Nov 2014 15

Trigger points

By: Dave Wheeler

One of the techniques that are used by most manual therapists: sports massage therapists, osteopaths, chiropracters and physiotherapists is trigger point therapy.

Trigger points are very small spots of hypertonic tissue - hypertonic means "hyper toned", in other words in a constant state of severe contraction.

Trigger point therapy involves applying pressure to the trigger point for a minute or so. Last week, as I was carrying out trigger point therapy with one of my clients, they described the spot as "exquisitely tender", which is pretty much the textbook definition of a trigger point.


The causes of trigger points

Trigger points can occur either within the muscle itself or the fascia that surrounds the muscle.

They can be caused by a number of different factors:

  • over-use (such as repetitive hunching of the shoulders, repetitive movement in sports or work)
  • posture out of alignment causing slight but permanent shortening of the muscles
  • fibromyalgia
  • nutritional problems
  • hormone imbalances
  • infection

Muscle activity is triggered by a nerve impulse, this is called innervation. When trigger points develop close to nerve endings they often become active, which means that pain is referred away from the trigger point along the nerve fibre to other areas.

Trigger points which don't refer pain elsewhere are called latent. It's these that are "exquisitely tender."


How trigger point therapy works

Trigger point therapy seems to work by forcing the nervous system to stop the nerves innervating the trigger point. The exquisite tenderness of applying pressure to the trigger point causes the nervous systems to try to find ways of avoiding the pain. Because the client is agreeing to the treatment, they don't move away from the pain but accept it, so the nervous system has to find another way - by stopping activiation of the muscle.


Treating common trigger points

Trigger points can occur in any of the muscles of the body or the surrounding fascia, but there are common places where it's typical to get them. For example, pretty much all of us have a trigger point towards the top of our shoulder in a muscle called the levator scapula (the muscle's job is to hunch the shoulder):

Actually, when I treat trigger points in the levator scapula, I ask the client to lie face-up, placing my hand under their shoulder and pressing up with my fingers so that their body weight is applying the pressure.

The muscle in the lower back, the quadratus lumborum (or QL), is also prone to trigger points - there can be a whole load of trigger points here, though 8 are common. The QL runs from the lower rib to the top of pelvis, attaching at the spine. 

When I'm treating trigger points in the QL, I always treat them with the client lying on their side - that way when I'm applying pressure, I'm not pressing onto their spine, but onto muscle.

Another really common place to find trigger points, especially on raquet sports players or decorators is the small muscle called the teres minor which sits inside the fleshy part of the back of the armpit. Again, I tend to treat this with the client laying on their side with their arm hanging off the couch.

Treating trigger points isn't just a case of slavishly following a standard procedure. Although pressure is typically applied to a trigger point for around 1 minute, the therapist needs to be able to discern when the trigger point begins to ease so that pressure is eased off.

As ever, if you think I can help, give me a call.