Trigger points can happen almost anywhere in the body. Any small area of tension within a muscle can be a trigger point.
What are trigger points?
Trigger points are areas of the fascia or muscle that are often stiff and tight. The feeling is often described as a “knot” in the muscle. These areas tend to be a focal point of pain for patients.
There at two types of trigger points noted in literature: active or latent. Active trigger points will have pain at the area of the knot but also can elicit a referred pain to other areas of the body. If someone is pressing on the active trigger point in your upper back, the pain may be felt into the shoulder and down the arm.
A latent trigger point will typically only cause pain in the exact area of the knot. While the cause of a trigger point is still greatly unknown, researchers believe that the stiffness arises from hypercontraction of the muscle fiber. This leads to metabolic stress of the myofibrils and reduced blood flow. This pathophysiologic response is thought to occur because of muscle overuse and trauma.
Recommended course: Positional Release: Reflex Release for Painful Trigger Points & Muscle Tension
Where are trigger points typically found?
Trigger points can happen almost anywhere in the body. Any small area of tension within a muscle can be a trigger point. Commonly, trigger points are found in:
- Upper and middle back musculature (trapezius, rhomboids)
- Hips and Lower back (gluteus maximus, gluteus medius, quadratus lumborum, iliotibial band)
Trigger Points and Myofascial Pain Syndrome
Myofascial pain syndrome evolves when there are multiple active trigger points located in one muscle or fascia of the muscle. Studies show that myofascial pain is the primary cause of regional pain in patients 75-95% of the time.
Myofascial pain differs from other types of pain (such as neuropathic pain) as it originates within the muscle itself. While researchers believe that myofascial pain is related directly to trigger points, there is still insufficient to truly explain the syndrome.
Trigger point therapy
There are various treatment interventions physical therapists use to alleviate trigger points. The goal of treatment is not to eliminate the trigger points but to manage pain levels and improve muscle function.
Therapists use Trigger Point Pressure Release to decrease pain related to trigger points. This process works by applying pressure to the trigger point directly, by either a physical therapist or done at home using things such as a tennis ball or Thera-cane. The sustained pressure on the trigger point will cut off oxygen to the surrounding areas. The goal of trigger point pressure is to release the contracted muscle.
Massage therapists also use massage to address trigger points, as it tends to increase blood flow. This increase in blood flow can reduce stiffness by reducing adhesions in the muscles and fascia.
Other trigger point therapies include:
- Stretching the painful or affected muscle
- Postural exercises to improve strength and change the way the body moves throughout the day
- Dry needling
Who can perform trigger point therapy?
Physical therapists are better able to understand the root cause of trigger points, whether it is tightness, weakness, or poor posture, and address the impairments. PTs will create an individualized treatment program to address trigger point pain and provide patients with strategies to manage their pain at home as well.
This article was written by Leyna Antonucci, PT, DPT.
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