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What are Trigger Points?
What are Trigger Points?
A Trigger Point (TrP) is a hyperirritable spot in a muscle. If you squeeze the TrP, you might feel a small knot that will feel tender. Perhaps even more interesting, when pressing on the TrP, you will also feel pain refer (or spread) distant from the spot🤔. For example, if you press on a trigger point in your upper trapezius, this will often feel exquisitely tender at the pinch site, AND you will also experience a sensation that wraps around your ear.
How do Trigger Points Develop?
How do Trigger Points Develop?
The most floated theory of TrP development suggests that the involved muscle fiber, due to overload, stress, cold, etc., gets stuck in a contracted state (the actin and myosin filaments remain overlapped).
When the muscle remains in a state of perpetual contraction, this leads to a local "energy crisis" which involves a mix of accumulated metabolic waste, a drop in ATP, and insufficient oxygen supply to the muscle.
The result is a sensitization of the tissues, followed by pain and dysfunction.
This is actually a fairly cool self-protective mechanism employed by your nervous system to get you to change your behavior. The problem is, because it hurts, we tend to stop using the involved muscle, and disuse can make the TrP persist.
What's the deal with referral pain?
As to why TrP pain refers or travels to distant areas remains a mystery. That said, some suggest that the sensitization of the local area muddies the waters, so the brain can't determine where to send the next pain signal.
It is also possible that the shortened sarcomere housing the TrP can compress or irritate nearby nerves. It follows that the compression results in abnormal sensations in the areas innervated by that nerve.
How Does Trigger Point Therapy Work?
How Does Trigger Point Therapy Work?
The treatment involves compression of the TrP. The compression is thought to help the sarcomere reset and relax. Once the fiber can return to a resting state, the "Energy Crisis" resolves, and subsequently, the discomfort eases.
What to Expect from TrP Therapy
What to Expect from TrP Therapy
Compression of an active trigger point can be is uncomfortable, though most describe it as a "hurt so good" sensation. Bear in mind that you and I will be communicating throughout the session to ensure it isn't overly aggressive. To make the process simple, we will use a pain scale of 1-10, where 10 is the worst pain imaginable and 1 is barely noticeable. The idea is to keep the pain rating under a 7 and below any muscle guarding threshold. This is generally enough pressure to allow the TrP to relax without causing any unnecessary pain.
In most cases, TrP compression is held for 15-20 seconds. The sensation might begin at a 7, but as the TrP releases, you'll find that the discomfort eases (with no change in pressure), and by the end of the 20 seconds, your pain rating might be a 2 or 3.
Oftentimes, a TrP will resolve in a single session. That said, this varies from person to person and often depends on how long you've been dealing with the trigger point.
Importantly, TrPs do tend to come back. To make the most of your therapy, we will talk about the things in your everyday life that could be perpetuating the TrP. The hope is we can identify the offending factors and avoid them altogether so that the TrP does not return.
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