Common Cause of Pain, but Most Practitioners Treat Only Symptoms
Active trigger points are hyperirritable small groups of cells in skeletal muscle and surrounding connective tissue that can produce local or referred pain and other symptoms.
Many ailments, such as mock sciatica, carpal tunnel syndrome, migraine headaches, brachial plexus issues, can be significantly managed or totally eliminated with trigger point therapy.
Have you ever had a headache, clonus or twitching muscles, after a massage?
The massage might have felt great, but most probably your therapist activated trigger points on your body.
Only a medical professional can provide a diagnosis, but a qualified massage therapist may provide relief of myofascial pain after simple assessments.
If relief is not found in 1-3 treatments,
then you may be referred to other modalities, such as medical, chiropractic, osteopathic or physical therapy.
Check the boxes:
Muscles are sensitive to pressure
Stiff, tight, spasmic feeling
Headache
Dull, aching, or burning pain in muscles
Pain going down the arm or leg
Numbness
Muscle imbalances
Unpredictable, erratic symptoms
Heat eases the pain
If you checked many of these, then you probably have active trigger points.
manual Trigger Point therapy (ischemic compression massage)
Physical Therapists can initiate treatment of this muscle through the use of myofascial release techniques, trigger point work, the use of spray 'n stretch, moist heat, and instruction in a home exercise program, including stretching and use of heat and cold.
electric stimulation,[37]
The rising costs of medications and surgery have begun forcing many mainstream universities and hospitals to research Trigger Point Therapy further[8],
and since 2005, trigger point injections have been covered by major USA health insurance.
For trigger point injections, not to be confused with acupuncture, the physician may use a pressure algometer instrument to find the source of the pain (trigger point), and inject carbon dioxide or a solution,
which may include dextrose, phenol, analgesic (e.g. lidocaine), corticosteroid (e.g. prednisone), Botox™ or MyoX™, directly into the site.
Injecting chemicals to treat trigger points seems to be analogous to dunking your head into the toilet to wash your face.
but the simplest and least invasive methods of direct pincer palpation (locating manually and pressing or holding firmly using thumb and finger), elbows and feet, as in
Barefoot Deep Tissue Therapy.
After release of trigger points in a
muscle,
several seconds of gentle stretching can help "reset" the muscle, however stretching of affected muscles is recommended only if there is no pain,
since muscle strands containing trigger points may be strained before the surrounding fibers "feel" a stretch.
If 1-3 therapy visits do not produce relief, then referral is recommended.
Paul also can teach clients how to work manually on themselves for many cases.
Paul studied under
John Harris, an Olympic Massage Therapist who has written books, videos and taught Trigger Point Therapy at the
Santa Barbara Body Therapy Institute.
Trigger points activate from several causes,
such as acute or chronic muscular overload due to trauma, overuse, poor posture, chilling of a muscle and even emotional stress.
This could be from repeat movement, or from low force, long-term static holds of posture, or even holding a pencil for too long.
Once a trigger point has activated, due to metabolic stasis in the area of the TrP, waste products begin to accumulate. These waste products are nerve irritants (bradykinin, serotonin, hyaluronic acid, etc.) which, in turn, produce and perpetuate pain signals.
Due to the accumulation of waste products, the blood supply to the area is decreased, resulting in a contracture (tight band) of muscle fibers and ischemia and resultant pain are felt by the patient.[5]
Left untreated, constant pain signals can make the brain decide to turn off the muscle, and leave some fibers contracted, as in frozen shoulder.
Pain Sources May Be Elusive
Active trigger points frequently refer pain to other areas of the body,
sometimes causing an imbroglio of misdiagnoses, including sciatica and carpal tunnel syndrome and gynecological opinions,
and failure of convention medical treatments (surgery and drugs) to relieve symptoms.
However the referral patterns have been well-defined and catalogued over the years.
An example is a trigger point in the piriformis or gluteal muscles causing sciatic-like pain,
which some doctors may misdiagnose as spine trouble; or
arm and neck trigger points which mimic carpal tunnel syndrome.
Why does the pain occur away from the trigger point? There are different theories:
one in very simple terms is analogous to peripheral neuropathy, where nerves for the toe are wired to the "toe" area of your brain, and no matter where the 3 foot long "toe" nerve is affected along its length, pain is felt in the toe.
Other examples of referred pain are arm pain for heart attacks, "brain freeze" after drinking a cold liquid, scratching your ear to relieve the tickle in your throat and "phantom pain" in an amputated limb caused by
mapping in the brain.
Myofascial pain should not be confused with
Myofascial Release.
"Nociceptive inputs in active TrPs could lead to muscle atrophy of the involved muscles." (Association of Cross-Sectional Area of the Rectus Capitis Posterior Minor Muscle with Active Trigger Points in Chronic Tension-Type Headache:
A Pilot Study. American Journal of Physical Medicine & Rehabilitation. 87(3):197-203, March 2008.)
The National Institutes of Health Clinical Center is sponsoring new research to investigate the biochemistry of trigger points in the trapezius, a large muscle lying between the neck and shoulder.
According to the NIH, trigger points in the muscle are typically caused by emotional stress, postures such as hunching shoulders, certain activities like using a telephone receiver without elbow support, or by wearing certain articles such as a heavy coat or heavy purse.
(Protocol Number: 02-CC-0245)
The Journal of the American Medical Association reported that frequent migraine sufferers felt better after acupuncture (which sometimes may relax trigger points.)
Trigger points are not the same as acupuncture points, but research is being begun by mainstream organizations on the
anatomic morphology and histology of acupuncture and trigger points.
Dr. David G. Simons joined Dr. Travell to publish medical books,
and later finally validated MTrPs by MRI.
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8448923/
and various treatment techniques have been accepted by medical insurance, such as Blue Shield, despite most physicians not being trained in such methods.
Unfortunately most medical doctors, and even many chiropractors, massage and other therapists, are not trained or skilled, or
do not seem to desire to spend 20 minutes assessing and manually working on a patient.
Many acupuncturists, if trained in Tui Na, will notice that TrPs are near some acupuncture points,
which
seem to be evidently points along the myofascial planes.
Since then Trigger Point Therapy has been used successfully by doctors and massage therapists on many clients who have suffered under the depredation of chronic myofascial pain with no relief from surgery or drugs.
[More TrP History]
https://journals.lww.com/ajpmr/abstract/2021/10000/assessment_of_myofascial_trigger_points_via.12.aspx
Biomechanical properties and blood flow of active and latent myofascial trigger points assessed via imaging were found to be quantifiably distinct from those of healthy tissue.
5.
Sheila Laws, D.C.,
NIMMO-Receptor Tonus Technique,
The American Chiropractor, Volume 24, Issue 02
Published 10/30/2005
(Return to Reference 5 in text)
6.
Wick, Franziska MD; Wick, Nikolaus MD; Wick, Marius C. MD
Morphological Analysis of Human Acupuncture Points Through Immunohistochemistry.
Research Article,
American Journal of Physical Medicine & Rehabilitation. 86(1):7-11, January 2007.
(Return to Reference 6 in text)
7.
The Immediate Effectiveness of Electrical Nerve Stimulation and Electrical Muscle Stimulation on Myofascial Trigger Points,
American Journal of Physical Medicine & Rehabilitation. 76(6):471-476, November/December 1997.
Hsueh, Tse-Chieh MD, MS 2; Cheng, Pao-Tsai MD, MS; Kuan, Ta-Shen MD, MS; Hong, Chang-Zern MD
(Return to Reference 7 in text)
10.
James E. Bagg, Jr.;
The President's Physician,
Texas Heart Institute Journal. 2003; 30(1): 1–2.
(Note: Paul Svacina volunteered at the Texas Heart® Institute and Emergency Department at St. Luke's Episcopal Hospital in the Texas Medical Center, Houston, in the 1980's)
(Return to Reference 10 in text)
28.
Nabih M. Ramadan, MD. (2007)
Current Trends in Migraine Prophylaxis
Headache: The Journal of Head and Face Pain 47 (s1) , S52–S57 doi:10.1111/j.1526-4610.2007.00677.x Department of Neurology, Chicago Medical School at Rosalind Franklin University of Medicine and Science, North Chicago, IL, USA.
(Return to Reference 28 in text)