Trigger points are found throughout the muscular system.
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 in a tight band of muscle that hurts when pressure is applied. Most of the time, you can feel the small pea-sized knot with your fingers; sometimes it is not, but when you hit the spot, the pain is undeniable. Another characteristic of trigger points is the referred pain syndrome.
Trigger points (TrPs) are sensitive tight bands of tissue and knots in the muscle or fascia, the connective tissue surrounding and separating the muscles, inhibiting normal fiber and muscle movement, leading to pain and stiffness.
TrPs are about the size of a pea and can usually be felt as semi-firm to hard knots in the muscle. The area around the point is tender, but once pressure is applied, the area becomes painful and may radiate pain to other areas of the body. For example, a TrP in the trapezius can cause shoulder, neck, and head pain.
The ends of the muscle where the muscle attaches to the bone is the most common location for trigger point development; however, they can also be found in the muscle belly.
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."
An example of referred pain is left arm pain before and during a heart attack. The arm is not injured, but it hurts. You can treat the pain in the arm, but it will not prevent, stop, or treat the problem, which originates in the heart.
This concept also applies to muscle pain. A trigger point in the gluteus minimus muscle can cause pain in the hip, where the muscle is located. But, the gluteus minimus also refers pain to the back of the thigh, calf, and down the outside of the leg to the ankle. If you only treat the discomfort in the leg, it may bring temporary relief, but the pain and discomfort will soon return. The trigger point in the gluteus minimus must be found and deactivated to eliminate pain.
Trigger points can also produce tingling, numbing, and sensations of an electric shock. These are symptoms of sciatica, thoracic outlet syndrome, carpal and cubital tunnel system, and whiplash. You should check for trigger points if diagnosed with any of these conditions. All contribute to the development of trigger points in muscles. You may find that once trigger points are deactivated, your pain decreases and may be eliminated.
Shown are the two most common gluteus minimus trigger points. Keep in mind trigger points can be found throughout the muscle.
The upper TrP refers pain in a spot near the gluteal fold. It also contributes to aching down the back of the thigh.
The lower trigger point refers to a spot on the outside of the buttock and sends sciatic-type pain down the outside of the leg.
The Different Types of Muscle Trigger Points
There are several different types of trigger points. You do not need to understand all the biological processes to treat them, but you should understand the differences.
Active Trigger Points
Active trigger points are the most recognized class because they are painful. They can cause aching, tingling, and numbness. The sensations may be constant or sporadic, experienced during movement or only while resting. When dealing with active trigger points, remember that where it hurts may not be the problem. Your arm pain may not be a problem in the arm but an indication of a trigger point located in the shoulder or neck. The pain of active trigger points drives people to doctors and therapists to find relief.
Latent Trigger Points
The most common but least understood 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 them. Discomfort moving a muscle through some range of motion movements with stiffness and weakness that affects connecting joints are also signs of latent trigger points.
Latent trigger points can be little time bombs waiting to cause pain. A muscle strain, overuse, repetitive motions, and stress can turn a latent trigger point into an active one. Once the trigger point becomes active, it becomes noticeably painful.
Primary and Satellite Trigger Points
The concept of primary and satellite trigger points can be confusing. But if you have ongoing chronic pain, you need to understand the basic concepts.
Primary Trigger Points
Primary trigger points are usually active trigger points. The difference between an active and a primary trigger point is the primary trigger point will cause the development of trigger points in other muscles. These are known as satellite trigger points.
Satellite Trigger Points
Satellite trigger points are contributors 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 location is on the side of the hip. It connects the hip bone (ilium) to the greater trochanter (located on the thigh bone femur). A primary trigger point in the gluteus minimus muscle can cause pain in the hip and hip joint, the lower buttocks, the top of the back thigh, and pain down the outside of the leg. The muscles in this referred pain pattern can develop satellite trigger points. The good news is that most satellite trigger points disappear once the primary trigger point is deactivated. However, suppose you experience pain relief once the primary trigger point is deactivated but continue to have symptoms in the muscle's referred pain area. In that case, you will need to find and deactivate the satellite trigger points.
How Do Trigger Points Develop?
- Inactivity, whether it is sitting too much or bedrest due to illness or injury
- Lifting and carrying something heavy like lifting boxes, carrying a briefcase or purse, lifting and carrying a child.
- Sitting slumped with your body weight on the top of the hips/lower back and rolling forward at the shoulders are sure ways to develop trigger points.
- Repetitive overuse injuries like typing, repeatedly throwing or kicking a ball, using manual and electric hand tools, and gardening.
- Stress and muscle tension
Trigger points also develop during injuries such as broken bones, muscle strains, sprains, 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 cause trigger points in the abdominal and back muscles.
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 occur with specific movements.
- Tingling and numbness
- Muscle and joint stiffness
- Muscle weakness
- Fatigue of a muscle or muscle group
Trigger point symptoms can mimic and contribute to many muscle-related diagnoses:
- 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 Golfer's Elbow
- Runner's knee
- Plantar fasciitis
How Are Trigger Points Treated?
The good news is that many 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. That does not mean the trigger point will be gone in one day. It can take days or, in rare cases, weeks to deactivate 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.
To accurately find and treat trigger points, you must have a reference to the pain patterns. You can browse the muscle categories on The Wellness Digest to search for the pain pattern that most closely matches your pain. You will also learn the symptoms, causes, and contributing factors to your specific pain.
I highly recommend The Trigger Point Therapy Workbook as a reference guide to learning about trigger points and their effects on the body. The beginning chapters of the book will teach you about trigger points and how to find and treat them. It also has precautions you may need to observe based on medical conditions. The rest of the book is dedicated to muscle treatment. Individual muscles have illustrations with symptoms for each trigger point listed. Written instructions and diagrams of trigger point locations will guide you to find and treat the pain. It takes time, practice, and patience to learn. But once you understand the basic concepts, you will have the knowledge to treat, relieve, and even eliminate trigger point muscle pain.
Another 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. You must continue self-treatment at home to deactivate the trigger point entirely.
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 trigger point therapy is consistency. Several 1-2 minute treatments throughout the day have shown to be most effective for this manual therapy. If treatment 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 old injuries can cause pain that trigger point therapy may help but not eliminate. But, if you are suffering from muscle and joint pain and cannot find the answers, trigger point therapy is worth your consideration.
The Trigger Point Therapy Workbook is a book everyone should have in their library. Even if you are not interested in learning TrP therapy, it will give you an insight into muscle pain caused by overuse, injuries, and muscle imbalances.
FlexFlixx Massage Balls are also a recommended tool used in the Workbook. Massage balls are a tool I recommend for everyone. Rolling the soles of the feet and the palm of the hands every day has preventive benefits and can help reduce pain in the lower legs and arms.
TENS units are often recommended by doctors and therapists for muscle pain. I recommend and use the Belifu Dual Channel TENS Unit. The Belifu has multiple settings that you can adjust to your comfort level. The instruction book will guide you through various settings and treatments.