Trigger Points

Excerpts from The Trigger Point Therapy Workbook by Clair Davies, NCTMB

"Trigger points are known to cause headaches, neck and jaw pain, low back pain, the symptoms of carpal tunnel syndrome, and many kinds of joint pain mistakenly ascribed to arthritis, tendinitis, bursitis, or ligament injury.  Trigger points cause problems as diverse as earaches, dizziness, nausea, heartburn, false heart pain, heart arrhythmia, tennis elbow, and genital pain.  Trigger points can also cause colic in babies and bed-wetting in older children, and may be a contributing cause of scoliosis.  They are a cause of sinus pain and congestion.  They may play a part in chronic fatigue and lowered resistance to infection.  And because trigger points can be responsible for long-term pain and disability that seem to have no means of relief, they can cause depression."

"I [Davies] found that, although the physiology of a trigger point was extremely complex, a trigger point for practical purposes could be viewed as what most people call a "knot": a wad of muscle fibers staying in a hard contraction, never relaxing.  A trigger point in a muscle could be actively painful or it could manifest no pain at all unless touched.  More often, though, it would sneakily send its pain somewhere else.  I gathered that much of my pain, perhaps all of it, was probably this mysterious displaced pain, this referred pain.  It was a mistake to assume the problem was at the place that hurt! 

"Janet Travell and David Simons describe a trigger point as simply a small contraction knot in muscle tissue.  It often feels like a partly cooked piece of macaroni, or like a pea buried deep in the muscle.  A trigger point affects a muscle by keeping it both tight and weak.  At the same time, a trigger point maintains a hard contraction on the muscle fibers that it is a part of.  In turn, these taut bands of muscle fiber keep constant tension on the muscle's attachments, often producing symptoms in adjacent joints.  The constant tension in the fibers of the trigger point itself restricts circulation in its immediate area.  The resulting accumulation of the by-products of metabolism, as well as deprivation of the oxygen and nutrients needed for metabolism, can perpetuate trigger points for months or even years unless some intervention occurs.  It's this self-sustaining vicious cycle that needs to be broken (Travell and Simons 1999, 71-75).

The difficulty in treating trigger points is that they typically send pain to some other site.  Most conventional treatment of pain is based on the assumption that the cause of pain will be found at the site of the pain.  But trigger points almost always send their pain elsewhere.  This referred pain is what has always thrown everybody off, including most doctors and much of the rest of the health-care community.  According to Travell and Simons, conventional treatments for pain so often fail because they focus on the pain itself, treating the site of the pain while overlooking and failing to treat the cause, which may be some distance away."

Trigger points can develop in any of the two hundred pairs of muscles in the body, which gives them a wide territory for creating mischief (1999, 13).  Trigger points can last as long as life and can even survive in muscle tissue after death, detectable until rigor mortis sets in (1999, 68). 

An underestimated trait of trigger points is that they can exist indefinitely in a latent state, in which they don't actively refer pain.  Travell and Simons believe that the long-term effects of latent trigger points may be of even greater concern than the pain caused by active ones.  They assert that latent trigger points tend to accumulate over a lifetime and appear to be the main cause for the stiff joints and restricted range of motion of old age.  In addition, the constant muscle tension imposed by latent trigger points tends to overstress muscle attachments even in younger people, which can result in irreversible damage to the joints and may be one of the causes of osteoarthritis.  You may not suspect that you have latent trigger points, but they're very easy to find.  They're exquisitely painful when pressed on.  Latent trigger points can be activated by very little stress or strain (1999, 12-21).

Not infrequently, people think that myofascial trigger points cause only pain in the face, teeth, and jaws, getting "fascial" mixed up with "facial."  Trigger points certainly can cause face pain, but myofascial pain can occur anywhere in the body.  The prefix "myo" in myofascial (MY-oh-FAH-shul) refers to muscle.  Fascia (FAH-shuh) is the thin, translucent membrane that envelopes and separates muscles like shrink-wrap.  (A good place to see fascia is on a chicken leg.)  When you have trigger points in a muscle, the fascia covering it typically gets tight and inflexible and becomes part of the problem. 

Luckily, in troubleshooting your own myofascial pain, the trigger point's exquisite tenderness to pressure always gives it away.  Trigger points always hurt when pressed on--there's never any question.

Pharmaceutical treatments only mask the pain.  The good  news is that trigger points can be surprisingly easy to fix on your own (and especially with the aid of a good massage therapist).  Additionally, referred pain is now known to occur in predictable patterns making it easy to determine which trigger points to work on.  In the upcoming weeks, I will be posting some common trigger point issues and how you can fix them  yourself, so be on the lookout for what might be causing your pain!!!

I will continue this series every Thursday:  Next Thurs I will continue sharing excerpts from Clair Davies' wonderful book on attachment trigger points, the mystery of referred pain, trigger point symptoms and self-massage techniques.  Subsequent weeks will be on some common situations starting with shoulders.

Even though I am posting excerpts from Mr. Davies' book The Trigger Point Therapy Workbook, I am by  no means able to post every important facet on this subject and highly recommend you purchasing this book for your own reference...it is that good!  Clair Davies' story is amazing as is his entire book.  I am very grateful to his dedication and revelation of this subject matter!!!