Trigger Point Therapy / Massage

What is it?

“Myofascial” Made Simple – The word myofascial means muscle tissue (myo) and the connective tissue in and around it (fascia). When stressed or injured muscles form trigger points, like contracted knots, which cause pain and tightness. Muscles have been an under-treated cause of pain. In fact, with a specialized area of medicine for almost every area of the body (heart, eyes, lungs, intestines, kidneys, etc), oddly, there is no muscle specialty in medicine. Myofascial pain from trigger points is often overlooked as a possible source of pain by those seeking relief.

Unfortunately, common though the condition may be, the diagnosis and treatment of Myofascial Pain has yet to be included in most medical training. The majority of patients seeking relief from pain are still treated with the traditional approach of anti-inflammatory medications, muscle relaxants, anti-depressant medications and/or strengthening programs. These prove ineffective if not detrimental as trigger points do not respond to them and may be aggravated by further straining (strengthening exercises). Trigger Point Therapy combined with Massage Therapy really works, and it is completely NATURAL.

Most People have no idea how good their body was designed to feel.

Kevin Trudeau

It is encouraging that myofascial trigger points are becoming more commonly considered when physicians diagnose their patients. Some primary care physicians, regularly administer trigger point injections. Some recognize the presence of trigger points and refer to Myofascial Trigger Point Therapists. Those that do, enjoy an enhanced success rate and grateful patients.

Myofascial trigger points are an extremely common cause of pain. Trigger points are painful when pressed on, cause a shortening of the muscle fibers, and have the ability to refer pain to a different location. (a trigger point in one muscle can create pain in another area) For instance, when the muscle at the top of your shoulder (trapezius) has a trigger point it will refer pain up the side of your neck and head, and can cause a headache.
Muscles make up between 36-42% of body weight, on average. They are a large percentage of our total weight and have a corresponding impact on our health. When all is in working order, muscles allow us to perform normal activities with ease. When our muscles harbor trigger points, we experience pain, physical limitation and loss of normal function. A diagnosis of Myofascial Pain Syndrome or Chronic Myofascial Pain means that the primary source of your symptoms are from these myofascial trigger points. Often, trigger points are present secondary to other sources of pain, such as arthritis or bulging discs. The trigger points may actually be causing the painful symptoms attributed to with these conditions. As such, they are often called “the great mimickers”.

Symptoms include:

• Back pain
• Headaches
• Neck pain
• Rotator cuff (shoulder) pain
• Jaw pain (TMJD)
• Tennis elbow
• Carpal tunnel syndrome
• Hand and arm pain
• Repetitive Strain Injuries
• Pelvic pain
• Hip pain
• “Sciatic” pain (buttock pain)
• Leg and knee pain
• Plantar fascitis (foot) pain
• Tendinitis/tendinopathy
• Burstitis
• Arthritis
• Disc pain (bulge/rupture/herniation) and radiculopathy
• Frozen shoulder
• Fibromyalgia

How Trigger Points Are Formed

The damage to muscle and connective tissue which results in trigger points can occur several ways. It can happen as the result of:

• Repetitive overuse injuries (using the same body parts in the same way hundreds of times on a daily basis) from activities such as typing/mousing, handheld electronics, gardening, home improvement projects, work environments, etc.
• Sustained loading as with heavy lifting, carrying babies, briefcases, boxes, wearing body armor or lifting bedridden patients.
• Habitually poor posture due to our sedentary lifestyles, de-conditioning and poorly designed furniture
• Muscle clenching and tensing due to mental/emotional stress.
• Direct injury such as a blow, strain, break, twist or tear. Think car accidents, sports injuries, falling down stairs and the like.
• Surprisingly, trigger points can even develop due to inactivity such as prolonged bed rest or sitting.

Active Trigger Points Cause Pain

After forming, trigger points have two phases, active and latent. The active, painful phase of the trigger point is the one which produces the unrelenting, debilitating pain symptoms and which motivates people to seek relief. The active trigger point hurts when pressed with a finger and causes pain around it and in other areas. It causes the muscle in which it’s located to be weak and due to the taut bands, to have limited flexibility. The active trigger point referral symptom may feel like a dull ache, deep, pressing pain, burning, or a sensation of numbness and fatigue. It can also cause sweating, tearing of eyes, goosebumps and dizziness. The affected dense, shortened muscles, laden with taut bands may even compress and entrap nerves, leading to another secondary set of symptoms. If unaddressed or ineffectively treated, eventually, other muscles around the dysfunctional one may be required to “take up the slack”, becoming stressed and developing secondary trigger points. It is not unusual for chronic pain patients to have multiple, overlapping referred pain patterns, making diagnosis and treatment more complex. It is easy to see why this widespread pain is often mistaken for Fibromyalgia-a related but separate diagnosis.

Latent Trigger Points Matter Too:
Trigger points can also lie quietly in muscles, sometimes for years. This type of trigger point is called latent. Latent trigger points are very common. Unless you press on the trigger point and feel the tenderness, you probably don’t know they are there. Most people have at least a few. Latent trigger points may persist for years after apparent recovery from injury. Trigger Point Therapy / Massage works wonders for these.

Latent trigger points cause:

• Restricted movement
• Distorted muscle movement patterns
• Stiffness and weakness of the affected muscle
  They generally do not cause pain unless compressed. Many things can cause a trigger point to become active. An old injury that periodically re-surfaces (that “trick knee” or low back “going out”) may very likely be due to latent trigger points “waking up” and becoming active when aggravated by muscle overload, a cold draft, fatigue, infection, illness, or stress.

How Many Trigger Points Can I Have?

Since a trigger point is an abnormal spot in a muscle the number and exact location varies. All muscle tissue is potentially prone to developing trigger points. Sometimes people have one trigger point but more often they have many. Prolonged referral of pain and weakness from a one trigger point to another area of the body will generally cause other trigger points to develop in that area. These, in turn, if left untreated, can activate and also refer pain, creating multiple pain patterns. The more areas that have pain and the longer you have had the pain, the more trigger points you are likely to have. It is rare for someone with pain to only have one or two muscles with trigger points.

Establishing if Trigger Points Are Present. A skilled practitioner who has been trained to recognize the symptoms of myofascial pain and palpate muscles for myofascial trigger points can assess whether myofascial trigger points are present. There are no commonly available lab tests or imaging studies that can confirm the diagnosis at this time. Myofascial trigger points can be seen on special MRI scans and special ultrasound but these are currently only used in research. Treating Myofascial Pain with Trigger Point Therapy Since a trigger point is the contraction mechanism of the muscle locked into a shortened position, the treatment of the trigger point involves unlocking that contraction mechanism (sarcomere). This can be achieved in several ways. Trigger Point Pressure Release (David Simons, MD and Janet Travell, MD) involves applying pressure with a finger or other instrument to the trigger point and increasing the pressure as the trigger point “releases” and softens.

There are a number of variations on this technique and a skilled practitioner will choose which is right for each patient and muscle treated. I have boldly combined Trigger Point Therapy with Massage Therapy incorporating the knowledge of several healing modalities as well, really works. Other techniques often used include Spray and Stretch which is a technique that uses a vapo-coolant spray (very cold because it evaporates the second it touches your skin) to distract the muscle into allowing a more complete stretch thereby helping to release the trigger point. (I do not include these in my treatments)

Treating each trigger point is relatively simple. Treating the whole myofascial pain syndrome so that pain fully goes away is a more complicated process. Once trigger points are released the muscle needs to be moved throughout its full range. Simple limbering movements done by the patient at home are important in the retraining of the muscle.

What to Expect from Treatment

Many people experience relief from pain during and after the first treatment. For others several treatments are needed before their pain starts to diminish. It is common for patients to experience some soreness for one to two days after treatment.

This usually resolves after the first few treatments. You may experience fatigue as the chronically held musculature is allowed to relax and return to a normal tone, however some patients experience an increase in energy. As the work-load of the musculature shifts and returns to abnormal balance, pain patterns may change. This is a temporary and normal stage of recovery from chronic pain.

It is not uncommon for people to experience relief from symptoms they were not seeking treatment for, such as chronic hand and forearm pain clearing up after being treated for a stiff neck. Returning to normal activities without pain is most often accelerated by adherence to the self-care program given to you by your therapist. Minimizing stress, pacing your activities and avoidance of overexertion (as well as focusing on what you can do instead of your limitations) are of prime importance. Good communication, patience and a positive attitude are essential.

Your rate of improvement depends on many conditions:

• Type and length of time injured
• Overall physical health
• Level of fitness
• Underlying skeletal abnormalities
• Nutrition
• Quality of sleep
• Depression or anxiety
• Patient compliance with self-care
• Other medical conditions (i.e. allergies, diabetes, thyroid dysfunction, etc.)

Along with hands-on treatment to release myofascial trigger points, your therapist will:

• Take a full medical and pain history
• Evaluate your pain map for referred pain patterns
• Assess the ergonomics of your work station and other regular activities.
• Assess and make suggestions to improve the quality of your sleep
• Make nutritional recommendations if required
• Teach you how to choose an appropriate exercise/movement program and help you to encorporate it into your life.
• Teach you to do self-treatment on your trigger points.

The goals are set cooperatively with you at the initial session and are periodically reassessed. Your input, insight and creativity are highly encouraged.

Trigger Point Therapy / Massage as a Touch Therapy offers a range of specialized techniques, using a combination of massage disciplines and healing practices to create a truly unique touch experience. With a holistic approach to massage, we understand that everyBODY is different and has differing healing needs. When massage is received on a regular basis, it helps to maintain a healthy, balanced body and mind. Optimum health is an essential ingredient to experiencing life at its best. Invest in the wellness of your body, it is the most powerful tool you have.

Remember… You are not your body. Your body represents what you eat, what you think, what you feel… Pain is a way your body can communicate with you. Learn to LISTEN.