I hear the words Trigger Point coming from just about every direction these days. The girl at the gym has a trigger point in her hip flexor that she just can’t reach, or so her health guru who administers her IMS has told her. The guy at physiotherapy has trigger points in his neck, caused by a motor vehicle accident he had years ago, which are continually reducing his ability to turn his head to shoulder check. And a new patient in my clinic asks if I can perform Trigger Point Therapy on her shoulder, like her last massage therapist did.
Traditionally, in massage therapy school we were taught that a trigger point is essentially a muscle knot. To simplify the “science”, it was enough to say trigger points are believed to be a collection of muscle cells that are stuck in a continuous state of contraction that may or may not cause dysfunctions or symptoms such a pain (both local and referred in specific patterns), nausea, weakness, numbness and tingling, muscle imbalances, reduced range of motion, and even headaches. It was said that these symptoms were caused by lack of blood in the contracted tissues. And for the longest time, this is exactly how I described a trigger point to my patients and on my website here.
Current science says what we were once taught as solid science about trigger points, is not necessarily true. A trigger point, or a muscle knot is perhaps better described as a sensitive spot, or even better still, as simply muscle or tissue pain. I say this because while skilled therapists can often feel what is believed to be knots or trigger points in tissue, these knots more often than not, do not behave in the way we were told a trigger point should. Sometimes a sensitive spot has no palpable knot as trigger points are described as having (so they cannot be lacking blood flow due to contraction). Sometimes they are found in non-muscular tissue as where trigger points are defined as residing. Other times palpable knots or hard spots in the tissue accompany no pain or dysfunction at all. Yet occasionally we will indeed find the traditional trigger point, that is palpable in a muscle belly that refers pain to just the right, predicable spot.
Just because the science is currently inconclusive on the nature of what a trigger point actually is and why we feel what we do in these hyper-sensitive areas of tissue, doesn’t mean they (as in tissue pain or discomfort) don’t exist in some way or form. It simply means the research is still young and we are working towards getting the answers still. In the meantime, a lot of the local massage techniques or modalities traditionally taught to relieve pain or dysfunction associated with trigger points may still work to relieve your symptoms. We just don’t understand all of the physiological mechanisms as to how they work! And that’s totally ok with me.
A number of techniques are known as Trigger Point Release, the most commonly thought of is Ischemic Compression or Trigger Point Pressure Release (TPPR). In order to perform TPPR the therapist will gradually warm the tissues with strokes or kneading before attempting to locate the trigger point. Once found, the therapist will hold a sustained amount of pressure directly on it. This can be a much deeper more intense technique applied directly to an already-tender area. While the pain or discomfort experienced by the patient is monitored, the therapist waits for the patient to feel it give or reduce in intensity. The therapist will then apply more pressure attempting to once again antagonize or aggravate the area and when this is achieved, the pressure will be relaxed before it is once again sustained and held for the process to be repeated until the trigger point is no longer antagonized by further pressure. The theory behind why this works was that after compressing the tissues for a time the area becomes saturated with new blood flow, thus relieving the pain and dysfunction. As I mentioned above, the cause of typical trigger point symptoms can’t possibly always be a lack of blood flow, as sometimes these trigger points seem to exist in tissues that aren’t discernibly contracted. We don’t know for certain what the cause of trigger point symptoms are, but it is believed that like all the pain we experience, these symptoms are neurological in nature.
Despite multiple suggestions and colourful descriptions including concepts we’ve all heard like the flushing of toxins or increasing blood flow to help reduce muscle tone, the true mechanisms of how or why TPPR works (or doesn’t work for you) is still unknown. In fact the reality is, there are no toxins to be flushed through massage therapy, and resting muscle tone is set by your nervous system, specifically your brain and spinal cord, and not in your tissues. Nonetheless, these techniques clinically and pretty consistently help reduce pain, discomfort and other symptoms experienced by some patients with trigger points, or tight knots, or areas of hypersensitive tissues – regardless of what you call them. As such TPPR is still very much a part of our massage therapy practice when deemed necessary.
And the fact that we are so uncertain about the nature of what trigger points are, or what actually causes them (was it a muscle imbalance or a local trauma, or could it be an irritated nerve along the way that’s sending pain signals to your brain for you to experience and as pain in your tissues?), leaves us open to other treatment strategies if traditional TPPR doesn’t work for you. Knowing we know so little can actually be a good thing when it comes to working with you at reducing your pain and increasing your functional gain!
For sources and more thoughts and research on Trigger Points, see the following: