Triggerpoint Therapy

Trigger point – (Myofascial):   An area of hyper-irritability within soft tissue structures, characterized by local tenderness and sometimes referred phenomena.  These referred sensations can include pain, tingling, numbness burning, or itching.

• Not all trigger points refer pain, some are just localized.  Each person is different depending on their life history.
• Localized areas of deep tenderness and increased tissue resistance that often produce referred pain.
• The origin of the trigger point is thought to be changes in the chemical balance in a local area, irritating the sensory systems.

Active trigger point: Cause of  the immediate pain, prevents muscle from fully lengthening and sometimes weakens.

Latent trigger point:  Unnoticed by the client until pressure is applied, Not actively painful.  Usually feels dense and fibrous.
Characteristics

1. Trigger points may be associated with Vitamin B-6  and other vitamin deficiencies.  Usually after a trauma or stressful event, the body is lacking in B-6, magnesium or Vitamin C.  Trigger points are more likely to develop.
2. Trigger point are usually bilateral, with one side being more symptomatic than the other.  Both sides need to be treated.
3. Trigger points may be a result of underlying visceral disease, arthritic joints, or other trigger points.
4. The most tender trigger points are usually not the source of the problem. Other areas need to be treated like the referral area and the surrounding tissue.  Look for tight stringy band in small supporting musculature.
5. Trigger points can cause referred pain, but not always.
6. The referral patterns are not the same in any 2 people.
7. Referred pain does not follow segmental, scleratomal or dermatomal patterns.
8. May cause pain and stiffness especially after periods of inactivity such as sleeping or sitting for awhile.

Possible Causes:

1. Acute overload, overwork, fatigue, direct trauma, chilling.
2. skeletal asymmetry such as short leg or pelvic imbalances.
3. Other trigger points can cause new points to occur.
4. Arthritic joints can cause trigger points.
5. Visceral diseases such as ulcers, renal colic, myocardial infarction, gall stones, kidney problems, irritable bowel syndrome can cause trigger points.
6. B-6, magnesium, vitamin C, folic acid deficiencies which are common after injuries or trauma may cause trigger points
7. hypoglycemia
8. chronic infection from a viral or bacterial disease.
9. food allergies or intolerances.  Wheat and dairy products should be checked first.
10. toxicity due to exposure to organic chemicals or heavy metals

Location:

Trigger points may develop any where in the body, but are most commonly found at the sites of the greatest mechanical and postural stress.
Hints for locating:

• look for changes in thickness of tissue, resistance to gliding strokes, lumps or strings.
• immobility
• edema
• pain or tenderness
• temperature changes-area is usually colder
• color  most often somewhat pale and unhealthy looking
• muscle shortening with weakness
• occasionally increased perspiration in reference zone
• hypertonicity
• ischemia

Factors that can worsen trigger points:

• fatigue, improper sleep
• chronic infection
• severe stress (mental, emotional, physical)
• nerve entrapment, compression
• excessive creatine in urine
• postural imbalances
• nutritional health of the tissue
• food allergy, inhalant allergy
• visceral (organ) disease – gall bladder problems, ulcers, kidney problems, irritable bowel syndrome
• exercise may worsen an active trigger point, but helps heal a latent trigger points

Signs of Trigger points:

• restricted movement, stiffness of muscles
• weakness in muscles
• passive or active stretching increases pain
• resisted contraction causes pain
• subcutaneous tissue feels coarsely granular, ropy, knotty,
• client “jumps” when pressure applied to trigger point
• deep tenderness and paresthesia
• client may feel “Numb” but sensation is normal
• dizziness
• taut palpable band in the affected muscle
• exercise makes the pain worse when there are active trigger points, but helps heal the latent triggerpoints
• hyperirritability, increased metabolism, decreased circulation

Thing to pay attention to:

1. What layer of tissue are you working on?
2. How can you work more efficiently?
3. What does the tissue feel like?  How does it change?
4. What other areas may be associated with the trigger point?

Cautions:

• Triggerpoint therapy can relieve the pain of angina, myocardial infarction and acute abdominal disease.  Refer clients to physicians when necessary.
• Rule out such conditions as: Tendinitis, bursitis, giant cell arteritis, neuralgia, infection (both viral and bacterial), neuropathies, disc problems, disc herniations.
• Check for thyroid malfunction, anemia, hypoglycemia and vitamin deficiencies.

Web Resources (links open in new windows and take you off site)
Trigger Points and the Myofascial Pain Index
By Leon Chaitow
This paper contains summaries of information explored more fully in the forthcoming book Clinical Applications of Neuromuscular Therapy (Volume 1 Upper body), by Leon Chaitow and Judith Walker, to be published by Churchill Livingstone in the summer of 2000.

Online Articles:

Integrated Treatment of Myofascial Trigger Points?
By Leon Chaitow ND DO. Senior Lecturer, University of Westminster

Overlooking Myofascial Trigger Points: The Key To YOUR Pain? from Devin J. Starlanyl

Trigger Point Therapy Trigger Point Therapy  by Boris Prilutsky

http://triggerpoints.net/index.htm

Books  (links take you to Amazon.com)
Travell & Simons :  Myofacsial Pain and Dysfunction, The Triggerpoint Manual; 2 volume set

Leon Chaitow.  Soft Tissue Manipulation

Bonnie Prudden.  Myotherapy.

The Trigger Point Therapy Workbook: Your Self-Treatment Guide for Pain Relief, Second Edition
by Clair Davies, Amber Davies, David G., Md. Simons 

Trigger Point Charts at amazon.com – Tavell