WHAT ARE “TRIGGER POINTS”?
Skeletal muscle is the largest single organ in the human body and accounts for nearly 50% of body weight. There are over 650 named muscles in the human body. Any one of these muscles can develop myofascial trigger points that refer pain and motor dysfunction, often to another location. Yet the muscles in general and trigger points in particular receive little attention as a major source of pain and dysfunction in modern medical school teaching and medical textbooks. In addition, trigger points do not show up in x-rays, MRI’s or other routine tests. The only way to identify them is with hands on manual palpation, of which today’s doctors have precious little time to perform.
Trigger points were first identified and described by Dr. Janet G. Travell and Dr. David G. Simons. They were pioneering physicians in the field of pain management and musculoskeletal medicine. Their work on trigger points began in the mid-20th century, and they published their findings in their influential two-volume book “Myofascial Pain and Dysfunction: The Trigger Point Manual,” which was first published in 1983.
As the story goes, Janet Travell was doing rounds in a cardiac ward, many of the patients would complain of pain in the chest wall, thoracic or scapular regions. The cardiologists would tell the patients: “Of course you’re hurting… you just had heart surgery.” Later, Travell was in a pulmonary ward. The patients would complain of the same type of pains. The pulmonologists would respond: “Of course you have pain there, you just had lung surgery.” And later as she was doing rounds in a general ward when the patients would complain, the general practitioners would respond with: “It’s psychosomatic!” But Travell began to notice that during manual examination of these patients she could locate palpable tight bands within the chest wall, cervical and thoracic musculature that would reproduce the patient’s pain complaints. The patients would respond with “You found it!”
Dr. Travell was a White House physician during the Kennedy and Johnson administrations, and her observations of musculoskeletal pain patterns in her patients led to the development of the concept of trigger points. Dr. Simons, a neurologist, collaborated with Dr. Travell to further investigate and document trigger points.
Their research involved extensive clinical observations, manual examination of patients, and the use of injection techniques to identify and treat trigger points. Through their work, they mapped out the locations of trigger points in various muscles, documented the referred pain patterns associated with them, and developed techniques for their treatment.
Today, trigger point therapy is a widely recognized and utilized approach in pain management and physical therapy, thanks to the pioneering work of Dr. Travell and Dr. Simons.
Trigger points, also known as muscle knots, are sensitive areas within the muscle fibers that can cause pain and discomfort. These points are usually found in taut bands of muscle and are often associated with muscle tension, overuse, or injury. Trigger points can occur in various muscles throughout the body and can cause referred pain, which means that the pain is felt in a different area of the body than where the trigger point is located.
Notice how a trigger point in the gluteal musculature can refer pain all the way to the calf and ankle.
TYPES OF TRIGGER POINTS
Trigger points have been categorized into three main types: active, latent, and satellite trigger points. The main difference between them lies in their level of symptom presentation and their influence on pain and discomfort:
Active Trigger Points:
Symptoms: Active trigger points are characterized by causing spontaneous pain or discomfort, even at rest. They can produce a constant or intermittent dull ache or sharp pain, which may be localized to the trigger point itself or can refer pain to other areas of the body.
Sensitivity: Active trigger points are tender to the touch. Palpation of these points often reproduces the pain that the person is experiencing, and pressing on them might cause a twitch response in the muscle.
Influence: Active trigger points are the primary source of pain and dysfunction. They can significantly affect muscle function, range of motion, and overall quality of life.
Latent Trigger Points:
Symptoms: Latent trigger points are dormant and do not actively produce pain or discomfort unless they are pressed or stimulated. They might not cause noticeable symptoms on their own.
Sensitivity: Latent trigger points can still be tender when pressure is applied, but they do not generate the same level of spontaneous pain as active trigger points.
Influence: Latent trigger points can contribute to muscle imbalances and restricted movement. They may become active trigger points if they are subjected to additional stress or strain.
Satellite Trigger Points:
Definition: Satellite trigger points are secondary points that can develop in response to an existing active trigger point. They are located in muscles that are functionally related or anatomically connected to the muscle with the active trigger point.
Symptoms: Satellite trigger points can refer pain and discomfort similar to active trigger points. However, their pain is often felt in areas away from the original active trigger point.
Influence: Satellite trigger points can complicate the pain pattern and contribute to the spread of discomfort. Treating both the primary active trigger point and any satellite trigger points is important for comprehensive pain management.
Active trigger points are the primary culprits for causing pain and discomfort, while latent trigger points are inactive until triggered by pressure or other stimuli. Satellite trigger points are secondary points that develop as a result of the presence of an active trigger point, and they can refer pain to different areas. All three types of trigger points—active, latent, and satellite—can play a role in muscle pain and dysfunction, and addressing them as part of a comprehensive treatment plan can help alleviate symptoms and improve muscle function.
What is the difference between “Trigger Points” and “Tender Points?”
The main difference between trigger points and tender points lies in their characteristics and associated conditions: Trigger points are localized knots or tight bands of muscle fibers that can cause referred pain when pressed or stimulated. They are typically associated with myofascial pain syndrome, which is a condition characterized by muscle pain and discomfort. Trigger points often have specific referral patterns, meaning they can cause pain or discomfort in areas distant from the actual point.
Tender points are specific anatomical locations on the body that are particularly sensitive to touch or pressure. They are not abnormal although they may become particularly sensitive as in the case of fibromyalgia. They are a defining feature of fibromyalgia, a chronic pain disorder. To be diagnosed with fibromyalgia, a person must have a certain number of tender points. Tender points are more diffuse and widespread than trigger points and are not associated with referred pain patterns.
In summary, trigger points are localized abnormal muscle knots that can cause referred pain, often associated with myofascial pain syndrome. Tender points, on the other hand, are specific, sensitive points on the body associated with fibromyalgia and are not typically associated with referred pain.
TREATMENT
Physical therapy can be an effective approach to treating trigger points and addressing the pain and discomfort they cause. Physical therapists use a variety of techniques to relieve muscle tension, improve muscle function, and reduce pain. Here are some common physical therapy techniques used to treat trigger points:
Manual Therapy:
Massage: Therapists use various massage techniques to manipulate and knead the affected muscles. This can help relax muscle fibers, improve blood circulation, and reduce muscle tension.
Myofascial Release: This technique focuses on releasing tension in the fascia, the connective tissue that surrounds muscles. Myofascial release involves gentle stretching and sustained pressure to alleviate muscle tightness.
Trigger Point Release: Therapists apply direct pressure to the trigger point itself to release tension and reduce pain. This can be done using their fingers, thumbs, or specialized tools.
2. Trigger point dry needling:
Trigger point dry needling is a technique used in physical therapy to treat trigger points and alleviate muscle pain and tension. It involves the insertion of thin, solid needles into the skin and muscle directly at the site of the trigger point. The goal of trigger point dry needling is to release muscle tension, improve blood flow, and promote healing.
Stretching Exercises:
Static Stretching: Targeted stretches are used to elongate and relax muscles, which can help alleviate muscle tension and reduce the impact of trigger points.
Dynamic Stretching: Gentle, controlled movements are used to gradually increase the range of motion and flexibility of the affected muscles.
4. Strengthening Exercises:
· Muscle Imbalance Correction: Strengthening exercises focus on addressing muscle imbalances that might contribute to the formation of trigger points. Strengthening weak muscles can help improve overall muscle function and reduce strain on other muscles.
· Postural Correction: Therapists prescribe exercises to improve posture, as poor posture can lead to muscle imbalances and increased tension.
5. Heat and Cold Therapy:
Heat Application: Heat can help relax muscles, increase blood flow, and promote healing. Therapists might use heat packs or hot towels on the affected area.
Cold Application: Cold therapy can reduce inflammation and numb the area, helping to alleviate pain. Cold packs or ice massages might be used.
Ultrasound and Electrical Stimulation:
Ultrasound: Therapists use ultra high frequency sound waves to deliver deep heat to the affected tissues. This can increase blood flow and promote healing.
Electrical Stimulation: Electrical currents can be applied to the muscles to reduce pain and relax muscle fibers.
Home Exercises and Self-Care:
Patients are often given specific exercises and stretches to continue at home, along with self-massage techniques and strategies for managing pain.
Posture and Body Mechanics Education:
Therapists provide guidance on maintaining proper posture and body mechanics during daily activities to prevent further trigger point development.
It's important to note that the treatment approach may vary based on the individual's condition, the severity of the trigger points, and any underlying medical issues. Physical therapists will conduct a thorough evaluation to determine the most appropriate treatment plan.
The goal of physical therapy for trigger points is to reduce pain, improve muscle function, and prevent the recurrence of trigger points. Patients are often advised to maintain an active lifestyle, practice good posture, manage stress, and perform their prescribed exercises consistently to achieve the best results.
If you feel your pain could be trigger point related, schedule now for a free consult with a physical therapist at Lanier Therapy in Motion to look at possible treatment options.