What’s a Trigger Point? PART 2

Trigger points are a VERY common but rarely recognized and often poorly managed cause of musculoskeletal pain. Unfortunately, many medical doctors and orthopedic surgeons do not know about Trigger Points. Trigger Points do not show up on X-rays, MRIs, Ultrasounds or other scans so it’s not uncommon for a patient to be told there is nothing wrong with them or that there is nothing that can be done to help fix their pain. The only way to diagnose a trigger point it through palpation (touch), which is why chiropractors are sometimes, but not always, able to find them. First, they have to be looking for them which is not always the case.

Fortunately, trigger point pain is something that can often be managed at home by yourself. A good rule with treating trigger points is that a painful spot in a muscle isn’t a trigger point unless it refers pain (or numbness or tingling) to the area of complaint when you press on it. It may take ten to fifteen seconds before referred sensation happens. With compression, some people feel referral from every trigger point exactly like in trigger point diagrams. Others feel only a slight tingling or sensation even from the most intense active trigger points.

There are a lot of ways to treat the trigger points.

Medically, your options will typically be pain meds or, if you do find a physician who is able to diagnose the trigger points they may recommend trigger point injections. Which inject an anesthetic or saline and often a corticosteroid into active trigger points.  It’s it not uncommon to receive 10-20 or more injections in a single session. Other options include “spray and stretch”, ultrasound, and as was discussed in a previous blog, chiropractic adjustments.  Fortunately, trigger points can often be self-treated by the patient.

Medically, your options will typically be pain meds or, if you do find a physician who is able to diagnose the trigger points they may recommend trigger point injections. Which inject an anesthetic or saline and often a corticosteroid into active trigger points.  It’s it not uncommon to receive 10-20 or more injections in a single session. Other options include “spray and stretch”, ultrasound, and as was discussed in a previous blog, chiropractic adjustments.  Fortunately, trigger points can often be self-treated by the patient.

The easiest way to break release a trigger point is to increase circulation to increase the supply of oxygen and energy to the muscle tissues. This allows the necessary energy to become available and reuptake of calcium will begin again, allowing the sarcomeres (muscle fibers) to lengthen, releasing the trigger point. The only way to reliably verify whether a specific trigger point is causing a specific pain is to deactivate the trigger point and see if the pain remains.

The Hallmark of a trigger point is referral pain with pressure which can be difficult to know where to start when treating trigger points. This blog is NOT a complete how to guide but just the beginning. I recommend getting the “The Trigger Point Therapy Workbook”.  It is a very thorough guide with helpful referral pain pictures to help get you pointed in the right direction.

Once you have identified some active trigger points there are a few different ways to help release them.  Different methods may be necessary for different people. Sometimes changing previously effective methods on the same trigger point are needed for the best results.  The easiest and most common way to treat a trigger point is to press firmly on the muscle bundle (knot) and hold for 10-60 seconds making sure the pain you have is being reproduced. The pain should refer to the area of concern and be no more than a 6 out of 10, 10 being the most severe. The pain should also decrease noticeably and feel as though the muscle has even released. If not, move on to another point.

Another method is a mild to moderate pressure using your thumb or three fingers of one hand and the heel of your other hand to push across the skin and over the trigger points.  This has a similar effect like when using the myofascial rollers that are so popular with athletes now.  They are likely helping to relieve and treat trigger points without even knowing it.  This treatment can help not only to reduce the pain associated with trigger point formation but also to improve range of motion.

If this is too much for you then please feel free to give us a call and set up a consultation with Dr. Bret Wickstrom to see what the best course of action is for you.