Trigger-points

Trigger-points are often described as " hyperirritable spots " in  muscle that are associated with palpable nodules in taut bands of muscle fibers.Trigger-points are diagnosed by physical therapists (PT's) after reviewing patient history, symptoms, pain patterns and manual palpation. When  skilled PT's  palpate a tight muscle and sense these taut band, they usually can also feelassociated trigger-points. The size of the nodule can vary from that of a small mustard seed to the size of a marble.

What causes trigger-points to form?

The list of possible causes includes acute physical trauma, poor posture or movement mechanics, over training, poor conditioning, inadequate rest between exercise sessions and possibly evennutritional factors.

Researchers that study trigger-points and a trigger point treatment model  believe that these palpable nodules are small contraction knots and a common cause of pain.  This model states that unexplained pain frequently radiates from these points of local tenderness to broader areas, sometimes distant from thetrigger point itself. Practitioners claim to have identified reliable referred pain patterns, allowing practitioners to associate pain in one location with triggerpoints elsewhere. Many physical therapists find the model useful in practice, but the medical community at large has not embracedtrigger point therapy. Although trigger points do appear to be an observable phenomenon with defined properties, there is a lack of a consistent methodology for diagnosing trigger points  and why they produce specific referred pain patterns.

How  to find and treat trigger-points

With some practice it can be easy to locate trigger-points.

Tip: A twitch response can be felt in the muscle by running your finger perpendicular to the muscle's directionor rolling on a foam roller; this twitch response often activates a response in a muscle that causes it to contract. Pressing on an affected muscle can often refer pain. Compression of atrigger point may elicit local tenderness, referred pain, or local twitch response.  

Usual Suspects: Clusters of triggerpoints are not uncommon in some of the larger muscles, such as the lower back, hips, glutes and upper shoulder areas where the muscles are constantly supporting the weight of your head.

Treatment methods:

• Trigger point therapy targets these " hyperirritable "sensitive sites of the body to apply concentrated amounts of pressure to relieve muscle spasm. If you work with a physical therapist they can educate you on how to properly identify, compress and deactivate your trigger-points.
• Trigger point injections: If pain does not respond to nonsurgical treatment, trigger point injections may be inserted into the specific trigger point to inactivate the point in an attempt alleviate myofascial pain.
• Self myofascial release (SMR)*:   A relatively simple technique that can be used to alleviate trigger-points. Studies have shown myofascial release through massage therapy to be an effective treatment modality for myofascial pain syndrome although most studies have focused on therapist-based rather than self-based treatment. Self myofascial release techniques (SMR), although not new, have become more and more prominent amongst athletes and fitness enthusiasts alike.

*It's important to understand the key term fascia in order to appreciate the mechanism by which self myofascial release technique may act on the body. 

Key term: Fascia & the relationship to trigger-points

Fascia is a specialized connective tissue layer surrounding muscles, bones and joints and gives support and protection to the body. (Need a visual?- Fascia is that clear layer or film that remains on the muscle when you peel the skin off of an uncooked chicken breast)

According to many therapists, trigger points in the fascia can restrict or alter the motion about a joint resulting in a change of normal neural feedback to the central nervous system. Eventually, the neuromuscular system becomes less efficient, leading to premature fatigue, chronic pain and injury and less efficient muscle performance

Self Myofascial Release (SMR) Exercises

For these exercises you will need a foam roll (which is very inexpensive). You can get them from anywhere that sell sports medicine or physical therapy supplies. Online, trywww.performbetter.comwho sell a variety of foam rolls.

Click here for a sample foam-roller-exercise program  to help reduce tension in tight muscles and relieve stress in several common trigger-points.

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