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Trigger Points – What I Tell My Patients

imagesA Trigger Point is where the muscle is told what to do by the nerve.  Trigger points exist in all muscles in all people. When these trigger points are pressed, whether someone is in pain or not, they are tender, and in a very few people they are not tender at all.

Trigger points (TrP) can be responsible for pain.  If this is so, then this type of pain is known as Myofascial Pain Syndrome, MPS.   TrPs can become painful or responsible for pain, (active Trigger Points) when one or more out of three scenarios occur:

1.       Direct trauma

2.       Postural adaptations

3.       Irritated nerve from perhaps the spine.

DIRECT TRAUMA:

This is when a part of your body has been hit directly with something, or a fall onto it; a car accident making the muscles become suddenly overstretched and becoming directly injured in the process. An operation can also produce active TrPs around the area of the surgery.

POSTURAL ADAPTATIONS:

This by far is the most common cause.

Using the muscles in the same way day in and day out over years can make some muscles tight and others ‘loose’. The tight ones will start to over work because of the tightness and over time the muscle then starts to scream out that it’s had enough and pain starts up. It’s like the final drop of water into a cup and it suddenly overflows.

A common example of this is at the end of a full working day, you put your hand over the opposite shoulder and self-massage it to ease the ache. Or you don’t sit ‘there’ in the draft because you know you will get an ache or a crick in the neck.

IRRITATED NERVES FROM THE SPINE

This one is probably the hardest one to describe, so bear with me.

The nerve comes from the spine to tell the muscles what to do, the muscles need a certain amount of impulse, (transmitter substance), from the nerve to actually contract enough to produce a movement, anything less than a certain amount of impulse will produce a localised contraction within the muscle belly, but not enough to produce visible movement of the body.

When this occurs, there can be a build up of muscular tension that can be responsible for pain, and at the very least reduced muscle strength and length. With a diagnosis of sciatica, TrP can in their own right produce the very same pattern and intensity of pain one might think was from a trapped nerve. Only through a thorough assessment and the beginnings of treatment can this be verified.  And oh how great if the symptoms are produced from TrP as this is far easier to treat than a ‘proper’ trapped nerve!

HOW AND WHY DOES TREATMENT WORK?

triggerpointtherapyTreatment consists of pressing the TrP, making sharp pain happen which then eases off with the sustained pressure. The stretch receptors in the muscle make the muscle relax it’s contraction – this is the only way the muscle CAN let go.

When the muscle releases, the TrP also releases also reducing the pain associated with that TrP.

Another interesting fact about a Muscle contraction is that the muscle will not release it’s contraction unless told to do so. So it will stay contracted until such a time that it is told to release, even if it’s to the detriment of it’s own tissues. Usually the muscle will release when another muscle pulls at it, thereby allowing movement: if the contraction of the muscle doesn’t produce movement IE bands of tightness caused by a TrP as described above, then the contracted part of the muscle stays contracted and no amount of stretching will release it to it’s full strength and length.

HOW DO YOU KNOW WHETHER TRIGGER POINTS ARE PART OF YOUR PROBLEM?

The physio can get a very good idea from how you describe the pain; this usually can help us in the right direction as to which kind of treatment would be the best for your problem.

You know when TrP are a part of your problem when after treatment on the TrP/TrPs, the symptoms actually reduce and the pain stays down. Sometimes the pain stays away only for a few days and then returns.  At this point, another reason for the pain is sought. So the trigger points can be used diagnostically.

As with anything in the medical arena, treatments to the body are not 100% guaranteed.  Some areas of medicine are not an exact science and the outcomes can only be guessed according to previously experienced outcomes that the practitioner/doctor has experienced before. This is why physiotherapy, like all other medically based therapies, may not solve a problem immediately and can take a few sessions to get the measure of the problem and how to treat it best.

WHAT’S GREAT ABOUT TRIGGER POINTS?

It doesn’t matter how old you are, or how long the problem has been around, or what your occupation was and is, or what gender you are: muscles respond very well to this type of treatment. And it can be the only type of treatment that can fully release the pain out of the body.

 By Joanne Clark MCSP Chartered Physiotherapist

 

 

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