n the 1950’s Senator John F. Kennedy had to rely on crutches due to immense pain from injuries obtained in the war. Back surgery did not relieve the pain. What changed JFK into the healthy strapping president on television a decade later? He came under the treatment of Dr. Janet Travell, who spent her career documenting and developing treatments for myofascial pain syndromes. Travell charted each trigger point’s pattern of pain and made it possible to track referred pain back to its source. Her treatments changed Kennedy’s life.
To understand the definition of a trigger point, it’s necessary to understand the purposes of muscles which are, in short, to support the body and contain the internal organs, allow movement, and to regulate the temperature of the body through movement.
Healthy muscles are elastic and supple, returning to their original shape after being stimulated. Unhealthy muscles do not necessarily spring back into shape. All muscles are quite vulnerable to injuries from overuse and accidents. When an injured muscle fails to spring back into shape and remains contracted (fixed in a shortened position), lactic acid begins to build up, blood flow is reduced, and mobility becomes limited. Muscles begin to feel like hard cords instead of supple clay.
Trigger points are points along the injured muscle that are the weakest and most painful points. They often send pain to other areas of the body. For example, injuries deep in the lower back can refer pain to the hip, rear and sacroiliac joint, making rotation of the hip joint, and even standing, next to impossible at times.
These very trigger points are my souvenirs of a fender-bender ten years ago that left me unable to stand first thing in the morning. What baffled me was that the pain and inability to support my weight would periodically change from one hip to the other, depending on which of the two deep trigger points was flaring up. (I learned later that this was dependent upon on which side I’d chosen to sleep). I was lucky: I had a great massage therapist to whom I still go regularly, and an excellent trigger point instructor at massage school. Now I know how to deactivate my own trigger points and I have not had a debilitating morning since. Stretching, especially yoga, also helps me calm these savage beasts.
Because pain from trigger points may appear elsewhere, they are sometimes misdiagnosed as chronic headaches or migraines, tendonitis, nerve damage, vertebral disk problems, arthritis, the “inevitable symptoms of old age” (I hope no one buys that argument!), or even mental illness. Pain medication, while sometimes the only way to make it through the day and offer the possibility that the body will relax, can sometimes mask the message that the muscles are in trouble.
My own solution is to take my body to a practitioner who knows deep tissue and is versed in trigger point locations and their patterns of referred pain. There are also some books written to help with self-treatment. (See the resources list at the end of this article, and our product article on the Thera Cane.)
There are three general therapies to treat trigger points. One common treatment is done by a doctor injecting a trigger point with anesthetic. Another deals with the patient following a regime of careful stretching designed to help release the muscle. Third is gentle pressure and regular massage sessions. Two or all three therapies are often used together to create a program that may help keep a trigger point under control, or in some cases, stop it altogether. In my experience, I have seen few clients with active trigger points that could not be calmed by massage and stretching, combined with a little patience. As for me, massage therapy combined with yoga is the treatment plan that gets the best results – but then I‘m a bit needle-shy.
Trigger point massage therapy involves providing pressure to a trigger point until the muscle partially or completely releases. Practitioners massage the area to warm up the muscles with relaxing strokes, and then apply pressure for short periods of time. Pressure should never be excessive or cause severe pain, as this can cause further contraction of the muscle and/or bruising. A good trigger point therapist will usually know at what angle to approach the trigger point, which is sometimes buried under other muscles or bones.
Trigger point massage relies on client feedback. Therapists need to know if a client is in pain. I’ve spoken to two practitioners who expressed concern over clients who, in one client’s own words, “…didn’t want to be a whiner…”; they’d just ‘suck it up’ instead of giving feedback that pressure was hurting, or even tell the therapist when he or she was on top of the trigger point.
As with other massage therapies, the client will probably be instructed to drink a lot of water, especially for the next 48 hours, to aid with the removal of built up acids and toxins that have been loosened. Levels of post-treatment soreness are often much greater in clients who don’t drink enough water to move the toxins out efficiently.
Basic Health Publications, Inc. (Laguna Beach, CA) 2006
Trigger Point Self-Care Manual
Healing Arts Press (Rochester, VT) 2005
Finando, Donna and Steven Finando
Trigger Point Therapy for Myofascial Pain
Healing Arts Press (Rochester, VT) 2005
Davies, Clair and Amber Davies, foreword by David Simons
The Trigger Point Therapy Workbook: Your Self-Treatment Guide for Pain Relief