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Trigger Point Massage Therapy and Referred Pain

 What does Trigger Point Therapy Do for Me? If you have a tight spot in your back that just will not go away or suffer from chronic pain or weakness, this is the treatment for you. Have you carried that knot around with you for years? Does the knot in your back seem to radiate pain down your arm? TPT will help break up that tissue and encourage the body to heal.

Trigger Point Therapy is a highly effective technique commonly used to alleviate chronic pain and dysfunction. It is a technique that can be used alone or integrated with other modalities in a session. A trigger point is a firm, palpable, highly irritable spot found in a tight band of muscle fibers that is generally characterized by extreme tenderness. Commonly referred to as “knots,” trigger points are worked by applying direct pressure, deep gliding pressure, and stretching the effected area.

 According to  Doctors Janet Travell and David Simons in their set of medical textbooks, Myofascial Pain and Dysfunction: The Trigger Point Manual Vol 1 & 2, myofascial trigger points are tiny contraction knots that  can develop in a muscle.  These are very small areas of normally low neurological activity within muscle fibers that have become irritated and locked into a contraction, becoming very highly irritable and which refer pain into another area. When this contraction persists, the blood flow is restricted in this fiber and it becomes ischemic. It is generally thought that this state is the result of an irregular amount of the neurotransmitter Acetylcholine being released from the nerve which stimulates that muscle. Trigger points often occur when the soft tissue is injured, overloaded, or strained.

When trigger points are present in muscles there is often pain and weakness in the associated structures.  But any paresthesia: itch, tingle, twitch, pain, etc. can be the result of trigger point activity. These pain patterns  are common and predictible and have been readily mapped to allow for identification of the causative sources. Many trigger points have pain patterns that overlap, and some create reciprocal cyclic relationships that need to be treated extensively to remove them. A skilled trigger point therapist can quickly trace the pain back to its source and deactivate those trigger points with specific pressure techniques.

 The misdiagnosis of pain is one of the most important issue taken up by Travell and Simons. Referred pain from trigger points often mimics the symptoms of other maladies and causes of discomfort. Travell and Simons suggest that most of the common everyday pain is in fact caused by myofascial trigger points and that ignoring this concept often leads to false diagnoses and the ultimate failure to deal effectively with pain.

The  Trigger Point Therapists at Nashville Neuromuscular Center always do a thorough assessment and listen to medical history including accidents and injuries to determine the likelihood of trigger points being the actual source of myofascial pain syndromes. We frequently refer to appropriate medical professionals to rule out any other more serious causes before just assuming that trigger point massage will be the cure-all for what ails you. 

Experienced Myofascial Trigger Point therapists use many techniques to deactivate the noxious points. Deep pressure  myotherapy or ischemic compression are most typical and usually combined with other deep tissue massage techniques to open the area and separate the musle fibers  to release the hold of the contracted trigger point.  Practitioners use elbows, thumbs or various tools to direct pressure directly upon the trigger point, and  a professional will understand the proper amount of pressure  and length of time necessary to get the best results. Trigger point Massage Therapy does not have to be painful.

 During or After the  trigger point massage, a qualified professional will incorporate specific stretching  techniques to invoke reciprocal inhibition within the musculoskeletal system. A successful treatment protocol relies on identifying  the trigger points, resolving them and, if all trigger points have been deactivated, elongating the structures affected along their natural range of motion and length. In the case of muscles, where most treatment occurs, this  stretching involves combinations of passive, active, active isolated stretching (AIS), muscle energy techniques (MET), and proprioceptive neuromuscular facilitation (PNF) stretching to be effective.  The fascia  surrounding muscles should also be treated, (myofascial release) to elongate and resolve strain patterns, otherwise muscles will simply be returned to positions where trigger points are likely to re-develop. Nashville Neuromuscular Center therapists are all certified and highly educated in the necessary techniques to perform safe and effective trigger point massage therapy.

The outcomes from  manual  trigger point massage therapy are directly related to the skill level of the massage therapist. If trigger points are pressed too short a time, they may activate or remain active; if pressed too long or hard, they may become irritated, resulting in  more pain in the area treated. Be sure you are in the hands of an experienced trigger point therapist.

For more information on Trigger Points and Trigger Point Therapy check out Claire Davies trigger point therapy workbook  - a fantastic reference and guide to helping yourself out of painful conditions.