A "Trigger point" is a hyper irritable locus within a taught band of skeletal muscle located in the muscular tissue and/or its associated fascia. The spot is painful on compression and can evoke a characteristic referred pain pattern and/or autonomic phenomena.
The trigger point is created when muscle filaments get caught and will not release, blood supply to the area is reduced, and so chemicals are not flushed away. Treatment will increase blood supply to the area and flush away chemicals.
1. The primary characteristic is pain, either local pain or a predictable pain pattern unique to each muscle.
2. Sensory or autonomic phenomena can occur such as spasms, redness, ringing in the ears, eye watering and headaches.
3. A trigger point is palpated as a hard nodule within muscle or fascia, its texture is different from the rest of the muscle and size can vary from a grain of rice to an olive or even a golf ball in extreme cases.
4. Activity of the trigger points can vary, they might be active one day and then not the next; might be related to activity or what the client is doing or the time of day.
Causes of trigger points
Short term causes:
Overload strain, like picking up a heavy box and overworking the muscle.
Direct trauma, like being poked in the arm!
Long term causes:
Poor posture, repetitive strain injury.
Physical, mental, emotional or chemical stress.
Treating Trigger Points
Trigger points can be located through palpation, initially finding a tight area in the muscle then focusing in on a small specific point of pain which can be extremely tender. The therapist is looking for a recurrence of the predictable pain pattern which the client presented with. This pattern could be local to the trigger point or might be in an area of the body relatively far from where the trigger point is located.
A classic example of this is when a client has carpal (wrist) pain and the trigger points causing the symptoms are actually located in the scalene muscles in the neck. Many trigger points in other neck muscles such as sternocleidomastoid, sub occipitals and upper trapezius are often found to be the root cause of headaches, each muscle indicating a different type of headache ("headband headache” round the forehead, “ question mark headache” above the ear, etc).
In general, trigger points are treated as part of a broader therapy session, returning to the point of issue 2 or 3 times during the session.
It is extremely valuable to stretch the muscle after treatment, passively by the therapist as part of the treatment, and then self stretching can be taught to the client if appropriate.
A client might expect to need up to 6 sessions to address a trigger point issue, but improvements are usually obvious after 2-3 sessions.