Trigger Points and Fascia
Pain Free Movement
Trigger points are a hot topic right now in the world of manual therapy. They are often hugely debated with both sides of the argument passionate about their opinion. I will say that at this point in time the scientific community is unable to produce a reliable and repeatable study proving an effective tool for locating trigger points, treatment of trigger points, or for that matter, if they even exist. For me this is a tough pill to swallow; I pride myself on providing evidence based treatment.
I can't totally discount my clinical experience either. Dr. Janet Travell (personal physician to JFK) coined the term trigger point and spent her career exploring treatment options for myofascial pain. I spent my schooling years (and many, many, more after that) studying her treatment manuals. I, myself, have experienced the pain associated with the typical referral patterns; I have also felt the relief of having these areas worked on.
Technically speaking, trigger points are described as hyper-irritable spots within the muscle fiber. They are tender to touch (although not all tender points are trigger points) and they have predictable referral patterns that have been well documented. They are thought to be palpable, although this is a sticky part in the debate. Clients having therapeutic treatment to trigger points often report feeling the referral pain as well as it localizing. They often report improvement in performance in addition to the alleviation of symptoms. The scientific community has yet to find ways to measure these reported finding.
Trigger points are often discussed to be found in one of two distinct phases: Active or Latent. Latent is described as a trigger point that is asymptomatic...until you push on it. Unless you push on the area you are completely unaware that it's there. On the other hand, an active trigger point is currently referring myofascial pain. Think of the headaches that originate in your neck. Fancy word alert...cervicogenic headache. Headaches starting in the cervical spine or neck. When you present with one of these you can push on the upper traps muscle and increase the pain in your head and neck. There's your trigger point.
Trigger point referral pain can often be misdiagnosed as other conditions. A trigger point in your piriformis muscle (deep in the hip) can often mimic the pain associated with sciatica pain. A major difference between the two from a treatment standpoint: it's much harder to treat true sciatic pain.
So why treat trigger points at all. First off, THEY ARE PAINFUL!! Muscles with active trigger points produce pain when we try to use them, they produce pain when they are stretched, and when they are really agitated, they will throb when you're doing nothing at all. No one likes to be in pain but perhaps the even bigger problem is that trigger points produce muscle weakness. A great example of the compounding problems of a single trigger point is one found in the gluteus medius. When your gluteus medius is not doing its job, the rest of the leg in almost its entirety does not function as its designed. You start to walk differently to accommodate this change and suddenly your knee starts to bother you. Then your foot and low back.
I continue to look for great research on trigger points to help my clinical practice perform at their best. I don't pretend to have all the answers but I definitely have a few things we can try. We can discuss your treatment goals, evaluate your activity levels, and work together to get you back to the things you love pain free.