Finding and releasing trigger points has always been one of my favorite parts of practicing massage therapy. There is just something so rewarding about finding just the right spot to press and then feeling the local twitch response as the hyperirritable skeletal muscle fibers begin to release and unwind. The process can be quite uncomfortable to the client, but with patience and deep breaths, the discomfort can be minimized, and the benefits maximized. Clients who have never experienced Trigger Point Therapy can be shocked at how they can have such intense pain when a point is pressed when they didn’t even know that spot was there before the pressure. They can yelp the all familiar cry of “What is THAT?” This reaction is often intertwined with intrigue and confusion if accompanied by a trigger point referral zone!
So, what are Trigger Points (TrPs)? Well, one thing they are not is “Tender Points.” Tender points are points on the body used to help healthcare practitioners diagnose Fibromyalgia. A patient has to demonstrate pain in at least 11 of 18 tender points. These points are found at specific locations and are the same for every patient. On the other hand, Trigger points are small, extremely irritable knots found in muscle tissue located along with a taut band of fibers. Trigger points can refer to pain to other parts of the body in a predictable pattern called a referral zones. Dr. Janet Travell was the first to research trigger points back in the 1940s. She began the process of mapping the referral zones of commonly identifiable TrPs within muscle groups. When a trigger point is found, palpated, and released (often accompanied by a local twitch response), the client will tend to feel a reduction of pain in that area.
There are two main types of trigger points, each with its own characteristics.
Active Trigger Point
This type of trigger point is just as it sounds! It is actively sending pain locally or distally to its mapped referral zone. Clients come into the office saying, “I have this spot!” They can point to it and show you where it hurts. Untreated trigger points can cause limited motion, pain, and muscle weakness resulting in postural compensation. Latent Trigger Point: These are the trigger points mentioned above that result in the client’s surprise when pressed. They don’t even know they are there because they don’t hurt or refer pain unless pressed upon. Latent trigger points can become active if irritated or left untreated.
Active trigger points can be further broken down into 2 sub-groups:
Primary Trigger Point
Primary trigger points are the initial result of a muscle being overloaded. Causes of muscle overload include injury, heavy lifting, immobility, postural dysfunction, repetitive use, stress, and other trigger points. If left untreated, a primary trigger point can activate latent trigger points and result in additional trigger points developing in the same or other muscles (called secondary trigger points).
Secondary Trigger Point
Secondary trigger points that develop in muscle fibers overloaded from compensating or doing the work of a dysfunctional muscle with a primary trigger point are called functional secondary trigger points. If a therapist finds and treats a secondary trigger point, they may get some small release, but it will be short-lived, and the trigger point will return because it results from the primary trigger point. Treating the primary trigger point will not resolve the functional secondary trigger point, but it will allow you to release it effectively. Satellite trigger points are secondary trigger points that develop or become active because they lie in the primary trigger point's referral zone and will often become latent or resolve themselves when the primary trigger point is released.
Basic Trigger Point Treatment
- Find the Trigger Point by palpating the tissue until you locate a small area of tightly contracted tissue or isolated spasm.
- Gently press on this area. If you have located a Trigger Point, the client will likely experience intense pain, feel referral pain/sensation elsewhere on their body, and/or the tissue may twitch.
- Hold the pressure for several seconds (count of 8).
- Ask the client if the pain is increasing, decreasing, or staying the same. Suppose it is increasing or staying the same, back off, and return with less pressure. If it is decreasing, continue the hold at the same pressure.
- After each hold, perform several slow effleurage movements over the treated area.
- Repeat this cycle of static pressure and effleurage 2 more times. You can apply pressure from different directions if it feels appropriate but work from origin to insertion.
- Get client feedback throughout the process. The pain scale of treatment should be about a 7 on a scale of 1 to 10.
- If the client experiences referral pain when you press on a Trigger Point, attempt to simultaneously press on the area of referred pain while maintaining pressure on the original point.
- Do not over treat an area! Working too many Trigger Points in one session can be overwhelming to the client.
- After releasing the trigger point within a muscle, have the client contract that muscle against mild resistance followed by a gentle stretch.