Working Trigger Points

Whether trigger points even exist is still a matter of some controversy. Proponents on both sides will argue and reach no definite conclusion. To explore working them, will require a slight detour into some simple muscle physiology.

Muscles work when a set of protein molecules composing them ‘overlap’ by being electro-chemically stimulated. These long chains slide past one another and the accumulated effect is a muscle contraction. Essential to the process are two things: nerve stimulation and minerals, particularly calcium (Ca).

The theory of trigger points involves the specific accumulation of Ca at certain points and the way nerve and muscle tissue react as a result. While still under investigation, the theory isn’t just wild speculation. One chief researcher was the official physician to President John F. Kennedy, known to have severe back pain. Trigger point therapy was regarded, at least by him and the doctor, as effective in his case.

Finding a trigger point, a small area where the muscles are in this particular condition, is a matter of careful examination. Many believe that taut bands of muscles are an indicator and a hard nodule (a central locus or area) can be felt. One difficulty is that trigger points can often refer pain.

To ‘refer pain’ means to stimulate one area where damage may actually be present but have it felt elsewhere. Naturally that makes finding the actual trouble spot tricky. One way is to run a finger perpendicular to the muscle direction, then look for a twitch response. Pressing the muscle at the point that causes it to contract is thought to be a way of locating the trigger point.

Others have reported an increase in heat in the area near the trigger point. If there’s higher chemical activity in an area of pain, this might be valid. Pain is often accompanied by inflammation, which can produce a small amount of heat.

Though the theory has its skeptics (which is healthy), and isn’t taught in medical schools, studies suggest there’s more to it than just wishful thinking. Once trained, therapists can regularly locate trigger points in independent trials. That suggests there is a factual basis that each is identifying.

The neurophysiology of muscular pain is still a hot area of research. But there are serious studies that tend to locate trigger points at the juncture of small, overstimulated muscle spindles. Think of a group of vines twisting around one another. Then imagine that at some point that ‘rope’ has a small knot other than at the ends. That’s a visual metaphor for a trigger point.

One way to approach them as a massage therapist is to use the common technique of tapotement. This is a gentle to moderate tapping motion that is frequently part of Swedish or sports massage. Using the fingers or a small instrument the area is tapped, moving above and below the suspected problem. Sometimes elbows are employed for slightly greater force. Keep in mind, it’s important to seek client feedback since excessive pressure can cause bruising.