Understanding trigger points
After my last Muscle of The Month article, someone very appropriately asked, “What is a trigger point?” Good question. I shouldn’t have assumed that everyone knew what a trigger point was. I learned about them back in 1997 when I was going through massage school. As it turns out, they are just as relevant now as they were then, when working with students in pain.
Surprisingly there have been studies (referenced in The Trigger Point Manual by Janet Travell and David Simon) that show a large number of people in pain have trigger points as part of their pain pattern. They evaluated everyone who walked into a number of pain clinics around the country. Upon evaluation, they found that approximately 80% of the people had trigger points as a component of their pain pattern.
What are trigger points?
A trigger point is a spot or a point in a muscle that refers a sensation to another area of the body. The sensation could be:
We can classify trigger points into two categories, latent and active. A latent trigger point is one that is not actively creating a pain pattern. The pain is either intermittent or not present until the trigger point itself is directly pressed or activated by some activity. An active trigger point is one that is actively creating pain or another sensation in your body. In other words, if a trigger point was referring pain to your arm, you would be walking around with pain in your arm on a regular basis.
What causes trigger points to form?
- Blunt trauma – such as a car accident or a fall.
- Overuse – perhaps a muscle working too hard by compensating for other muscles.
- Lack of use – muscle dysfunction and a decrease in lack of blood flow can be due to lack of use.
Not to get too technical but, we are talking about dysfunction on the cellular level. A small number of muscle cells remain in a state of contraction when a trigger point exists. Why? This usually occurs because the calcium used to change the charge inside the cell, which causes the contraction to happen, is not removed or neutralized. As a result, the cells stay in a state of contraction. This forms a small bolus or a tiny “knot” in the muscle at a cellular level. It’s not that the entire muscle is in a state of contraction, just “X” number of muscle cells.
How do you get rid of a trigger point?
The way in which Dr. Janet Travell used to get rid of them is a technique called “spray and stretch.” This technique is described in her book The Trigger Point Manual. This is not a realistic technique for yoga teachers to employ. However, it is interesting. Dr. Travell would spray a vapo-coolant over the skin, along the line of the referral area, while simultaneously stretching the muscles. If this method was not effective enough she would also employ injections. In this scenario, a needle and syringe full of an analgesic would be used to inject the trigger point itself. There are other options. Following closely with the injection is dry needling which has also been shown to be effective.
The method I employ most commonly goes back to my days in massage school. In a yoga room, this method boils down to focusing pressure on the trigger point itself, not necessarily on the area where the trigger point is referring to. Better still is a very specific treatment of the muscle by a qualified therapist.
What do the treatments do?
These methods do a few things. Both force fluid away from the trigger point. When released, fresh fluid comes back in. In simple terms, we are flushing out the area where waste and toxins may have built up and led to enough dysfunction to cause the trigger point or maintain an environment that keeps it going. The direct pressure on the trigger point can help to “reset” the neuromuscular junction and the exact area where the physiological dysfunction is happening. It essentially plays with the nervous system.
The other method that we are all employing on the yoga mat is to stretch the very muscle that has the trigger point in it. Stretching the muscle, even without a vapo-coolant, can help alleviate the trigger points. Be mindful though that contracting the muscle, or stressing and straining the muscle may exacerbate the problem.
What are the symptoms of a trigger point?
Please be careful as you read this next section. Differentiating between a trigger point and an injury is a tricky business. Unless you are a doctor, you have no right to diagnose anyone with any type of condition. All I will do here is share the most typical symptoms exhibited by trigger points. You have to hold onto the idea that these descriptions of pain could be associated with a number of other conditions.
The most common description that I’ve heard of trigger point pain is that there is a dull achiness or that the area feels weak or dead. Sometimes the pain is described as coming and going away. I then question the person to see if this is especially true related to changes in body temperature. In other words, say a student has pain somewhere. As they start to practice, the pain goes away. After they “cool off” the pain returns. This is a good indication that it’s a muscular problem. Of course, go confirm this with a medical professional!
Some other clues I’ve learned to use relate to the population of people that I used to treat in my chronic pain clinic. Very often I would have people showing up after having been through some type of medical odyssey. What I mean by this is that they had had every test possible, x-ray, MRI, and all the other goodies and the results were negative. No one could find anything. For me, this is a good indication that trigger points are involved, because they just won’t show up on tests like that. So when a student complains about a pain pattern that has been around for a while, I usually ask if they’ve been to a doctor or if they have had any images taken. That type of information is very helpful for knowing what it may or may not be. It helps rule things in or out.
By knowing if I’m dealing with a trigger point or not, I make different choices about what I have students do, how they do it, and how I may or may not adjust them in certain postures. Information is good. From there, you can make more informed decisions. The most important takeaway is that pain may be coming from a relatively distant source, not necessarily where the pain itself is felt. Here is a link to a great Self Treatment Book: The Trigger Point Therapy Workbook: Your Self-Treatment Guide for Pain Relief