Trigger Point Therapy - When to seek treatment
It all started with the American physician Dr Janet Travell who, during her career, discovered trigger point work and used it to treat musculoskeletal pain. Dr. Travell captured each muscle with their respective Trigger Point pain pattern, giving us an amazing tool for the treatment of musculoskeletal pain. Travell and Simons’ Myofascial Pain and Dysfunction: The Trigger Point Manual
But what is exactly a Trigger Point and what are Trigger Point pain patterns?
A Trigger Point also commonly known as “knot”, is a hyperirritable spot within a taut band of a muscle. Muscle contraction results from an interaction between the actin and myosin filaments that generates their movement relative to one another. A Trigger Point develops when these filaments get stuck in contraction and are unable to return to their relaxed state.
Steady pressure applied over the Trigger Point over a short period of time (usually enough between 8-12 seconds) has shown to effective release them, allowing the filaments in that particular point back to their relaxed position and releasing simultaneously the pain and other symptoms associated with that Trigger Point.
Trigger Points can be latent or active. Latent Trigger Points are not causing active pain and noticeable symptoms like active Trigger Points do.
Trigger Points can also produce pain and symptoms locally where they are located or refer pain and symptoms in a predicted pattern into another area. These is what we refer to as Trigger Point pain pattern (see picture).
Dr Travell captured each muscle’s Trigger Points pain patterns. Having this knowledge available allows the therapist to identify the pain pattern and link it to the Trigger Point of origin. The therapist can then move to the next step, release the Trigger Point to release the pain and other symptoms associated with it.
Trigger Point therapy is therefore a treatment method focused on the release of Trigger Points, myofascial pain and other related symptoms, in our case through steady pressure over a period of time.
Trigger Point therapy is indicated for the treatment of musculoskeletal pain, clinical presentations, radiating pain, limited range of motion and injury rehabilitation.
What’s the biopsychosocial model and why is it more effective using Trigger Point work having this model at the core of the treatment?
Today we know through research (1*) that pain response and its intensity is a result of at least these 3 combined factors, biological, psychological and social. This discards as effective any systematic treatment method that doesn’t have into consideration the previous 3 elements.
A hypersensitised system will trigger a higher pain response. It’s therefore important addressing the whole system and increasing the activity of the parasympathetic nervous system during a massage session.
A therapist that understands this concept and its importance when dealing with musculoskeletal pain will get faster and better results
Why does the NO PAIN NO GAIN not apply?
Our muscles and fascia behave similar to slime. If you have kids you probably know what I mean. If you try to get through slime, slow steady pressure will get you deeper sooner than fast and rough force, when approached in this last way the slime adopts a solid form behaving like a wall. Something similar happens to our soft tissue, making slow and steady sinking through the tissue the most effective way to accessing deeper layers and releasing main restrictions and Trigger Points.
On another note, when pushing and forcing against the tension of the tissue, it reacts by contracting to protect itself and the area against potential damage. It makes sense. This is the reason why NO PAIN NO GAIN doesn’t apply here. Sinking with a slow and steady pressure and with a “listening” touch allows the tissue to open up and release tension in an effective way.
The rule of no absolute rule
Like in most case scenarios, the answer is probably an approach with different methods of treatment combined together.
Imagine superheroes. Spiderman, Ironman, Superman and Hulk combining their powers to create a new character. In body work we can actually do this to increase the effectiveness of the treatment. There is no treatment method that has all the answers exclusively, so a combination is our way to deal with pain. We call this treatment method “Clinical massage” and it includes techniques like Myofascial release, trigger point work, different forms of stretching (like STR or PNF) and sports massage between others.
References:
- The biopsychosocial model of the assessment, prevention, and treatment of chronic pain. K Bevers, L Watts, ND Kishino, et al. – US Neurol, 2016