Trigger Point

Trigger Point: A hyper-irritable spot in skeletal muscle that is associated with a hypersensitive palpable nodule in a taut band . The spot is painful on compression and can give rise to characteristic referred pain, referred tenderness, motor dysfunction, and autonomic phenomena (1).

3 Types of Trigger Points:

• Active trigger points: A Myofascial trigger point that causes a clinical pain complaint. It is always tender, prevents full lengthening of the muscle, weakens the muscle, results in patient-recognized pain when directly compressed, mediates a local twitch response of muscle fibers when adequately stimulated, and when compressed with the patient's pain tolerance, produces a referred motor phenomena (often in the trigger points pain reference zone), and often autonomic phenomena (1).
• Latent trigger points: A myofascial trigger point that is clinically quiescent with respect to spontaneous pain, but is painful when palpated. Most often, latent trigger points have a taut band and restrict muscle extensibility (these are likely the trigger points most commonly addressed) (1).
• Satellite trigger points: Satellite trigger points are sites that exhibit symptoms similar to trigger points when compressed; however, these symptoms resolve when the primary trigger points are treated. Generally, these sites are identified during treatment.

For more on trigger points, check out these courses and articles:

Courses

• Muscle Fiber Dysfunction and Trigger Points
• Trigger Point Assessment (and Palpation)

Articles:

• Motor Point Map
• Evidence of Altered Reciprocal Inhibition Associated with Latent Myofascial Trigger Points
• Trigger Point Release with Stretching Improved Plantar Heel Pain Better than Stretching Alone
• Kinesiology Tape Application to the Upper Trapezius Reduces Pain, Trigger Point Irritability and Increases Muscle Strength

Commonly Asked Questions:

Can I release my own trigger points?

• Yes. A variety of common methods are used for self-administered trigger point therapy. This is actually the likely benefit of techniques like foam rolling. Additional tools like spheres, canes, and vibration tools may also be used. Several courses describing these techniques have been linked below.

How to get rid of trigger points?

• Effective techniques include self-administered release techniques like foam rolling and vibration (linked courses below); manual techniques like ischemic compressions, static, manual release, and dynamic manual release (linked courses below); and needling, including acupuncture, dry-needling, and injections.

What is the main cause of trigger points?

• This is a complicated question. The Brookbush Institute, following a review of the research, asserts that trigger points are symptoms arising from muscle fiber or motor end plate dysfunction. However, the neurophysiology of this phenomenon is relatively complex and not completely understood at this point. For more, check out - Muscle Fiber Dysfunction and Trigger Points

Where are the most common trigger points?

• A ranked order list may not be available; however, some of the most common sites include the upper trapezius, levator scapulae, tensor fascia lata, vastus lateralis, and gastrocnemius.

Observable Phenomena Associated with Muscle Fiber Dysfunction:

• Taut bands
• Palpable nodules (note that imaging studies have confirmed evidence of trigger points as a physical phenomenon within the muscle).
• Changes in the chemical milieu of the muscle cell.
• Increased tone (over-activity)
  • A general increase in tissue density
  • Resistance to stretch
  • Changes in EMG activity
  • Changes in muscle spindle activity (H-reflex)
  • Twitch response
• Myalgia
  • Pain upon deep palpation
  • Latent trigger points (tender points)
  • Active trigger points
  • Referral pain
  • Diffuse myofascial pain and allodynia
• Centralization
  • Whiplash syndrome
  • Chronic low back pain
  • Fibromyalgia syndrome

Unnecessary Debate:

• There has been some debate regarding the "existence" of trigger points and whether they represent a phenomenon that should be addressed. The debate stems from treating the term "trigger point" as a structural entity rather than a characteristic set of symptoms (as described by the creators of the term). That is, the term "trigger point" is similar to the label "low back pain" and not the label "herniated nucleus pulposus (HNP)." The gross majority of opposing views on trigger points are based on this common fallacy. Note that imaging studies have confirmed evidence of trigger points as a physical phenomenon within the muscle; however, these studies should be considered evidence of physical changes associated with symptoms labeled "trigger points" rather than making prior assumptions about what a "trigger point" should look like and whether those images confirm those prior assumptions.

Trigger Point Treatment (Related Courses):

Self-administered Techniques:

• Scapula Muscles: Release and Lengthening
• Shoulder Internal Rotator and Posterior Deltoid: Release and Lengthening
• Lumbar Extensor: Release and Lengthening
• Hip Flexor: Release and Lengthening
• Hip Internal Rotator: Release and Lengthening
• Hip External Rotator: Release and Lengthening
• Tibial External Rotator: Release and Lengthening
• Plantar Flexor: Release and Lengthening

Manual Techniques:

• Static Manual Release: Suboccipitals, Sternocleidomastoid (SCM), Scalenes and Cervical Extensors
• Static Manual Release: Upper Trapezius, Levator Scapulae and Splenii
• Static Manual Release: Upper Trapezius, Levator Scapulae, Rhomboids and Pectoralis
• Static Manual Release: Infraspinatus, Teres Minor, Subscapularis, Pectoralis Major and Posterior Deltoid
• Static Manual Release: Trunk Muscles
• Static Manual Release: Hip Flexors
• Static Manual Release: Hip Internal Rotators
• Static Manual Release: Hip External Rotators
• Static Manual Release: Tibia External Rotators - TFL, Vastus Lateralis, Biceps Femoris and Lateral Gastrocnemius
• Static Manual Release: Lower Leg Muscles

1. David G. Simons, Janet Travell, Lois S. Simons, Travell & Simmons’ Myofascial Pain and Dysfunction, The Trigger Point Manual, Volume 1. Upper Half of Body: Second Edition,© 1999 Williams and Wilkens