PREVENTION What Is A Trigger Point?
lients come into the office all the time saying they have a knot in a muscle here or there that hurts. It’s fun to enlighten them about trigger points and how they are defined. The pur- pose of this article is to explain where the term trigger point came from, what it is, and how a massage therapist works with a client that has one. Janet Travell MD coined the term “trigger point” in 1942. Spe- cializing in skeletal muscle pain, she focused her work to explain myofascial pain syndrome and trigger points. She mapped the trigger points in the body and the referral patters of them. She also wrote Myofascial Pain and Dysfunction with David Simmons MD; a two-book manual that physical therapists, and other rehabilita- tion therapists, and massage therapists use for reference. It was her success with muscular pain, which encouraged John F. Kennedy’s personal orthopedic surgeon to ask for her assistance with his back pain related to war surgery. When he became president, she became his personal physician. Janet Travell, MD and David Simmons, MD came up with a definition of a trigger point, as the presence of exquisite tenderness at a nodule in a palpable taut band of muscle.
C A current trigger point definition is:
• Pain related to an irritable point in skeletal muscle or fascia. • A painful point, which can be felt as a nodule or band in the muscle with a twitch response when stimulated. • Small areas either localized or across an entire muscle group.
What causes trigger points? Some examples are: repetitive stress injuries, a sedentary lifestyle, bad posture, forward head posture, improper weight lifting techniques, and occupational or athletic injury. These may all lead to trigger point formation or they could also be secondary to another pathological process. Obesity, surgery, and some forms of degenerative arthritis can change pos- ture, which might cause the muscles to work differently than they were designed to. Over time, this can place stress on the muscles, possibly causing the development of trigger points; which can be painful and uncomfortable. There are two types of trigger points. Active points cause pain or weakness and referred pain to other areas of the body. Latent points may not be painful until pressure is applied externally and may also cause muscle shortening. Often, people schedule an office visit when experiencing a
persistent lack of mobility or pain with hopes to resolve it. Many times they have tried other approaches to make the pain go away, such as a visit to the doctor. Frequently, they are given a prescrip- tion for muscle relaxers, told to rest, stretch, and perhaps receive a physical therapy referral. For many, these suggestions don’t help. By the time new clients arrive in my office, they describe in great detail the size, shape and location of pain, often that is caused by a trigger
32 Essential Living Maine ~ September 2014
point. Sometimes, clients will have lived with the pain for a long time. It can require many sessions of work to find and breakdown the trigger points.
When a massage therapist works with muscles having trigger points, the client may describe pain as referring to another area of the body, typically in the same region. For example, points around the head, upper back, and shoulders might radiate down the arm, or deep into the shoulder joint and some of the rotator cuff muscles. There may be pain localized right at the spot of the trigger point. Often the pain may go away as a result of this work. There may be twitching in the muscle while it is being worked, and there can be multiple trigger points in one muscle. Patience and knowledge of anatomy and even kinesiology helps therapists to work with trigger points. Treating trigger points is a marvelous opportunity for education and communication between therapist and client. I use a pressure scale between 1-10 when discussing what is appropriate for them. Applying pressure or using heat in addition to ice are methods I em- ploy with treatment. I also encourage clients to stretch at home as well as rest breaks and other forms of tension relief. These include baths, exercise, and instruction for using a tennis ball or foam roller in between sessions.
During treatment for trigger points, identifying how they came about is important as is emphasizing that stretching, icing, and strengthening is critical for the reduction of pain. I usually see clients for multiple sessions before pain begins to go away. That doesn’t mean the work is done as points in other muscles may be lurking. The original trigger point most certainly can return if one continues with the same repetitive stress or work that caused it to come about in the first place. Having a keen knowledge of anatomy, listening to the client, and asking open ended questions about their pain helps to get to the source of the pain and allows them to return to physical health.
Heather Piper is the owner and primary Muscular Therapist at River Bend Therapeutic Massage in Kennebunk Maine. She has worked at two well-known spas, The White Barn Inn, and the Cliff House Resort & Spa; she had worked with athletes and performers all over New England. She is licensed to practice massage in Maine and Massachusetts. She has a keen knowledge of anatomy and kinesiol- ogy. Heather uses her skills to assist the client’s return to physical health. She can be reached via email:
heather@ksystems.us, or at her website:
riverbendtherapeuticmassage.massagetherapy.com. See ad on page 6.
Heather Piper, LMT
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