Trigger Points
Those of you who suffer with them, know all too well that at the best, Chronic Trigger Points can be terribly annoying. At their worst, they can be nearly debilitating. But what exactly is a “Trigger Point”? The term “Trigger Point” was coined by Dr. Janet Travell in 1942. Dr. Travell is considered the foremost expert on Trigger Points, and went on to co-author a ground-breaking book with David Simmons called Myofascial Pain and Dysfuntion: The Trigger Point Manual. She also happened to be JFK’s personal physician while he was president. A Trigger Point is a nodule (a “lump”) of hypersensitive muscle. It is essentially a hard, marble-sized ball of muscle that causes pain. Although no one knows for sure, there are all sorts of theories floating around about Trigger Points, what causes them, fool-proof methods of treatment, etc. I am not going to delve into these, as there are numerous websites devoted solely to this topic. If you suffer from Trigger Points, you have probably already been on some of them. Trigger Points are small bundles of muscle fibers in the various muscles of the body. For reasons that are not fully understood, these bundles get “facilitated” (turned on), and sometimes it seems like there is nothing that will shut them off. It is known that these Trigger Points have an intimate relationship to fascia (HERE). Drs. Travell and Simmons definition / explanation of Trigger Points is as follows:
- Pain related to a specific, irritable, marble-sized point in skeletal muscle or fascia that is NOT caused by acute localized trauma, inflammation, degeneration, abnormal growths (malignant or non-malignant), or infection.
- The painful point can be felt as a nodule or band in the muscle, and a twitch response can sometimes be elicited on stimulation of the trigger point.
- Manual Palpation (pressing or squishing) of the Trigger Point reproduces the patient’s complaint of pain, and the pain radiates in a very specific distribution (referral) pattern that is typical of the specific muscle where the Trigger Point is found.
- The pain cannot be explained by findings of Orthopedic or Neurological Examination or MRI.
If you notice the third point, it says that Trigger Points in specific muscles have “very specific” pattern of referral. Here is the best free TRIGGER POINT REFERRAL & PAIN GUIDE that I have yet to find on the web. What we quickly learn via experience and scientific research on the subject is that although we can readily find these trigger points via palpation, no one really knows what causes them or how to fix them (even though there are about a million websites that promote various practitioner’s ability to do so).
Effectively Treating Patients Who Live With Trigger Points
The Medical Community is truly at a loss as far as long term treatment of Trigger Points is concerned. If you are one of those who suffers from Trigger Points, you are well aware of this fact. I know this not only because of over two decades of being in practice, but because I have a brother (an ER doctor) who has dealt with chronic Trigger Points for years.
The things that are usually tried first for Trigger Points include therapy (STRETCHING), electric stimulation, ultrasound, vibration therapy, and stretching. These might help people with minor Trigger Points, but rarely make any sort of long term difference. The next step is usually drug based. Injections of novocaine-like substances directly into the Trigger Point, or the usual pain relievers, anti-inflammation drugs (CORTICOSTEROID / NSAID), or MUSCLE RELAXERS. These help for the short term, but the results never last. Interestingly enough, injecting plain saline solution into the Trigger Point seems to get as good of a result as injecting various medications. Some doctors are using a technique called “Dry Needling” that they claim works just as well or better (Neurologist CHAN GUNN is said to be the father of this technique). This is simply sticking a needle into the Trigger Point — sometimes repeatedly (has anyone here ever heard of acupuncture?). By the way, acupuncture is a viable treatment for Trigger Points, as several studies show that Trigger Points are related to acupuncture points.
The most effective self-treatment option that I have found is to use a device like a “Thera-Cane” or “Back Buddy” (or any one of the numerous similar knock-offs on the market). These allow a person to ‘mash’ or ‘squash’ their own trigger points, which seems to be one of the best treatment options available (this is essentially what massage therapists do — use a thumb or “knobber” to hold pressure on the Trigger Point). Because Trigger Points are intimately related to the Fascia, most people who have Chronic Trigger Points tend to have FASCIAL AHDHESIONS. When I couple SCAR TISSUE REMODELING THERAPY with COLD LASER THERAPY for people who are dealing with Trigger Points in their Trapezius or shoulder muscle (by far the most common place that people get Trigger Points) I tend to see pretty good results — particularly when I add a DAKOTA TRACTION device to help release the SCM, and other musculature of the anterior neck. HERE is another article I wrote on the subject.
Although originally maligned by the Medical Community, Laser Therapy has become fairly mainstream for treating people living with Trigger Points (HERE). In late 2010, I broke down and bought a cold laser to use on my hands due to the beating taken by two plus decades of adjusting patients. The laser made a big difference (that would be big as in “BIG”) in just three days.
