1Trigger Point Therapy Basics

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Trigger Point Therapy Basics



Myofascial Pain and Dysfunction:

The Trigger Point Manual (1999)

Au. Janet Travell, M.D. and David Simons,M.D.

The quintessential text on Trigger PointTherapy. It is a medical textbook. Large

amounts of information in the followingpresentation were developed utilizinginformation from this volume.



The Trigger Point Therapy Workbook:Your Self-treatment Guide for Pain Relief,2nd Edition, 2004

Au: Claire Davies

A Massage Therapist’s Guide to

Understanding, Locating and Treating

Myofascial Trigger Points, 2006

Au: Leon Chaitow

Sandy Fritz



Trigger Point Therapy

A Trigger Point is an area of local nerve

facilitation and chemical imbalance of a musclethat is aggravated by stress.

The stressor maybe of many sorts and can affectan individual psychologically or physically.

Trigger Points are small areas of hyperirritability

within a muscle, fascia or tendon.




If the area is located near a motor nerve end

point, the individual may experience referredpain caused by stimulation of the nerve due to

the muscular facilitation.

Trigger Points are often located at these

positions.

Trigger Points consist of a small band of taut

fibers and may be palpated.




Palpation of a Trigger Point may elicit a twitch

response, a slight jump of in the muscle fibers.

Any of the more than 400 muscles within the

body can develop Trigger Points. They are oftendifficult to detect in the deeper layers of muscle.

Trigger Points are generally accompanied by

characteristic referred pain patterns.




In addition, Trigger Points often will restrict

range of motion and induce muscular andmyofascial pain.

With classic Trigger Points the referred painpatterns will direct back to the site of origin, i.e.

headache back to the trapezius.



Trigger Point Sensitization

Process that encourages the stimulationof local nerve structures that leads toincreased sensitivity and pain.

Involvement includes the release ofchemical mediators as found in the

process of inflammation.

This may result in the swelling of thesurrounding tissues.





The sequence is believed to happen inthe following manner: (Mense and Simons 2001)

‘Something happens’ to the muscletissues. This could be sudden strain, blunttrauma, cold, or rapid stretch.

This ‘something happening’ causes the

release of irritating chemicals includingbradykinins and prostaglandins.





The chemical release increases thesensitivity of local nerve cells that reportpain to the CNS.

The chemical mediators create localizededema.

Swollen tissue decreases blood flowresulting in ischemia and reduced oxygenlevels in the blood.





Once stimulated to an increasedsensitivity, local nerve cells have areduced tolerance resulting in greater

sensitivity to stimulation.

Stimulated nerve cells then amplify the

messages being received andoccasionally sending misinterpreted non-pain signals as pain.





Trigger Points are usually located through the

use of palpation.

The following responses may be noticed with

palpation:

-Skin changes: tense and resistive togliding strokes, damp due to perspiration

from sympathetic stimulation.

-Temperature changes: increased in acutephases but decreased in chronic phases

due to restricted circulation because of

fibrotic tissues.




-Noticeable changes in tissue density due to

the contracted fibers of the Trigger Point.

These contracted fibers are often felt as a

small nodule or linear fibers in contraction

such as a ‘spaghetti noodle’.

Credit: Travell & Simons



Credit: Davies

T i P i Th




Treatment:

Trigger Point treatments should not be done forextended periods of time.

Most basic neuromuscular techniques are

effective in relieving TP’s.

These may include:

- Positional Release

- Direct manipulation of proprioceptors

- MET’s

- Direct manipulation of the TP

T i P i Th




Treatment cont.

Once the TP has been located a method to reduce

the hypersensitivity should be employed.

In cases of extreme hyperirritability the most non-

invasive methods should be tried first.

T i P i t Th




Regardless of the method, the goal is to lengthen

the contracted fibers.

Lengthening the fibers results in an increase in

circulation to the effected fibers helping them to

normalize.

The most common method to lengthen the

contracted tissues is direct pressure. This

pressure maybe applied and held for a period of

time or the pressure maybe applied with a

stroking technique.

T i P i t Th




A certain amount of experience and practice is

necessary to develop an appropriate technique.

Pressure should be applied gradually with

attention paid to the response to the clientsbehaviors. Communication is important.

The practitioners sensitivity to tissue changes is

the most appropriate guide to the pressure

applied.

T i P i t Th




Begin applying pressure until one or more of

these signs are noticeable:

-Twitch response

- Recreation of the pain or the developmentof referred pain

-Pilomotor reflex

-Communication with the client indicates

the pain level a 5-6





The pressure may be increased if the therapist

feels the tissue softening or the spasm releasing.

Once the referred pain has diminished or the pain

level has decreased to 0-1, release the pressure.

This application may be repeated 2-3times.





An alternative method utilizing direct pressure is

to stroke over the TP.

Once the TP is palpated back-up ½ to 1 inch,

apply pressure as previously noted and strokeover the TP passing ½ to 1 inch slowly.

This may be repeated 2-3 times.





Caution:

When utilizing direct pressure techniques be

aware of the referred pain patterns associated

with the Trigger Point you are working on.

It is rare that a you will find Trigger Points that

create the same pain as a compressed nerve.

Know the potential areas for endangerment and

respect them.



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1Trigger Point Therapy Basics