About Trigger Points and Trigger Point Therapy
Myofascial Trigger Point Therapy, also known as " Trigger Point Therapy ", refers to the treatment of myofascial trigger points (MTrP) or 'trigger points' (TrP) that are found in muscles and fascia. Myofascial trigger points are painful, tense areas that are found in muscles. MTrPs affect muscles and fascia. Myofascial trigger points can be found anywhere on the body and are one of the most common causes for chronic musculoskeletal pain, also known as myofascial pain. A certified DGSA Trigger Point Therapist can release these painful and tense points in a muscle and assist in achieving long-term results. There are two primary methods for treating trigger points, Manual Trigger Point Therapy and Dry Needling.
What Is a Trigger Point?
Dr. Janet Travell , MD (1901-1997), an American medical doctor and the personal rheumatologist of U.S. President John F. Kennedy, was the first to propose the term "myofascial trigger point " in 1942.
In 1983, Travell, together with Simons published the work "Myofascial Pain and Dysfunction - The Trigger Point Manual". This book changed the understanding of acute and chronic musculoskeletal pain.
History of Trigger Points
The study of muscular pain can be traced to the 15th century. Many terms have been proposed to describe muscle related pain. The most currently acceptable terms are myofascial pain and myofascial trigger points. Dr. Janet Travell, MD (1901-1997), an American medical doctor and the personal rheumatologist of US president John F. Kennedy, was the first to propose the term myofascial trigger point " in 1942. In 1960 Dr. Travell teamed up with Dr. David G. Simons, MD (1922-2010) to further explore the realm of trigger points and myofascial pain syndrome. In 1983, Simons and Travell published their work entitled "Myofascial Pain and Dysfunction - The Trigger Point Manual". This book was a breakthrough in the world of rheumatology, orthopedics and physiotherapy. It changed the understanding and treatment approach towards chronic pain. Since 1983, thousands of physiotherapists, doctors, chiropractors, massage therapists and other health professionals worldwide have applied trigger point therapy in their practice.
Illustration of a trigger point . Adjacent shortened muscle fiber sections ("contraction knots") form a palpable taut band, where trigger points can be found (Source: David G. Simons, MD, Janet G. Travell, MD & Lois Statham Simons “Myofascial Pain & Dysfunction - The Trigger Point Manual", Volume 1, 1999)
Definition of Myofascial Trigger Points
Clinically, myofascial trigger points are easily identified as painful areas in a muscle. These microscopic changes occure in muscle fibers causing them to contract and chronically shorten. This is usually due to the overloading or incorrect loading of the muscle. One theory suggests that oxygen and nutrients that are supplied to the trigger point are constantly compromised. This leads to a sustained contraction, that is unable to resolve itself.
The "Energy Crisis Theory" for Myofascial Trigger Points: An injury to the sarcoplasmatic reticulum leads to an unregulated release of calcium ions within the muscle fibers. As a result, these ions constantly contract and compress the small blood vessels within them. This comprimises the circulation and oxygen supply to the muscle fibers. The lack of oxygen and the increasing metabolic demand of the muscle cell is referred to as the energy crisis. This can lead to local inflammation and pain as well as to further contraction of the muscle fibers and the formation of myofascial trigger points.
In detail: Microlesions in the muscle fiber (muscle cell) organ called sarcoplasmatic reticulum occure. They are triggered for example by muscular overload, such as by an injury or overuse. The sarcoplasmatic reticulum is a membrane system within the muscle fiber. One of the functions of the sarcoplasmatic reticulum is to transport and store calcium ions. Any lesion in the sarcoplasmatic reticulum system may lead to excessive release of calcium ions and thus sustained contractions of muscle fibers. This is because calcium triggers muscle fiber contraction. Multiple contractions of this kind in a specific region in the muscle, may form a taut band, that is easily palpable by trained practitioners. These sustained muscle contractions can then lead to poor circulation in that area due to blood vessels being compressed, preventing adequate oxygen supply to the muscle and not allowing it to heal properly. If this condition becomes chronic, the muscle may further contract and become painful. This is referred to as the "Energy Crisis Theory".
Pain and Myofascial Trigger Points
As mentioned above, myofascial trigger points are a major cause of chronic musculoskeletal pain. However their significant role in pain management wasn't been identified for a long time. This could be due to the fact that trigger points may not be painful other than to direct pressure. They refer pain elsewhere to adjacent or remote areas. The origin of the pain and the area where it manifests can be different. For example low back pain may be related to trigger points in the abdominal muscles, while headaches can be related to trigger points in the neck muscles. The referred pain is a characteristic feature of myofascial trigger points. It forms the basis for its name "Trigger Point ", since it relates to one area triggering pain elsewhere.
Diagnostic Criteria of Myofascial Trigger Points
Four diagnostic criteria for myofascial trigger points have been proposed in the literature and through clinical practice. These criteria include:
- a taut band (muscle fiber bundle) in the muscle
- a pressure-sensitive area within the taut band
- referred pain from a trigger point
- a local twitch response of the trigger point or taut band in response to mechanical stimulation of the trigger point.
These diagnostic criteria have been shown to have a high intertester reliability in trained practitioners. This could imply that trigger points can be diagnosed reliably.
Example of a common referred pain pattern - upper trapezius muscle (Source: David G. Simons, MD, Janet G. Travell, MD & Lois Statham Simons “Myofascial Pain & Dysfunction - The Trigger Point Manual”, Volume 1, 1999)
What Is Myofascial Trigger Point Therapy?
Dry Needling of the extensor carpi radialis longus muscle.
The goals of myofascial trigger point therapy:
- improve blood circulation to the trigger zone
- stretching of the taut band
- release of surrounding fasciae
There are several ways to treat trigger points. Manual Trigger Point Therapy, Dry Needling and the combination of these two techniques, have been shown to be highly effective. Manual Trigger Point Therapy includes specific manipulations to the muscles, fascia and connective tissues. Dry Needling includes the use of sterile disposable acupuncture needles to improve circulation and blood flow to the affected muscle trigger point areas. This helps to promote healing and reduce pain. The more accurate the treatment is on the affected trigger point, the better the results.
Manual Trigger Point Therapy of the short head of the biceps femoris muscle.