I have just found the concept of Trigger Point Therapy. Could you explain the concept and the practical use for this on a client? Also, could you give an example of this with any muscle that would need this kind of treatment?
Congratulations on asking a great question. There is much literature on myofascial trigger point therapy and how it affects the body. Many health professionals use trigger point therapy in helping the body correct/release problems or dysfunctions that may be present. Physical therapists, osteopathic physicians, chiropractors and massage therapists are just some of the health professionals qualified to practice this technique.
What is a Trigger Point?
Researchers Travell and Simons in 1986 concluded that myofascial trigger points had been recognized as a primary cause of pain, dysfunction and distress of the sympathetic nervous system. Researchers Melzack & Wall (1988) in their pain research found that there are few chronic pain problems where myofascial trigger point activity is not a key feature maintaining or causing chronic pain.
A trigger point is a localized area of somatic dysfunction, which behaves in a facilitated manner (i.e., it will amplify and be affected by any form of stress imposed on the individual whether this is physical, chemical or emotional) (Korr 1976). This localized area, when palpated either by digit, elbow or other tool of trigger pointing, will cause pain or other symptoms through referral. Muscles housing trigger points can frequently be identified as being unable to achieve their normal resting length using standard muscle evaluation procedures (Janda 1983). The trigger point itself always lies in hypertonic tissue and not uncommonly in fibrotic tissue, which has evolved as the result of exposure of the tissues to diverse forms of stress.
In short, “trigger points” are characterized by the existence of a small hypersensitive area, commonly known also as a “region” connecting with a related “target” or “reference” area of pain. The trigger point is described as a small circumscribed hypersensitive area in muscle or in connective tissue from which impulses arise and produce referred pain. The referred pain can be described as dull and aching in character and varies from mild discomfort to severe disabling distress.
There appears to be numerous causes for the production and maintenance of myofascial triggers including:
- Postural imbalances (Barlow 1959, Goldthwaite 1949)
- Congenital factors-warping of fascia via cranial distortions (Upledger 1983)
- Emotional stress reflecting on soft tissue (Latey 1986)
- Occupational & leisure overuse patterns (Rolf 1977)
Typical Treatment Methods
There are various successful methods of treatment that have been recorded over the years ranging from:
- Ischemic compression (deep pressure methods, Simons 1989)
- Acupuncture and/or ultrasound (Kleyhans & Aarons 1974)
- Chilling and stretching the muscle where the trigger lies (Travell & Simons 1986)
- Active or passive stretching (Lewit 1992)
- Surgical excision (Dittrich 1954)
After applying pressure to the trigger point and sensing the release through either touch, movement assessment or feedback from the client, some form of active or passive stretching will encourage the muscle housing the trigger point to return to its original resting length.
Some of the major problems trainers have with myofascial trigger point therapy are:
- They are not qualified to perform MTP-myofascial trigger point.
- If qualified, locating the area is difficult due to poor feel in the hands or limited knowledge on functional anatomy.
- They have limited knowledge on assessing the body as a unit in functional movement (i.e., must understand the effect the foot has on the shoulder).
If you are not qualified, there are three easy options:
- Enroll into a reputable diploma massage course that enables you learn about and perform MTP. You will find a reputable course through PTontheNET.com or through your local fitness association. Word of mouth is the best way to find it.
- Further your knowledge on functional anatomy. There are some great courses on function on PTontheNET.com by the best in the business: Gary Gray, Chuck Wolf, Michol Dalcourt, etc. Understanding that the body works in all three planes of motion and not training the body that way may in fact be causing dysfunction. This will lead to trigger points due to muscle imbalance causing joint dysfunction (i.e., muscles are short/overactive iliopsoas/hip flexor complex and muscles that are lengthened hamstrings/glutes).
- Use a foam roller to trigger point your clients. This is a far less invasive way to find the trigger points, plus the clients find them themselves. I would suggest you complete a course titled Foam Roller Flexibility - Self Myofascial Release on PTontheNET.com first. This will explain everything you need to know about how to use it and how to get the best results for your client. It also answers the questions the clients are bound to ask.
Application of Trigger Point Release
If you search the Pre-Made Program Library on the site, there are programs already designed for clients with “anterior tilt/lower cross syndrome” and “upper cross syndrome” as well as various other problems. Click on either of these particular programs, and you will see a foam roller is used as part of the correctional process in conjunction with stretching and correctional exercises.
- Barlow W 1983, Anxiety and muscle tension pain. British Journal of Medical Practice. 13:5
- Dittrich R 1954, Somatic pain and autonomic concomitants. American Journal of Surgery
- Goldthwaite J 1949, Essentials of boy mechanics. Lippincott, Philadelphia
- Janda V 1985, Pain in the Locomotor System. In Glasgow E (ed) Aspects of manipulative therapy. Churchill Livingstone, London
- Janda V 1983, Muscle Function testing. Butterworths, London
- Kleyhans, Aarons 1974, Digest of Chiropractic Economics
- Korr I 1976, Spinal cord as organiser of the disease process. Yr book of the Academy of Applied Osteopathy, Newark, Ohio
- Latey P, 1986 Muscular manifesto. Latey, London
- Lewit K 1992, Manipulation in rehabilitation of the locomotor system. Butterworths, London.
- Melzack R, Wall P 1988, The challenge of pain. Penguin, New York
- Rolf I 1977, The integration of human structures. Harper and Row, New York
- Simons D 1989, Myofascial pain syndromes. Current therapy of pain. pp251-266, BC Decker
- Simons D, Travell J 1998, Trigger point manual, 2nd edn. Williams and Wilkins, Baltimore
- Travell J, Simons D 1986, Trigger point manual, 1st edn. Williams and Wilkins, Baltimore
- Upledger J 1983 Craniosacral therapy. Eastland Press, Seattle