Trigger points are described as pain points in skeletal muscle that often have palpable nodes or ‘knots’ in taut bands of muscle fibers. These nodes are often small muscle knots or contractions, and are a common cause of pain. If touched, the trigger point may be tender, may refer pain to another part of the body, or may lead to other dysfunctions. The word “myofascial” is a combination of “myo” meaning muscle, and “fascia” referring to the connective tissue surrounding the muscles.
Trigger points have been studied by a small number of doctors for several decades, but myofascial release has not become part of mainstream medicine. The existence of tender areas in muscles, however, has been recognized for many years, but there has been little agreement about what these areas mean.
Janet G. Travell MD (1901-1997) is responsible for the most detailed and important work on myofascial trigger points. She was the White House Physician for Presidents John F. Kennedy and Lyndon B. Johnson, and her work treating Kennedy’s back pain was very successful. In her book with David Simons, Myofascial Pain and Dysfunction: The Trigger Point Manual, they report research findings that up to 75% of pain clinic patients may have a trigger points as the source of their pain.
There are many ways to treat painful trigger points. First, the trigger points must be identified, and then they can be treated. Often they are worked out by manual massage, injections, “dry” needling, electro-stimulation, “spray-and-stretch” spray with stretching techniques to elongate the muscle and fascia, and other techniques.
No and Yes! Trigger points are very sensitive and the surrounding tissue may be tender, too. The practitioner may use his or her hands, elbows, feet, or tools to apply direct pressure to the trigger point. Always let your practitioner know if they are applying more pressure than you can handle.
Also injections and “dry needling” are frequently used. Injections are often performed with local anesthetics like lidocaine, other analgesic medications, or salt water. Dry needling can be equally effective, but may cause more soreness after the treatment since there is no analgesic.
Please wear loose fitting clothing, or you may need to change into a robe for treatment. You may need to be placed in a variety of treatment positions for a typical trigger point therapy session. Also, your practitioner may have you walk around the office so they can assess the way you walk and carry yourself.
