“A highly irritable localised spot of exquisite tenderness in a nodule in a palpable taut band of muscle” (Travell & Simons 1993)
This may sound familiar if you have ever found tender spots when massaging or pressing on an area to relieve tension or pain. What you have found are trigger points, and they are something we all have in common. Some people are never bothered by trigger point pain, whereas for other people they can be the cause chronic pain and other symptoms. The tricky thing about trigger points is that they often cause pain elsewhere in the body, which is called ‘referred pain’. This can sometimes make it hard to find the root cause of chronic pain and can lead to mis-diagnosis and even mis-treatment. Yet pinpointing and treating the right trigger point is simple and ease pain quickly and effectively.
What exactly are trigger points, how do they form, and how can we treat them effectively?
What are trigger points
Trigger points form in the myo-fascia of the body. Myo means muscle, and fascia is the main connective tissue in the body wrapping round and through everything else. Muscles are wrapped in several layers of fascia, from individual cells to the whole muscle.
Normally muscles work elastically to help us move and the fluidity of the fascia surrounding them allows this movement. However, sometimes small areas of muscle can be damaged. Even after the body repairs this, a tiny amount of scar tissue is left and over time this causes changes in the way the muscle and fascia around it work. This is similar to getting a snag in a jumper, where you might be able to reshape the jumper around it, but there is always a slight change to the fabric.
A snag like this in a muscle can cause the body to think there is still an injury and repeatedly try to repair damage that isn’t there. This causes more scar tissue which forms into a trigger point with associated muscle weakness, tension, stiffness and pain.
What causes trigger points
Trigger points can be due to many causes, some of the most common being:
Surgery and scar tissue
Anyone who has had surgery will have scar tissue. Scars are the body’s way of repairing any damage to the soft tissues, particularly the muscles and fascia, and they are stronger but less flexible than the original tissue. After the initial repair, sometimes the scar tissue can continue to spread along natural lines of tension internally and can attach itself onto internal structures, which is known as an adhesion.
We automatically think of accidents as major events which result in hospitalisation and possibly surgery. However, there are many everyday mishaps, bumps and trips that are soon forgotten but that can also cause smaller scale injuries and resulting micro scarring.
Under and over-use
Most people can recognise the effects of overdoing things, whether its sport or gardening, but are not as familiar with the effects of underuse, for example, what happens to the rest of our body if we spend endless hours sitting still at a computer. For our tissues, the end result of over or under-use are similar – tight and irritated soft tissues. Our bodies feel sore and, depending on how often we repeat whatever we do, this can lead to restrictions forming in soft tissues irritated by the extra strain.
Before you sit up straight, be reassured that very few of us have perfect posture. However, we all have natural postures that we adopt for the different tasks in daily life and these sometimes pull our body out of natural balance. Being off balance is harder work for our tissues which will become irritated if this is prolonged.
This can be mental, emotional or physical stress depending on the situation. In the short-term stress is healthy as it allows us to react to situations. Prolonged stress is a different matter, especially when we can’t control the causes. A natural reaction to any stress is to physically tighten our body which can become our default state over time.
How can we treat trigger points
As trigger points often create referred pain patterns, you may wonder where to start and how to find the exact trigger point that is causing your current pain. Fortunately the pain patterns of many common trigger points have been mapped. A good starting point, therefore, is to arm yourself with a trigger point book which explains the patterns and how to find the trigger points responsible.
Starting with the pain you experience, it is simple to match this to a pattern and trigger point. Trigger points respond best to sustained gentle pressure which allows time for the fascia and muscle tissue to release. Pressure can be applied manually or using a trigger point ball.
You can find more information about trigger points and how to treat them in our book Trigger Points: Using the Power of Touch to Live Life Pain-Free.