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About Trigger Points
TRIGGER POINT FEATURES.
PAINFUL AND DECEPTIVE, BUT RELATIVELY EASY TO TREAT. This special condition of muscle tissue causes a great number of people a great deal of pain. Unfortunately trigger points remain unnoticed unless the examiner is aware and specifically looking for them. They deceive in part because they are hidden from easy observation. (Machines in a typical doctor's office can't detect them.) They also deceive because the pain they cause is most often felt at another location. Pain perceived at a distance from its actual source is known as "referred pain". But once trigger points are located (usually through range of motion testing and palpation) they are amenable to treatment through relatively simple procedures, such as manual pressure, specialized stretch techniques, acupuncture-style needling, and injection.
PAIN REFERRAL. 85% of trigger points refer pain to another location in the body. Each trigger point produces a characteristic pattern of referred pain, that is, a pattern generally unlike one produced by trigger points in other muscles, or even trigger points in other fibers in the same muscle. Accordingly, knowledge of muscles' typical pain referral patterns helps greatly in determining which muscle, and sometimes even which part of a muscle, is involved.
RESTRICTION OF MOTION AND POSTURE. Beside creating referred pain, the other key action of trigger points is to restrict the length to which the affected muscle can extend. This means that the motion of that part of the body becomes restricted or "stiff". Thus a trigger point in the left levator scapula muscle can prevent the neck from turning very far to the right. In severe cases the neck becomes immobilized. Trigger points in certain fibers of the gluteus maximus muscle can prevent the individual from bending over very far at the hip, and, in addition to causing hip pain, may cause a distortion of posture in which the hip becomes rotated backward. Any part of the body can stiffen and lose its mobility because of trigger points.
OTHER SYMPTOMS. Sometimes trigger points causes paresthesia (numbness, tingling or a burning sensation). Certain trigger points can cause dizziness and unsteadiness rather than pain, which is especially detrimental to the elderly.
CONFIRMING SIGNS. Direct pressure on a trigger point often recreates pain that the subject identifies as 'their pain'. This reaction confirms the relevance of that point. Manual plucking of the taut band of muscle in which the trigger point lies often produces a local twitch response, which provides another useful confirmation.
KEY AND SATELLITE TRIGGER POINTS. Trigger points can influence each other and have dependency relationships. In other words they are sometimes arranged in hierarchies in which some, which are called "key" trigger points, cause or perpetuate others, which are called "satellite" trigger points. In this situation the clinical picture is more complex. Sometimes, for example, disabling a key trigger point will simultaneously disable dependent satellite trigger points that have been causing additional pain according to their own referral patterns. On the other hand, treating only a satellite trigger point may bring no lasting relief as long as an undiscovered key trigger point in some other muscle keeps reactivating it.
TRIGGER POINTS ARE NOT IMAGINARY. The reality of trigger points is evident to anyone who has had pain quickly relieved by a simple trigger point treatment. For skeptics -- which means most people who've never had such treatment -- the reality of trigger points has been demonstrated by sensitive instruments that can photograph the abnormal structure of the muscle at the trigger point, and instruments capable of measuring their unusual biochemical and micro-electrical signatures. For example, Travell and Simons (1999: 69) provide a microscopic photograph of a trigger point from dog muscle that clearly shows the sarcomeres all bunched up at that point. In another example, Jay Shah, working with colleagues at the National Institutes of Health, developed a technique using tiny pipettes by which he was able to get tissue samples from trigger points in living people and compare them to those from normal muscle tissue in the same people. The trigger points samples showed lower PH and significantly greater concentrations of several biochemicals important in the chemistry of pain, namely substance P, bradykinin, serotonin, norepinephrine, tumor necrosis factor, interleukin-1ß and calcitonin gene-related peptide (Shah et.al. 2003).
In sum, both microscopic photographs and biochemical assays have documented the unusual structure and chemical makeup of the trigger point as compared to normal muscle tissue. People who may have been told for years that their pain was just "in their head" (psychosomatic) now have rigorous evidence that trigger points exist.
This page is part of a larger website intended to educate people about trigger point bodywork and other methods of non-invasive, drug-free pain relief. Myofascial therapy was developed by physicians in the last few decades. Its primary purpose is to eliminate myofascial pain, but it also improves movement and posture.
I offer myofascial treatment and other pain management services in the Millburn, Livingston, Bloomfield and Cedar Grove area of northern NJ. If you live in a town such as Glen Ridge, Clifton, Little Falls, or Fairfield, NJ I would still be the closest certified therapist. Maplewood, Livingston, Roseland and Totowa also fall into this category, as do Mountain View, Preakness, West and South Orange, NJ and much of the rest of New Jersey. Verona, Essex Fells and Montclair and Caldwell NJ of course are in the immediate vicinity. If you live elsewhere you may be able to find a practitioner nearby.
Copyright 2007 Joseph Hoane