Trigger Point Therapy
Acute or chronic overload causes zones in our muscle fibres to change pathologically. Muscle dysfunction and muscle hardening develop, which can cause pain – often even in distant regions of the body. So-called myofascial trigger points are responsible for this. Through targeted trigger point therapy, these pathological changes in the muscles can be eliminated in the long term.
What are trigger points?
Trigger points are narrowly confined, highly sensitive spots within a tense band of muscle. They often feel like small knots and respond to pressure with radiating pain. A trigger point in the shoulder area, for example, can cause headaches or complaints in the arm – so the actual cause is often overlooked.
What happens during the treatment?
After a brief medical history, the affected trigger points are treated with targeted manual pressure. The combination of static pressure, ischaemic compression and gentle stretching brings the cramped muscle fibre to relax. Blood circulation improves, metabolic waste products are carried away and the pain subsides.
When is trigger point therapy useful?
Trigger point therapy is an effective method, especially for chronic complaints that could not be sufficiently relieved with classic massage. Targeted treatment is also worthwhile for work-related poor posture, sports injuries or unexplained radiating pain.
Myofascial trigger point therapy is an established manual treatment method for chronic pain and muscle tension. At my practice at Asylstrasse 77 in Zurich, I specifically treat one possible cause of many complaints – the myofascial trigger points – and not just the symptoms. Find out more here about the method, its areas of application and its scientific basis.
Myofascial trigger point therapy was founded about six decades ago by the American physicians and scientists David G. Simons and Janet Travell.
However, as early as around 1900, several researchers had already described changes in the muscles:
With these terms they described pressure-tender muscle changes and increased viscosity in the soft tissues.
David G. Simons and Janet Travell discovered that under stress, certain neuromuscular junctions between nerves and muscles can become dysfunctional, causing particular fibres in the muscle to cramp and shorten. These bands compress the blood and oxygen supply, which – as in a heart attack – leads to severe local pain. These sensitive spots in a tense band of muscle are known as trigger points. In the case of a severe disturbance, these trigger points produce constant pain; if the disturbance is milder, only movement and stretching of the muscle is painful.
In the spinal cord, the continuous bombardment of stimuli in the pain-conducting nervous system can cause certain pain-transmitting substances to spill over and activate other pain pathways. As a result, severe or chronic pain can eventually be felt in parts of the body that have nothing at all to do with the actual injury.
The muscle pain described occurs throughout the body. A considerable proportion of back pain has a muscular origin. Only in a smaller proportion of cases are joint inflammation, herniated discs or degenerative changes the cause.
The place where pain originates and the place where it is ultimately felt are often far apart – one reason why the muscular causes of pain are frequently overlooked. With shoulder pain, for example, often only part of the pain arises in the joint itself; usually it is only the surrounding muscles that are affected. The cause of tennis elbow is usually to be found in the forearm muscles, and headaches are frequently based on tense nape and neck muscles. Overuse-related muscle disorders are also found in practically all cases of knee and Achilles tendon pain in runners, which not infrequently originate in the calf.
As a rule, the longer a trigger point has been present, the more stubborn it is. Just as movement sequences, such as changing gears when driving, become automated over time and the corresponding nerve connections become entrenched, trigger points can build up fixed nerve connections.
Clinically, a myofascial trigger point (MTrP) is a highly localised, microscopically small zone in the skeletal muscle, located on a taut band, which reacts strongly to mechanical stimuli such as pressure and stretch.
The reaction to mechanical stimuli can be referred pain, or sensory disturbances as well as autonomic reactions may occur (dizziness, tinnitus, sweating, tearing, etc.).
According to current understanding, MTrPs arise from a „vicious circle“ in which a lack of ATP develops (ATP: adenosine triphosphate, the universal and immediately available energy carrier in cells and an important regulator of energy-supplying processes), together with hypoxia (insufficient oxygen supply to the tissue) and failure of the ion pumps. This is referred to as a local energy crisis, in which the muscle can no longer relax.
As a result, the contracted portion of the muscle remains in a stable „rigor complex“ (a stable bond, also called an „actomyosin cross-bridge“). This state also exists in rigor mortis, because the dead body lacks the mechanisms needed to release it. A rigor complex can only be released by a renewed supply of ATP, and a dead body can no longer produce ATP.
The state of total shortening ultimately shows itself on palpation as a small nodule: the myofascial trigger point.
Active myofascial trigger point
A point that causes the patient pain. It always reacts painfully to pressure, and the muscle is usually shortened. On direct compression of the point, it often triggers the patient’s referred pain. Sensorimotor or autonomic symptoms are not uncommon.
Latent myofascial trigger point
It can show all the clinical characteristics of an active trigger point. It is always accompanied by tension in a bundle of fibres. Clinically, however, it causes no complaints. Precise pressure can trigger symptoms similar to those of an active trigger point.
Primary myofascial trigger point
A central trigger point that arises from acute or chronic overload, or after injuries. It does not arise through the activation of another trigger point.
Secondary trigger point
This term used to refer to trigger points in synergists, neighbouring muscles and antagonists. Today, all of these fall under the term satellite trigger point.
Satellite trigger point
A trigger point that has arisen in the referred pain zone of a primary trigger point.
Therapeutic effects of myofascial trigger point therapy
According to current understanding, direct treatment of a myofascial trigger point can lead to increased blood filling in the affected part of the tissue or organ, also known as reactive hyperaemia. This is an accumulation of blood caused by pressure and irritation of a vessel segment. Nociceptive substances such as serotonin, prostaglandin and bradykinin are „squeezed out“ in the process. As a result of the intense pressure, cells can rupture and myoglobin can be released. The functional unit, the neuromuscular junction, is dissolved and the energy crisis can be ended. The shortened muscle can regain its functional length through connective tissue techniques and stretching of the surrounding connective tissue and fasciae. The intramuscular spaces are widened – mobility and neural mobility can improve.
