When I was in school there seemed to be a limited amount of conversation around trigger points. From my memory, they were not the topic of conversation but more a physical finding, part of a bigger system. Part of the supporting cast of characters of a broader condition. For a while I also stuck to a very simple explanation of why they were present which was that the muscles involved were “overworked or injured”. I also learned very quickly that having effective methods to address trigger points is essential from the patient perspective. Let’s be honest, most people are initially presenting with pain or discomfort and it’s my job to help identify the cause and provide a solution. So let’s dive into what is a trigger point and what is the best way to treat them.
Trigger points are described as taut bands of skeletal muscle. When they cannot relax, these fibers create a nodule or what is more commonly called a “knot”. Trigger points were initially described by Travell and Simons, pioneers in the medical community for this work. Their mapping of the trigger points and their consistent pain patterns they cause are now used all over the world.
Trigger points do often show up in areas around where there is injury or chronic tension. That tension may be created by dehydration, emotional stress, repetitive movements, poor postures, protective patterns related an area with any underlying condition (whether it be from the musculoskeletal or other organ systems). I’ve heard trigger points to be described as the musculoskeletal systems “emergency brake” stabilizing as area and limiting range of motion. So as much as they may be annoying and even very painful you can think of them as a good thing showing up in a body system that’s not functioning optimally.
Thankfully trigger points respond very well to many different conservative methods some which can even used as at home. Here is a short list:
- Cupping (also known as myofascial decompression)
- Dry needling
I have come to appreciate over my years in private practice that what is causing the painful experience is an important first step. It is equally important to identify the cause of that pain and the stressors that are feeding the “cause”. Let me give you an example. If you’re having a headache in your temples. Through an examination maybe we identify a painful knot in the upper trapezius muscle which is consistent with that pain pattern. When addressing the muscle, if it provides relief to the headache you could say that we’ve been successful. In many cases it is limited relief. When we unveil the cause of the trigger point in the upper trapezius muscles there is a more balanced resilient system less likely to have the problem again.
The best clinicians are able to provide relief for the patient quickly and address the cause for long-term change. My measure of success is not only when the patient leaves happy but when they have a better understanding of why the body responds as it does in crisis and they have the tools to address it in the future.
The best way to treat a trigger point is by addressing how the person eats, thinks, and moves. Let’s look at it in 3 steps.
- Treat the trigger point using the methods in your wheelhouse.
- Stress the body by reintroducing the food, environment, task, etc. that is the likely culprit.
- Retest by looking for trigger points again.
Being primarily in a musculoskeletal practice I spend a great deal of time looking at proper movement and centration of joints and necessary stabilization around those joints which has helped me to have great success. With that being said, I caution both the patient and providers out there to keep an open mind. The chronic problem likely has a chronic cause, meaning long-term exposure or a way of living may be feeding the condition and not the most obvious.
I often reflect back to one of my very first patients when I was still a chiropractic intern. She came back to the clinic week after week with the same trigger points and the same symptoms. She happily got care and was grateful for relief although by the next time I saw her it was the exact same. I tried every method I had been taught and addressed stress, posture, sleep, stretches, and exercises. It was not until we spent some time on nutrition that I found a major weakness in her body system. By making some very minor changes in diet alone we saw an immediate improvement in her symptoms and guess what, no trigger point.
That is why best way to address a trigger point is through a combination of proven interventions and addressing the weaker areas. Although annoying and painful, the presence of trigger points are often a helpful clue to reaching to better health.