What is a Trigger Point (TP)?

Simply put, it is a type of muscle spasm. Approximately 60% of our body is muscle. Nothing in the body moves without muscle work. The heart is a muscle. The food in our intestinal tract moves because of muscles. We breathe because of muscles. Each of the hundreds of muscles, large and small, is made up of microscopic muscle cells. For any muscle to work the microscopic cells must work together.

A Trigger Point (TP) is a small nodule or knot in a muscle which is in constant uncontrolled contraction or spasm. It can be classified as active and be extremely tender and painful or latent (inactive) and cause tightness in the muscles but not cause pain. Both are basically the same but only different in perceived pain at rest. (Return to top)

What's the difference between a cramp and a muscle spasm?

A cramp and a muscle spasm are the same thing but different in intensity. We think of a muscle cramp as something in our leg or arm but it can happen in any muscle anywhere in the body. Also, the entire muscle can cramp up or just a small clump of muscle cells can go into a spasm and form a small knot within the muscle itself. These don't hurt like a full cramp does. They just feel a little tight or stiff. But when these knots (trigger points) are worked they flare up and can cause severe pain. Even a little activity can cause them to flare up.(Return to top)

So, it's just a muscle spasm. Right?

Yes - and - No. Very often these muscles with TPs have nerves passing through them or surround other body structures. If they tighten around a nerve bundle the results can mimic Sciatica or Carpal Tunnel Syndrome. If they surround the intestine they can cause blockage and mimic Spastic Colon (Irritable Bowel Syndrome) and even be a cause of TMJ (jaw) pain. They will often cause the headaches and backaches we experience.(Return to top)

Can't I take a muscle relaxant for cramps or trigger points?

Sometimes a muscle is tight and you feel stiff but actual trigger points haven't developed yet. A true trigger point is an involuntary contraction of a group of muscle cells. So is a cramp in the leg. When it's a true spasm a muscle relaxant would have to be so strong that it forces all muscles in involuntary contraction to stop contracting. This includes the heart muscle which isn't healthy to stop. For those cases where there are true spasms specialized physical therapy must be done to the specific spasm or cramp. A wide full body approach doesn't work.(Return to top)

How common are Trigger Points?

VERY common! Most people will have them at some time or another. Rest, a little massage, heat and stretching often take care of them. When tightness, stiffness and occasional pain persist beyond a few weeks, even without excessive muscle work, it's best to have specific therapy done for the TPs before they set in and become chronic.(Return to top)

What happens when Trigger Points become chronic?

Your body is always healing, adapting and changing based on it's activity, stresses and irritations. A low grade irritation may not hurt but it will change the body. In muscles TPs will begin to form a type of scar tissue within it to tighten and prevent the muscle cells from becoming irritated through work, stretch or activity. This fibrous tissue triggers the pain much sooner to prevent damage to an injured area. However, the damage has healed and no longer is a problem but the body doesn't recognize that and continues to act as if it was still over stressed or injured. This creates a cycle of TPs causing pain leading to more TPs.(Return to top)

What are some of the symptoms of Trigger Points?

This is where it gets interesting. Because trigger points can be found anywhere and be a part of may other conditions they often are associated with but forgotten as part of a diagnosis. Yet, due to their ability to affect nerves passing through or near them they can cause a wide diversity of symptoms. It's rare to have a single person having all these but it is possible. Generally these symptoms are part of a bigger picture that the doctor should analyze.

Stiffness	Poor balance	Goose bumps	Vertigo	Depression
Generalized pain	Staggering gait	Running nose	Pleurisy	Constipation
Localized pain	Urinary frequency	Buckling knees	Nausea	Diarrhea
Localized sweating	Illegible hand writing	Muscle tightness	Tinnitus	Numbness
Dizziness	Blanching of the skin	Weak ankles	Fatigue	Headaches
Cold sensation	Disturbed sleep	Paresthesia	Muscle ramps	Ptosis
Copious salivation	Perceived but not real swelling	Weakness	Chest Pain (like HA) but no HA

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How long does it take to cure Trigger Points?

Gradually, over many months and sometimes years the problem gets worse than a person can ignore and they seek treatment. At that time people will sometimes say it's only been a few months but there is no accident date to pinpoint. A good exam will learn that the problem started a long time sooner and has just gotten worse in the last few months. Just like anything in the body, it takes time to heal. How long depends on how widespread the problem area is, how severe it is, how a person responds to therapy and what a patient does to get well or continue irritating a condition. Generally, it takes from 4 to 10 weeks to recover from TPs to the point where they are gone.(Return to top)

So, just work on the painful areas. Right?

No. As you can see from the drawing of the trapezius muscle it covers a very large area and only makes up one of the many muscles in the neck. Headaches commonly are caused by TPs in the entire region. If you only treat where the pain focus is you'll miss most of the TPs and allow them to keep on going for more pain soon. TPs can be in any area of the muscle or in muscles very close to the pain area. They all must be found and treated.(Return to top)

What types of therapies help Trigger Points?

The most effective therapy is direct manual trigger point therapy. This works on the specific knots or TPs. It's somewhat painful but almost all patients find it acceptable and well worth the few minutes of discomfort. Other therapies like diathermy, electrical muscle stimulation, ultrasound and massage are beneficial and helpful. Mobilization, stretching, adjustments or manipulation are often a part of the therapy because tight muscles tighten joints which need to be returned to flexibility.(Return to top)

How will I know when I'm well?

Most people feel noticeably better after the first treatment. The steps to wellness go from constant pain to occasional pain to discomfort and tightness to feeling OK to final wellness. We all know when we have pain but the best way to know when you're well is when the TPs are gone. Muscles with TPs have usually created tight fibers within them which are difficult to break up. In addition, research has found that muscles have a form of memory which maintains their condition over an extended time. As the TPs become chronic it becomes more difficult to eliminate them. That's what takes the 4 to 10 weeks. Most people feel much better and almost no pain after 3 to 7 weeks but it's the last few weeks that gets rid of the final TPs. Once the TPs are gone, look or test for them again once or twice over the next several weeks to monitor to make sure they are really gone for good.(Return to top)

Will Trigger Points come back?

No - and - Yes. Most people can finally be rid of their long term pain. However, just as a person can have a sprained ankle one time and sprain the same ankle several years later the pain is in the same are but it's a different injury. The important thing is to recognize it and take care of it next time before it gets bad. Several times I've had patients that were in an accident come in the same day while other people in the same accident didn't. By beginning treatment before the muscles develop TPs they were pain free and released within a few weeks while the other people still suffered for months following the accident.(Return to top)

Can anyone do Trigger Point therapy?

Yes, with some specific training. We often teach a patient's family or friend how to help them at home for faster recovery. Some TPs you can even do on yourself. The initial requirement is that the patient has to become knowledgeable in where, how, how hard or soft and when to stop the therapy. The two greatest problems with self treatment are 1.) Stopping when the pain is almost gone but not continuing over a long enough time to get rid of the trigger points, and 2.) Trying to get rid of them too fast by doing it too often or too hard or for too long on each trigger point during a therapy session.(Return to top)

Can Trigger Point therapy be dangerous?

It would be a rare occurrence. The patient is the one that should control the pressure at a tolerable level of pain or discomfort. This will be far short of possible damage. Two possibilities are 1.) The point being pressed upon is not a trigger point but something else. Make sure you understand how to find TPs, and 2.) A person with extremely fragile skin, that bruises with the slightest bump, may see bruising at the TP. Because the pressure is not enough to bruise a normal skin, if this occurs talk to your doctor about this.(Return to top)

Trigger Point Information