Handling Pain At the Trigger PointPrint
Handling Pain at the Trigger Point
Handling Pain at the Trigger Point
By Debbie Cleveland
Tuesday, November 22, 2005 10:03 AM EST
When you wake up in the morning, and you have a knot in your shoulder, have you ever wished that there were some sort of “button” that you could push and have the pain go away? Well, if a trigger point causes the knot, then relief could be right under your fingertips, literally!
Janet Travell, who is recognized as the leading pioneer of diagnosis and treatment of trigger point therapy and referred pain, defined them as “a highly irritable localized spot of exquisite tenderness in a nodule in a palpable taut band of muscle tissue.” Which, in plain English, means a trigger point will really hurt when you press on it. The “nodule” she was talking about, is the actual trigger point. The “taut band” is your very tight muscle.
Trigger points will often feel like a knot, or a lump that can range in size from about the size of a pin “head” to about the size of a pea. In larger muscles, they may be about the size of your fingernail. Trigger points can cause headaches, neck and jaw pain, low back pain, tennis elbow, and carpal tunnel syndrome.
They are often the source of pain in joints, such as the shoulder, wrist, hip, knee, and ankle. In addition to pain, the effects of trigger points can include limited range of motion, muscle weakness, and numbness or tingling.
There are two types of trigger points, active and latent. All trigger points cause pain when pressed; however, “active” trigger points frequently refer pain to other areas of the body. This explains why the pain you are experiencing in your head may actually be coming from a trigger point in your shoulder, or the pain in your lower back may originate from the deep muscles in your hip.
A “latent” trigger point will still feel like a lump or knot, but only produces pain when pressed upon, and won't give the same referral pain as an active point.
Some of the causes of trigger points are stress, both external stresses and postural stresses, such as poor posture, prolonged isometric contraction, (working at the keyboard), and strain to the muscle.
Trigger points are also thought to be caused by poor nutrition, such as vitamin B, C or folic acid deficiency, hypothyroidism and depression and anxiety.
Trigger points will keep the muscles tight, restricting blood flow and compressing nerves, causing a vicious pain/spasm cycle in the muscles.
This may result in decreased flexibility, limiting movement and encouraging bad postural patterns that may continue the cycle for years.
Massage therapy, specifically trigger point therapy, is one of the best methods to help you get relief from the pain that trigger points bring.
Although this statement is true, one of the things my clients tell me that they dislike about this treatment is the fact that trigger points hurt when compressed.
Some people are reluctant to have trigger point therapy done, but the important thing to realize is that if done correctly, it will be a “good” pain.
Your massage therapist will be able to incorporate trigger point therapy into your session, so that by relaxing the muscle and attachments first, it is easier to access the trigger point, and the degree of pain may be somewhat less.
If you are doing self-treatment, you will want to use deep stroking massage prior to specific trigger point work. According to Clair Davies, who authored the book “The Trigger Point Therapy Workbook, compressing the trigger point is the right idea, but a repeated milking action moves the blood and lymph fluid out more efficiently.”
To work out your trigger point, begin by warming the affected muscle with slow, repetitive muscle strokes, along the entire length of the taut band within the muscle. Work from one end of the muscle to the other.
Your pressure should start out light, and gradually increase. Follow this with compression on the trigger point, using a trigger point tool if possible to save putting strain on your hands. Hold for 7 to 10 seconds, breathing deeply through the pain.
Then release, and move the affected muscle through its range of motion, so that you can feel the release of the trigger point.
When deciding what constitutes “good” pain versus “bad” pain, use your judgment. Davies states, “Aim at a pain level of seven on a scale of 1 to 10.” But only you will be able to decide what you can tolerate and what you cannot. Repeat this sequence of compression and movement; using the number scale suggested by Davies, until your pain level is about two or three.
Often you will see some immediate improvement, but don't worry if it takes you a few sessions to feel relief.
Used correctly, trigger point therapy can be a great tool in helping to reduce pain, and gain greater range of motion, as well as reduce chronic pain.
If you have questions about this type of self-massage therapy, ask your massage therapist or physician about trigger points and myofascial pain. I recommend reading “The Trigger Point Therapy Workbook,” by Clair Davies. (www.triggerpointbook.com)
Debbie Cleveland is a licensed massage therapist in Elbridge