About Trigger Points

According to research 75% of pain clinic patients have a Trigger Point as the sole source of their pain (Travell and Simons, 1983).

There is growing evidence that many common aches and pains may be attributed to Trigger Points. These are often undiagnosed and patients may continue to suffer for many weeks, months, even for many years.

The most widely accepted definition of a Trigger Point is a “hyperirritable spot”, usually found within a band of muscle. The spot is painful when pressed and can give rise to referred pain (pain perceived at a site adjacent to or at a distance from the site of an injury's origin) or tenderness (Travell and Simons, 1983).

Active Trigger Points can cause pain when resting. They are tender when palpated (felt with the hands), with referred pain that is similar to the patients pain complaint. The pain is often described as being 'spreading' or 'radiating'.

Latent Trigger Points do not cause spontaneous pain but may restrict movement or cause muscle weakness (Ling and Slocomb, 1993).

Patients who have Trigger Points often report regional, persistent pain that usually results in a decreased range of motion (ROM) of the muscle. Often, the muscles used to maintain body posture are affected, e.g. the muscles in the neck, shoulders, and pelvic girdle. Although the pain is usually related to muscle activity, it may be constant (AAFP).

In the head and neck region, Myofascial Pain Syndrome with Trigger Points can manifest as tension headache, tinnitus, temporomandibular joint pain, eye symptoms, and torticollis (AAFP).

Upper limb pain is often referred and pain in the shoulders may resemble visceral pain or mimic tendonitis and bursitis. In the lower extremities, Trigger Points may involve pain in the Quadriceps and calf muscles and may lead to a limited range of motion (ROM) in the knee and ankle. Trigger-point hypersensitivity in the ‘Glutes’ (the buttock muscles) often produces intense pain in the low back region.

Trigger Point Therapy

Trigger Points can be easy to fix (Davies, 2001). The methods used for treating Trigger Points include Ischaemic Pressure and Myotherapy. Using applied sustained pressure to the Trigger Point a thumb or strong finger is pressed directly on to the Trigger Point, this process will continue for up to one minute.

For more chronic and very hyperirritable Trigger Points employing pressure for 7-10 seconds, several times a day, over a period of days to help to relieve tenderness in the muscle.

The patient must not tense the muscle to ‘protect’ the Trigger Point, but must completely relax to allow the therapy to work.

Spray and Stretch Technique

Cooling the Trigger Point with an ice spray to desensitise the muscles followed by stretching the tissues has also been shown to be beneficial in the treatment of acute Trigger Points.

These techniques may fail if:

• The Trigger Point is too irritable and may therefore require many treatments.
• The therapist releases the pressure, rather than increases the pressure.
• The therapist presses too hard at first and causes excessive pain and autonomic responses which cause the patient to tense.
• The patient has perpetuating factors that continue to make the Trigger Points hyperirritable.
 
References

American Academy of Family Physicians (AAFP) http://www.aafp.org/afp/2002/0215/p653.html Accessed 23 April 2011.

Clair Davies, David G. Simons, Amber Davies (2001) 'The Trigger Point Therapy Workbook: Your Self-Treatment Guide for Pain Relief.' Harbinger.

Ling FW, Slocumb JC. (1993) 'Use of trigger point injections in chronic pelvic pain.' Obstet Gynecol Clin North Am. 1993;20:809–15.
 
Sola AE, Bonica JJ (1990) 'Myofascial Pain Syndromes'. Chap. 21. In: The Management of Pain, Ed. 2. Edited by Bonica JJ. Loeser JD, Chapman CR et al. Lea & Febiger, Philadelphia. (pp. 352-267).
 
Travell JG and Simons DG (1983) 'Myofascial Pain and Dysfunction - the trigger point manual' (Vol 1 and Vol 2). Williams & Watkins, Baltimore.