Have you ever experienced achy muscles, tingling, or tight areas that don’t respond to movement? The majority of us will answer, “Yes!”, because these are common effects of living in the gravitational world. No matter how hard we try we are bound to acquire trigger points. “Posture, work conditions, sedentary habits, and injury can cause muscles to lose their memory of proper resting length in relation to other muscles resulting in shortened tissue and trigger points”(1).
What are trigger points? According to Dr.’s Travell and Simons, authors of Myofascial Pain and Dysfunction: The Trigger Point Manual Volumes 1 & 2, a trigger point is a “hyperirritable spot in the skeletal muscle that is associated with a hypersensitive palpable nodule in a taut band”(2). In our everyday language, it’s that spot that “hurts-so-good” when your massage therapist, or loved one, pushes on a knot.
Trigger points, TrP’s for short, exhibit certain characteristics that help us distinguish them from other soft tissue dysfunctions:
1. Trigger points feel like nodules or knots that are pea-like in size but are not lymph nodes.
2. TrP’s are hypersensitive and hyperirritable to touch affecting the local region of soft tissue resulting in decreased circulation, muscular spasm, and increased pain.
3. TrP’s are found in taught bands of muscle tissue that often feel ropey, or if you’re lucky, feel like steel cables.
4. Trigger points cause symptoms locally and in regions distal to the point, meaning they often block circulation and produce pain distally.
So how do TrP’s develop? The Contracted Sarcomere Theory is the theory that trigger points are formed as a result of contracted sarcomeres caused by a chemical imbalance at the point where a nerve and muscle communicate (1). You may be thinking, “Well how does a chemical imbalance occur that leads to contracted sarcomeres that lead to trigger points?”. I knew you’d ask. Researchers believe that chemical imbalances are likely caused by mechanical overloads such as acute trauma, overuse, and repetitive use. Interestingly, Travell and Simons also found that chronic myofascial pain is linked to vitamin and mineral deficiencies, specifically B1, B6, B12, vitamin C, and folic acid. Metabolic disorders, mental and emotional stress, as well as exposure to cold, viruses, and bacterial infections have been linked to the formation of trigger points (2).
Symptoms of TrP’s range from pain, paresthesia (numbness), muscle tension, reduced range of motion, motor function disturbance, sleep disturbances, and autonomic disturbances. I found it interesting that Travell and Simons found related autonomic nervous system symptoms to trigger points including abnormal sweating, eye redness, watering of the eyes, blurry vision, persistent runny nose, increased salivation, and goose bumps! Sounds like seasonal allergies or a cold to me, but it’s worth performing a thorough assessment for trigger points even after a cold to eliminate any accrued myofascial tension.
In a recent study published in the Scandinavian Journal of Pain, researchers found that the more trigger points a tension-type headache patient had the more negative effects there were on their sensory and emotional health on a daily basis (3).
There are specific protocols when deactivating TrP’s which can be very uncomfortable. Compressing the knot for 8-12 seconds is standard, but longer time frames can be used as long as pain and any referral sensations are decreasing. Experts agree that releasing more than 5 muscles with trigger points in one session could easily be too much, so planning out sessions to attack the whole body is advised (unless you enjoy the pain then, so in that case, let’s roll).
The key point I like to make when it comes to minimizing the number of trigger points you have is to make sure you are regularly stretching. By maintaining a healthy natural resting muscle tone you are keeping your tissues hydrated, free from restriction and contracture, and avoiding most chemical imbalances.
Using a foam roller, lacrosse ball, and softball is also effective to regularly work on your TrP’soutside of the treatment room. For head, neck, deep shoulder, rib, wrist, and deep core/hip trigger point work, I recommend seeing a qualified professional who is skilled at locating and treating trigger points. Also, if you notice you have a hard time working on your own trigger points with tools without cringing, clenching your jaw, breathing properly, or staying in a calm parasympathetic state, a professional bodyworker can help you navigate those thresholds skillfully.
And, if you keep experiencing the same TrP’s resurfacing in the same spots, I recommend trying structural bodywork. In my experience, reshaping the fascial network can help take the load off of tired and overworked muscles that regularly develop trigger points.
- Williams, Anne (2013). Massage Mastery: From Student to Professional. USA: Lippincott Williams & Williams. Ch 21 pgs 615-627.
- Travell, Janet; Simons David; Simons Lois (1999). Myofascial Pain and Dysfunction: The Trigger Point Manual (2 vol. set, 2nd Ed.). USA: Lippincott Williams & Williams.