Trigger point therapy
Could myofascial trigger points be causing my back and neck pain?
Yes, it is certainly possible. From my experience if you have a constant or frequently recurring neck or back problem there is a good chance it is either the primary reason for your pain or a strong secondary reason that at least contributes to it. If so, your pain will be reduced by a greater or lesser degree when your receive trigger point therapy depended on how active, how many and how deep the trigger points are located.
Simply because many neck and back pain problems appear to be obvious and direct, they can be misdiagnosed even by experts. In many cases the cause of chronic and recurrent skeletal pain is due to trigger points, an extremely common soft tissue problem that often goes undetected. In fact, there is a good chance you have two or more different problems going on right now in your body that are causing your chronic pain and you do not know about the trigger point problem that is most responsible for the pain that bothers you so badly.
A more complete name used to describe this problem is a myofascial trigger point. The word myofascial is made from two root words, myo or muscle, and fascia which is the thin soft tissue membrane that is wrapped around muscles, tendons, ligament and joints.
It is possible your stubborn muscle and joint pain is due to one nodule or a group of them, that you can eliminate yourself with trigger point therapy over a relatively short period of time. As you will see, it is not difficult to find and effectively work on trigger points, and this discussion will be all you need to get started doing good trigger point therapy work.
What is a trigger point?
Trigger points are small, well-defined, hyperirritable nodules or lumps spots located in a taut band of skeletal muscle, and often occur with or as the result of other chronic musculoskeletal disorders. They not only produce pain when pressed in the local area where they are found locally, but also refer or relay pain to another distant point.
Trigger points are an extremely common cause of both acute and chronic pain, near joints and throughout the length of small and large muscles of the neck, low back, and elsewhere. What is special about trigger points is that they are painful when pressed on, and cause involuntary and spontaneous shortening of the muscle fibers in which they are located, and are able to create pain in another area of the body – called referred pain. Referred pain means that a trigger point in one muscle or one area when stimulated by simple pressure can create pain in another area. For example, when a trigger point in a heavy low back is deeply pressed upon it will refer pain down into the buttock or upper thigh, or if the thick muscle where the base of the neck and shoulder meet (trapezius) has a trigger point it can refer pain up into the neck or base of the skull resulting in an immediate dull headache.
Trigger points can develop as a secondary consequence to primary conditions that also cause pain by themselves, such as a disc herniation, spinal misalignment or osteoarthritis. In these cases a trigger point can develop because of the stress and irritation that the primary problem causes, and in this way a second problem results that is also a source of pain. Even when the disc herniation, spinal misalignment or osteoarthritis is not actively causing pain, the trigger point can be mimicking the pain. In these cases using pain medication for the primary problem will not reduce the pain successfully because the secondary trigger point does not responds to pain killers and the pain will continue.
Unfortunately, the majority of patients seeking relief from skeletal pain still receive the standard medical treatment approach of anti-inflammatory and muscle relaxant medications, or anti-depression drugs, or a physical therapy program of muscle strengthening exercises that have absolutely no affect on trigger points, and could aggravate them further.
How do I find a trigger point?
Study the accompanying chart to get a general idea where trigger points can be located in the area of your chief complain, whether it is in the neck, arm, low back, buttock or leg.
Use the flat broad pad of your thumb to deeply probe into the muscles around your problem area. You are looking for painful nodules or cords of tissue within the muscles belly or near a joint. The pain that you will feel when you find a trigger point will be out of proportion to the pressure you are applying at the time; you will feel more soreness and sharp discomfort than you would expect based on the amount of pressure you are using to examine the tissue. You will notice that the pressure that you use if moved just a fraction of an inch away will not hurt at all, yet if you reapply that same pressure back onto the trigger point it will hurt once again. This will prove to you that it is not the pressure that is causing the pain, but that you have found an abnormal area that is sensitive to the pressure.
The trigger point will feel very well defined and discreet, almost like it was a BB or bean in the tissue. You will notice that if you press it from side to side it will move a bit; it will be a mass within the tissue that if you press down deep enough you will be able to pinch between the thumb and index finger and hold onto.
The pain and discomfort will be sharp and have a tendency to make you want to jump when you run into the trigger point. You will also notice that once you have located the trigger point you will have a natural inclination to not be too abusive or rough with it. There is something about an active trigger point that makes you not want to aggravate it; it is part of the nature of the problem than you want to not stir it up.
Lastly, you will want to take note if you can feel a radiation of pain from the trigger point to another part of your body, either a few inches away or at a greater distance in another part of the body. This is called referred pain, and it is often sharp and well localized but it can also be of a dull and difficult to define nature also. The referred pain will usually last for as long as you apply sufficient pressure to the trigger point , or just a short while longer, but it will not continue for very long after the trigger point pressure is abandoned; you do not have to worry that you will start a new kind of painful problem by pressing this way.
How should I do trigger point massage treatment?
How to do self trigger point massage
Most often with persistence and time you will be able to eliminate or at least reduce your trigger points – assuming you can get to them. Even when the triggers are out of easy reach, with a little bit of ingenuity you can use simple tools and objects to apply pressure to your trigger points to treat them well enough to help yourself.
Here is a great suggestion for using trigger point therapy: First, try doing it yourself, and then if you cannot make the desired changes happen you can then go to a professional to have the triggers worked on by someone else. Besides saving money by doing this simple work yourself, you will save a lot of time. You can always have the more difficult to reach areas treated at a chiropractor’s, massage therapist’s, or acupuncturist’s office when you have gone as far as you can.
To treat the offending trigger points:
- Study the trigger point you see here for general information where trigger points are probably located in relation to primary pain area.
- Your goal is to find any small firm nodule that can be the size of a mustard seed (very small) to larger than an almond. It will be more tender feeling than you would expect based on the amount of pressure you use to locate it, and the pain will have a peculiar ability to be so intense and sharp that it makes your muscles jump as though you were trying to get away from it. Lastly, the trigger point will often refer or radiate pain away from the local area to another area a small or large distance away.
- Apply deep firm pressure with the flat area of your thumb in the area where you suspect the triggers are located.
- Slowly follow a pattern in this search area while you look for the painful and nodular trigger points. Overlap as you look so you do not miss anything.
- Rather than just pressing straight down with the thumb when it has been pressed deep into the tissue, move your thumb around in a small circle to look for the painful nodules.
- Usually when a trigger point has been identified it is not necessary to use as much force to massage and press on it. Most of the time the deep pressure that is used to find the trigger and excite the pain response that tells you have found it, is not needed to reduce the trigger point. Once you are on a trigger point you can back off or reduce the pressure perhaps by half.
- The correct amount of force is the force needed to feel a slight but comfortable level of discomfort – many people say “it hurts good.” You do not want to use so much aggressive probing and heavy pushing that there is great discomfort. Not only is this not necessary, but it does not work as well as a lighter and more comfortable amount of pressing.
- Using this lighter force apply a small circular motion on and around and up/down the trigger as though you were trying to lightly milk it, massage it, or iron it out. You usually do not have to use so much force that you create a lot of pain – because you could – but it is not necessary if you learn how to gently coax and massage the nodule so that it slowly starts to fade away. Within a minute or less you should begin to feel as though the trigger point is melting away, and that it is getting smaller and more difficult to localize.
- If you have multiple trigger points you could have so much work to do and so many points to massage that your thumb will get sore and you will have to stop before your triggers are gone. If this happens you will want to use some type of handy tool that you probably have at home for this purpose. Some ideas for effective trigger point massage tools:
- You r knuckle of a sharply bent finger or thumb
- Your sharply bent elbow
- Eraser end of a pencil
- Rounded end of a fork or spoon handle
- Rounded end of a steak knife
- End of a lipstick or lip balm container
10. Gently massage each trigger for no more than 60-90 seconds at a time. During this time you can expect the trigger to soften a bit, or maybe a lot. Then stop. If you over work the trigger you will be surprised at how sore and bruised feeling it can become to such brief and light pressure. This happens because this is not usual muscle and connective tissue; it is abnormal tissue; it is a trigger point and it will feel and react differently than if you applied the very same pressure in the same circular pattern for the same time to a normal area of tissue.
11. Plan on working this area again in 24-48 hours in the same way for the same time.
12. Keep on doing this until the area no longer has any trigger point formations and you are feeling better
If you are unsuccessful or you cannot find the triggers, I strongly suggest that you seek out a chiropractor or massage therapist you have confidence in and have this trigger point massage done professional for maximum results.