Trigger points can be implicated in a wide range of common conditions that involve chronic pain, including sciatica, plantar fasciitis, low back pain, trigger finger and frozen shoulder, to name a few. They are often resistant to traditional forms of muscle stretching and when severe they can cause pain in distant parts of the body. This is called referral pain. Massage therapists are experts on the muscles, tissues and fascia that contribute to trigger points and they have developed a number of techniques to treat trigger points and help you achieve long awaited pain relief.
What are Trigger Points?
Trigger points are defined as “a focus of hyperirritability in a tissue that, when compressed, is locally tender and, if sufficiently hypersensitive, gives rise to referred pain and tenderness.”1 In other words: a trigger point is believed to be a localized spasm or knot in the muscle fiber that may cause pain to be referred to other, more distant parts of the body. “I have seen clients who have been told they have arthritis of the elbow when the problem was actually the bicep muscle being so tight that the arm could not straighten and stress was being placed on the inside elbow joint, causing both pain and an inflammation,” says Julie Donnelly, a licensed massage therapist in Sarasota, Florida.
According to Steve Jurch, Director of Allied Health Training at the Community College of Baltimore County, trigger points are typically caused by three types of muscle overload: acute, sustained and repetitive. “These types of muscle overload can occur in a variety of settings, including occupational and athletic settings, and can also result from underlying pathologies,” he explains.
Here is how a trigger point forms: Muscle overload causes an abnormal release of acetylcholine (from dysfunction in motor end plates). This release causes an influx of calcium into the sarcomeres (the smallest functional unit of striated muscle tissue) in the affected area which, in turn, causes these sarcomeres to contract. “Because of the sarcomere contraction, there is an increase in the tension of the muscle fiber,” Jurch explains. “This tension creates contraction knots in the short sarcomeres, and these knots evolve into a trigger point. The lengthened sarcomeres along with the contraction knots; referred to as the trigger-point complex, constitutes the taut band in several adjacent fibers.” To help visualize trigger point formation consider this analogy: Take a 12 inch piece of rope and tie knots in it until it’s only 10 inches long. With this example it is easy to see that the knot is getting tighter and the fibers on either side of the knot are being overstretched.
Take shoulder and elbow pain as an example. “The two-headed biceps muscle originates at the shoulder at the supraglenoid tubercle and the coracoid process of the scapula and inserts into the tuberosity of the radius and bicipital aponeurosis,” Donnelly says. “When the muscle contracts normally, a person will take their straight arm and touch their shoulder. However, when the muscle is in spasm, they won’t be able to fully straighten the bent arm.” In this case the feeling of shoulder pain may actually be the result of a tight biceps muscle.
How Massage can Help
Perhaps one of the biggest benefits of massage therapy is that it’s noninvasive and fairly easily tolerated. “Second,” says Jurch, “is that other forms of treatment may not address all of the necessary areas.” Meaning there may be a feeling of pain in one area whose source is actually in another. “A massage therapist can understand the relationship between each of the muscles that have an impact on a joint,” explains Donnelly. “Knowing which muscle needs to be released first in order for subsequent muscles to be effectively treated is immensely helpful.”
That a massage therapist is focused on muscles, tendons and insertion points is also helpful, according to Donnelly. “A massage therapist can use the referral patterns of the trigger points to follow the point of pain described by the client back to the originating muscle, locate the trigger point in that muscle and apply direct pressure to release the spasms,” she explains.
Typically, massage therapists use a type of compression—sometimes referred to as digital pressure—to help relieve trigger points. “The goal of treating trigger points is to remove the spasm and return the sarcomere to its original length,” Jurch explains. “Digital pressure works by applying pressure to a ‘knot’ for anywhere from 30 seconds to 90 seconds, until a change in the tissue is felt.”
Throughout the treatment your massage therapist will maintain clear communication with you about your level of pain or discomfort and they will adjust pressure or technique as necessary. “Unlike a relaxing massage, trigger point therapy can be uncomfortable to receive, especially while applying the direct pressure on the trigger point,” Donnelly says. “I always explain to clients that it’s very important for them to tell me immediately if the pain is not tolerable so I can adjust my pressure.” Once the massage therapist feels the tissue relax they will remove pressure and perform some general massage strokes to the area.