A diagram of some of the muscular trigger points found in the body.
Explaining the trigger point phenomenon is complicated. A person who is not educated in muscle pain and pain syndromes may have trouble understanding the available literature that is available. This article is written for people who are looking for an easily understood explanation of this little known or understood contributor to muscle pain.
Note: Trigger points therapy should not be confused with acupuncture, acupressure points, or reflexology as they are different systems and treatments.
What Are Muscle Trigger Points?
Diana G. Travell and David G. Simons, the pioneers of trigger point therapy defined a trigger point as “a hyperirritable spot in skeletal muscle that is associated with a hypersensitive palpable nodule in a taut band. This spot is painful on compression and can give rise to characteristic referred pain, referred tenderness, motor dysfunction, and autonomic phenomena” (Simons, Travell, and Simons 1999).
In simpler terms a trigger point is a small knot or area in a tight band of muscle that hurts when it is pressed. Most of the time a small pea sized knot is felt, sometimes it is not, but when you hit "the spot" the pain is undeniable. Another characteristic of trigger points is referred pain.
An example of trigger points in muscle fibers.
What Is Referred Muscle Pain?
Mosby’s Medical Dictionary 6th edition defines referred pain as "pain felt at a site different from the injured or diseased organ or body part.”
A common example of referred pain is left arm pain before and during a heart attack. The arm is not injured, but it hurts. The arm pain can be treated but that is not going to prevent, stop, or treat the actual problem which is the heart.
This also applies to muscle pain. A trigger point in the gluteus minimus muscle can cause pain in the hip, where it is located. But it is also known to send pain into the back of the thigh, the calf, and down the outside of the leg to the ankle. If you only treat the pain in the leg it may bring temporary relief, but pain and discomfort will soon return. The trigger point in the gluteus minimus must be found and deactivated to relieve the pain.
Trigger points can also produce tingling, numbing, and sensations of an electric shock. These are common symptoms of sciatica, thoracic outlet syndrome, carpal and cubital tunnel system, and whiplash. If you are diagnosed with any of these conditions you should check for trigger points. All contribute to the development of trigger points in muscles. You may find that once trigger points are deactivated your pain is decreased and in limited instances eliminated.
The Different Types of Muscle Trigger Points
There are several different types of trigger points. To treat them you do not need to understand all the biological processes but it is important to understand the differences.
Active Trigger Points
Active trigger points are painful. They can cause aching, tingling, and numbness. They may hurt constantly or flare up with movement. They can cause pain while you're in motion or at rest. When dealing with active trigger points it is important to remember that where it hurts may not be the actual problem. Your arm pain may not be a problem in the arm but may be a trigger point located in the shoulder or neck. The pain of active trigger points is what drives people to doctors and therapist to find relief.
Latent Trigger Points
The most common trigger point is the latent trigger point. These are not painful until pressure is applied. You can have latent trigger points for years and never know until you press on it. Discomfort moving a muscle in certain motions along with stiffness and weakness in the muscle as well as the connecting joints are signs of latent trigger points.
Latent trigger points can be little time bombs waiting to cause pain. A muscle strain, overuse, and repetitive motions, as well as stress, can turn latent into an active trigger point when they become noticeably painful.
Primary and Satellite Trigger Points
The concept of primary and satellite trigger points can be confusing. But if you have on-going and chronic pain it is important to understand the basic concepts.
Primary Trigger Points
Primary trigger points are usually active trigger points. The difference between active and primary trigger points is that the primary produce trigger points in other locations and muscles. These are called satellite trigger points.
Satellite Trigger Points
Satellite trigger points are believed to be a primary contributor to recurring and chronic pain. They develop within the primary trigger point's pain referral area. Going back to the gluteus minimus example: The gluteus minimus is located on the side of the hip and connects the hip bone (illium) to the greater trochanter (located on the femur which is the thigh bone). A primary trigger point in the gluteus minimus muscle can cause pain in the hip and hip joint as well as the lower buttocks, the top of the back of the thigh, and pain down the outside of the leg. The other muscles that are included in this referred pain pattern can develop trigger points which are the satellites. The good news is that most satellite trigger points disappear once the primary trigger point is deactivated. If your pain is relieved once the primary trigger point is deactivated but you continue to have symptoms in the referred pain area you will need to find and deactivate the satellite trigger points.
The gluteus minimus muscle (left) is located on the side of the hip. The pain pattern (right) is the hip, buttocks, and leg. A primary trigger point in the glute min can create satellite trigger points in the following muscles: piriformis, gluteus medius, gluteus maximus, vastus lateralis, and peroneus longus.
How Do Trigger Points Develop?
- Lifting and carrying something heavy like lifting boxes, carrying a briefcase or purse, lifting and carrying a child
- Repetitive overuse injuries like typing, repeatedly throwing or kicking a ball, using manual and electric hand tools, gardening
- Sitting slumped with your body weight on the top of the hips/lower back and slumping forward at the shoulders are sure ways to develop trigger points
- Stress and muscle tension
- Inactivity whether it is sitting too much or bed rest due to illness or injury
Trigger points also develop during injuries such as broken bones, muscle strain, sprains, slipping and falling, deep bruising and illness. Coughing during a cold or bronchitis can cause trigger points in the chest, rib area, abdomen, and back. Problems in the digestive tract can set up trigger points in the abdomen and back.
What Are The Signs and Symptoms That Trigger Points Have Developed?
The symptoms of trigger points are the same as many other muscle related conditions. Some of the symptoms are:
- Pain can be constant or come and go. It may only be felt with certain movements.
- Tingling and numbness
- Muscle and joint stiffness
- Muscle weakness
- Fatigue of a muscle and/or muscle group
Trigger point symptoms can mimic and contribute to many muscle related diagnoses including:
- Most types of headaches including migraine, cluster, and stress-related headaches
- Temporomandibular joint disorder (TMJ)
- Thoracic outlet syndrome
- Asthma and other breathing problems
- Rotator cuff dysfunction in the shoulder
- Carpal and Cubital Syndrome
- Tennis and Golfers Elbow
- Runner's knee
- Plantar fasciitis
How Are Trigger Points Treated?
The good news is that trigger points are easy to treat and you can learn how to treat them yourself. Applying pressure to the area for 5-7 seconds several times throughout the day will deactivate most trigger points. This does not mean that the trigger point will be gone in one day, it can take days or weeks to completely get rid of a trigger point. But you will experience a reduction in pain and increased mobility within a few treatments. Treatment consistency is the secret to eliminating trigger point pain.
The easiest way to learn self-treatment is to find a therapist trained in trigger point therapy or Neuromuscular Therapy. A therapist can show you how to self treat specific trigger points that are a problem. You must then continue with self-treatment at home to fully deactivate the trigger point.
To accurately find and treat trigger points you must have a reference to the pain patterns. You can browse the muscle categories here on The Wellness Digest to find the pattern that most closely matches your pain and learn the symptoms, cause, and contributing factors to your specific pain.
I highly recommend The Trigger Point Therapy Workbook as a reference guide and to learn about trigger points and their effects on the body. The beginning chapters of the book will teach you about trigger points, what they are, how to find and treat them. It also has precautions that you may need to observe based on medical conditions. The rest of the book is dedicated to muscle treatment. Individual muscles are illustrated and symptoms for each trigger point listed. Written instructions along with diagrams of where trigger points are located will guide you to find and treat the pain. It takes time, practice and patience to learn, but once you learn the basic concepts you will have the knowledge to treat, relieve, and even eliminate trigger point muscle pain.
The Trigger Point Therapy Workbook is the go-to book to learn about trigger point and their effects on the body. Clear descriptions and diagrams will help you find and treat trigger points throughout the body.
Trigger Point Therapy for Myofascial Pain is an excellent book. It is a great addition to your library for the accurate diagrams of trigger point locations and referred pain patterns.
The Thera Cane Massager is made to help you access those hard to reach areas of the back, hips, legs, and feet to treat trigger points and sore muscles. Recommended with the Trigger Point Workbook.
Massage balls are also recommended for use in the Trigger Point Workbook. These hard rubber balls are used to treat back, hips, feet and other areas of the body.
Is Trigger Point Therapy Effective?
Trigger point therapy has helped many people reduce or eliminate pain and muscle and joint stiffness. The key to effective therapy is consistency. Several 1-2 minute treatments throughout the day have shown to be most effective for manual therapy. If therapy is not consistent, and not continued until the trigger point(s) are deactivated the pain will return.
Does it work for everyone? No. Underlying medical conditions, flare-ups from chronic illness and serious old injuries can cause pain that trigger point therapy may help but not eliminate. But if you are suffering from muscle and joint pain but cannot find the answers, trigger point therapy is worth your consideration.