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Also Myofascial Trigger Points, frequently abbreviated to TPs

Tense, immobile spots in muscle tissue, small "knots" which can be palpated (detected by fingertip pressure) are usually myofascial trigger points. These taut spots are uncomfortable, often restricting the functioning of a muscle or group of muscles. To fingertip pressure, a trigger point feels like a significantly denser spot in the muscle, as though a small area is remaining contracted while the rest of the muscle relaxes.

Trigger points result from frequent, repeated stress or strain of a muscle. They occur at very specific and predictable places and refer soreness to nearby areas—this referred pain is a defining feature of trigger points. The referred pain may be nearly constant (a so-called active trigger point) or may come about only when pressure is applied (latent trigger points).

The term trigger point was coined by orthopedist A. Steindler in 1940. The word myofascial ("of muscles and connective tissues") was added in 1952 by Dr. Janet Travell, the physician who went on to map the trigger points and the referred pain from them in a colossal two-volume work.

A trigger point may cause nearby muscle fibers to become stressed, giving rise to a secondary trigger point. Satellite trigger points sometimes develop due to the presence of a cluster of trigger points in an area. The locality of a grouping of trigger points is called (by those who name such things) the zone of reference.

How Trigger Points Work

The physiology of trigger points has left the experts scratching their heads for a very long time, but recent research has finally shed a little light on how these odd points come about and what physiological function they may serve.

A trigger point is a very low-energy system, allowing muscle fibers to remain contracted with very little fuel (ATP) expended. This seems to be achieved by a massive dump of the chemical messenger for contraction (acetylcholine) at the point where the nerve connects to the muscle. This sets up a chemical feedback loop which keeps the muscle taut without input from the nervous system and minimal expenditure of energy.

The resultant tight spot in a muscle is often sore and inflamed and may restrict blood flow to surrounding tissues. Chronic trigger points may even compress nerves, causing weakness and partial loss of feeling in extremities. While it may sound like trigger points are a completely negative thing, the physiology geeks seem to feel that they may have some usefulness. Trigger points may be helpful for maintaining tension in a muscle to stabilize a joint or to maintain postural tension. They are a remarkable low-energy system for setting up tautness across a muscle and may sometimes even protect overly mobile joints.

How to Work on Trigger Points

Trigger points may serve a purpose, but they often outlast their usefulness. It is probably not too fanciful to say that your musculoskeletal system uses trigger points to protect itself, but doesn't necessarily know enough to get rid of them when the stresses and strains are gone.

Alleviating trigger points may be done in the course of ordinary massage therapy. Trigger point work requires very good communication between client and therapist. A good way to find trigger points is to follow a suspect muscle with light to medium fingertip pressure. Go very slowly—the trigger point will be very distinct and you may get a word of confirmation from your victim client (such as "That's it!" "Ouch!" or even "Holy crap!"). After locating trigger points, many therapists cool them down with ice packs or cooling spray.

The next step is where the communication comes into play—using pressure from a thumb, knuckle or even the flat of the elbow, firmly compress the trigger point. The angle that you press at is crucial, and it may take a bit of experimentation to get it just right. Experience will be your best guide. You will know that you are compressing correctly when the client is getting a "good pain," one that feels therapeutic but is not overwhelming—watch out that you do not give more pressure than the client is comfortable with! Hold this pressure between seven and 30 seconds, keep the client breathing in slow, deep breaths. I personally count seven slowly, except in the case of really tenacious trigger points, which I may hold as long as a 20 count.

Immediately after releasing pressure, vibrate the tissues with fingertips or palm. If possible, stretch the area out somewhat and move on to all other trigger points in the area. It is a good thing to work all the major trigger points in an area, but take care not to exhaust your client or overwork an area. Take breaks and do light massage, even work other areas between working on trigger points.

After receiving trigger point work, a client may feel tenderness in the area, but movement should be improved (they may also feel lightheaded and a bit giddy if you did a lot of trigger point work, this is the normal effect of all those darn endorphins). The client should stretch the area frequently and apply heat to it (whirlpool baths or hot showers work well) over the following 24-48 hours. Anyone who gets trigger point work should also drink plenty of water and keep hydrated. Regrettably, renewed strain may bring back the same trigger points, so the therapist needs a good memory (or good notes, in my own case) for the next time.

Myers, Thomas, "Body Language" Massage Magazine, September/October 2004 pp135-140.
School notes from Austin School of Massage Therapy
Plus a few years of practice on my clients

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