been (temporarily) deactivated using a release or therapy.

  • restrict ranges of motion
  • cause muscle weakness
  • cause muscle fatigue
  • alter muscle activations (affecting neurological control of your movements)
  • induce muscle cramps, and
  • affect posture and joint function, creating further issues.
  • 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 (11)⁠

An effective strategy to eliminate trigger points

Dr Graeme's comments

I've got over 30 clinical studies of the various trigger point therapies and releases, but unfortunately because they've chosen to set their goals as (temporary) relief rather than elimination they are not a lot of use. To work out something that would work for my patients I needed to use the limited trials that were useful (such as the one mentioned above) plus a lot of good science that has been done on trigger points themselves and the effects of various therapies.

Overview

The trial discussed above found that 12 weeks of very extensive trigger point therapies only eliminated 1/3 of the trigger points. This shows us that typical courses of therapy will have practically no impact on the number of trigger points. However, they did manage to relieve the symptoms and eliminate 1/3 of the trigger points. This suggests that if the therapy was continued more would be eliminated. Of course for most this would need to be an effective home therapy or it would become very expensive.

This is the basis of our treatment strategy. We have full details in our article How to treat trigger points at home but give a summary here. The guide has several home treatement options, but we will just give the easiest and most effective one.

Professional advice

You may be able to do a lot of therapy yourself, but to help you get the best possible results and to stay safe we recommend that you get some professional advice.

  • trigger points are often part of a more complex musculoskeletal problem they can help manage
  • they can help you find the trigger points and show you how to do the therapy more effectively.

Avoid aggravating activities

You may need to at least temporarily avoid activities that aggravate the condition

Effective self therapy

We’ve seen that 12 sessions from the world’s best only partially remedied the problem, so you'll need a lot more than 12 applications over time, and they need to be very effective. Luckily we’ve got the ideal solution: using a vibration massager.

Vibration massagers are very easy to use

We have complete instructions in our vibration massage usage guide , but they are basically very easy to use. You just sit the machine on the part that needs massaging and let the vibrations penetrate. You don't need any special skills.

Vibration massagers are highly effective

We mentioned before that trigger point releases and therapies work by disrupting the core positive feedback loop. Vibration massage is arguably the most effective therapy of all because it has been scientifically proven to help disrupt all the sections of the feedback loop at once.

Vibration massagers are arguably the perfect trigger point therapy because:

  • the disrupt each part of the trigger point feedback loop
  • there is no pain or needles
  • it is simple enough to do as self therapy, saving time and money.

How to choose a vibration massager

There are some good units on the market, but a lot that are not that effective. Please see our article How to choose a massager. Be especially aware that most massage guns are based on percussion massage rather than vibration. This is a gimmick that makes them a lot less effective and potentially dangerous.

The DrGraeme Ultimate Quad Head Massager
The DrGraeme Ultimate Quad Head Massager

Our massagers

We make two hand held massagers that are easy to use and give excellent therapeutic vibrations. These are our General Purpose Massager and our Ultimate Quad Head Massager. They are very effective on trigger points. We have had the General Purpose Massager for about a decade and it is widely used by professionals across Australia, New Zealand, the UK and Europe. Our newer machine the quad head has the advantage of being able to treat a larger area at one, plus can easily be used as a “chair massager” or “cushion massager.

Get an effective massager

Professional at desk
Professionals: click the 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. Uemoto L, Nascimento De Azevedo R, Almeida Alfaya T, Nunes Jardim Reis R, Depes De Gouvêa CV, Cavalcanti Garcia MA. Myofascial trigger point therapy: Laser therapy and dry needling. Curr Pain Headache Rep. 2013;17(9).
  2. Denneny, Diarmuid et al. Trigger point manual therapy for the treatment of chronic noncancer pain in adults: a systematic review and meta-analysis. Arch Phys Med Rehabil. 2019;100(3):562–77.
  3. 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.
  4. 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.
  5. Boyles R, Fowler R, Ramsey D, Burrows E. Effectiveness of trigger point dry needling for multiple body regions: A systematic review. J Man Manip Ther [Internet]. 2015;23(5):276–92. Available from: http://dx.doi.org/10.1179/2042618615Y.0000000014
  6. Tough EA, White AR, Cummings TM, Richards SH, Campbell JL. Acupuncture and dry needling in the management of myofascial trigger point pain: A systematic review and meta-analysis of randomised controlled trials. Eur J Pain [Internet]. 2009;13(1):3–10. Available from: http://dx.doi.org/10.1016/j.ejpain.2008.02.006
  7. 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.
  8. Espejo-Antúnez L, Tejeda JFH, Albornoz-Cabello M, Rodríguez-Mansilla J, de la Cruz-Torres B, Ribeiro F, et al. Dry needling in the management of myofascial trigger points: A systematic review of randomized controlled trials. Complement Ther Med . 2017;33(December 2018):46–57.
  9. Rickards LD. The effectiveness of non-invasive treatments for active myofascial trigger point pain : A systematic review of the literature 2006;9:120–36.
  10. Hakgüder A, Birtane M, Gürcan S, Kokino S, Tura FN. Efficacy of Low Level Laser Therapy in Myofascial Pain Syndrome: An Algometric and Thermographic Evaluation. Lasers Surg Med. 2003;33(5):339–43.
  11. Shah J et al. Myofascial Trigger Points Then and Now: A Historical and Scientific Perspective. HHS Public Access. 2015;7(7):746–61.
  12. Jafri MS. Mechanisms of Myofascial Pain. Int Sch Res Not. 2014;2014:1–16.
  13. Zhuang XQ, Tan SS, Huang QM. Understanding of myofascial trigger points. Chin Med J (Engl). 2014;127(24):4271–7.
  14. Bron C, Dommerholt JD. Etiology of myofascial trigger points. Curr Pain Headache Rep. 2012;16(5):439–44.

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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