CHRONIC MYOFASCIAL PAIN -Understanding Trigger Point Therapy
Trigger Point therapy was developed by Janet Travell and David Simons, MDs, and is used to treat myofascial pain. They produced two large volumes of trigger point therapy and it has been around since the 1940’s but few doctors even know what trigger points are.
A classic trigger point is defined as the presence of discrete focal tenderness located in a palpable taut band of skeletal muscle, which produces both referred regional pain and a local twitch response. Trigger points help define myofascial pain syndromes. Acute trauma or repetitive microtrauma may lead to the development of a trigger point. Lack of exercise, prolonged poor posture, vitamin deficiencies, sleep disturbances, and joint problems may all predispose to the development of microtrauma. Occupational or recreational activities that produce repetitive stress on a specific muscle or muscle group commonly cause chronic stress in muscle fibers, leading to trigger points. Acute sports injuries caused by acute sprain or repetitive stress ( tennis elbow or golf shoulder), surgical scars, and tissues under tension frequently found after spinal surgery and hip replacement may also predispose a person to the development of trigger points. In the head and neck region, myofascial pain syndrome with trigger points can manifest as tension headache, tinnitus, temporomandibular joint pain, eye symptoms, and Torticollis. Upper limb pain is often referred and pain the shoulders may resemble visceral pain or mimic tendonitis and bursitis. In the lower extremities, trigger points may involve pain in the quadriceps and calf muscles and may lead to a limited range of motion in the knee and ankle. Trigger point hypersensitivity in the gluteus maximus and gluteus medius often produces intense pain the low back region. With proper and timely intervention, these TrPs can be broken up and eliminated. If chronic myofascial pain has persisted for some time, you may have fibrotic muscles and/or calcified areas at the attachment points. This usually indicates multiple perpetuating factors, and it will take longer work and a lot of patience to regain function.
Trigger points are often misdiagnosed by doctors and mistaken for other maladies as bursitis or nerve impingement. As a result, they prescribe pain medications for masking the pain or perform injection therapy of Botox, cortisone, prescribe physical therapy, or worse, surgery. These methods do not treat the source of the pain - that being the trigger point. Many doctors have not been trained in trigger points and don’t know how to treat them. If you have pain, they prefer to prescribe physical therapy; however, physical therapy does not treat the pain and trigger points directly. The physical therapist will have the patient perform exercises that often aggravate the trigger points and intensify the pain. If TrPs (Trigger Points) are treated immediately and vigorously by a trigger point specialist (massage therapist), and perpetuating factors (conditions that aggravate and perpetuate the TrPs) are eliminated or controlled, TrPs can often be eliminated quickly. Unfortunately, if a TrP is left untreated or muscle action is restricted to avoid pain, the TrP usually becomes latent. A "latent" TrP doesn't hurt at all, unless you press it. You might not even know it's there. It weakens and prevents full lengthening of the affected muscle. If the muscle is pushed to work in spite of the pain with physical therapy, especially if perpetuating factors exist, active TrPs may develop secondary and satellite TrPs. TrPs seem to form throughout life as a response to many things that happen to our bodies — overuse, repetitive motion trauma, bruises, strains, joint problems, etc. Pain creates a neuromuscular response, and the muscle around the pain site tightens, "guarding" the hurt area. An active TrP not only hurts when it is pressed but it "triggers" a referred pain pattern not at the site of the trigger-point origin, but remote from it. The pain is often described as spreading or radiating. A latent trigger point does not cause spontaneous pain, but may restrict movement or cause muscle weakness. This is not a onetime fix and is an intervention of treatments by a skilled trigger point therapy specialist. How many treatments depends on how long you have had the pain and how your body responds to the therapy. You may feel sore the next day after therapy and may even feel worse before you start to feel better. The therapy is intense and painful for most but in order to become pain free and manage the pain, you must be patient with your body’s response and attend regular sessions as suggested by the trigger point therapy specialist. The minimum is once per week and depending on the severity of the pain more sessions per week may be required. The more aggressive you are with the treatment in the beginning of therapy, the quicker the results. Then a maintenance schedule of one to two times per month should be followed. You will want to insure the pain does not return and make the appropriate changes in your lifestyle and avoid those indicators that have caused the trigger points. If physical therapy and other pain management protocols have not worked to resolve your pain, then the trigger points likely were never addressed.
Reid Medical Massage specializes in Myofascial Trigger Point Therapy and Thai Massage for deep and effective healing of chronic and nagging pain. Workers' comp, auto accidents, and Blue Options accepted.
Trigger Point therapy was developed by Janet Travell and David Simons, MDs, and is used to treat myofascial pain. They produced two large volumes of trigger point therapy and it has been around since the 1940’s but few doctors even know what trigger points are.
A classic trigger point is defined as the presence of discrete focal tenderness located in a palpable taut band of skeletal muscle, which produces both referred regional pain and a local twitch response. Trigger points help define myofascial pain syndromes. Acute trauma or repetitive microtrauma may lead to the development of a trigger point. Lack of exercise, prolonged poor posture, vitamin deficiencies, sleep disturbances, and joint problems may all predispose to the development of microtrauma. Occupational or recreational activities that produce repetitive stress on a specific muscle or muscle group commonly cause chronic stress in muscle fibers, leading to trigger points. Acute sports injuries caused by acute sprain or repetitive stress ( tennis elbow or golf shoulder), surgical scars, and tissues under tension frequently found after spinal surgery and hip replacement may also predispose a person to the development of trigger points. In the head and neck region, myofascial pain syndrome with trigger points can manifest as tension headache, tinnitus, temporomandibular joint pain, eye symptoms, and Torticollis. Upper limb pain is often referred and pain the shoulders may resemble visceral pain or mimic tendonitis and bursitis. In the lower extremities, trigger points may involve pain in the quadriceps and calf muscles and may lead to a limited range of motion in the knee and ankle. Trigger point hypersensitivity in the gluteus maximus and gluteus medius often produces intense pain the low back region. With proper and timely intervention, these TrPs can be broken up and eliminated. If chronic myofascial pain has persisted for some time, you may have fibrotic muscles and/or calcified areas at the attachment points. This usually indicates multiple perpetuating factors, and it will take longer work and a lot of patience to regain function.
Trigger points are often misdiagnosed by doctors and mistaken for other maladies as bursitis or nerve impingement. As a result, they prescribe pain medications for masking the pain or perform injection therapy of Botox, cortisone, prescribe physical therapy, or worse, surgery. These methods do not treat the source of the pain - that being the trigger point. Many doctors have not been trained in trigger points and don’t know how to treat them. If you have pain, they prefer to prescribe physical therapy; however, physical therapy does not treat the pain and trigger points directly. The physical therapist will have the patient perform exercises that often aggravate the trigger points and intensify the pain. If TrPs (Trigger Points) are treated immediately and vigorously by a trigger point specialist (massage therapist), and perpetuating factors (conditions that aggravate and perpetuate the TrPs) are eliminated or controlled, TrPs can often be eliminated quickly. Unfortunately, if a TrP is left untreated or muscle action is restricted to avoid pain, the TrP usually becomes latent. A "latent" TrP doesn't hurt at all, unless you press it. You might not even know it's there. It weakens and prevents full lengthening of the affected muscle. If the muscle is pushed to work in spite of the pain with physical therapy, especially if perpetuating factors exist, active TrPs may develop secondary and satellite TrPs. TrPs seem to form throughout life as a response to many things that happen to our bodies — overuse, repetitive motion trauma, bruises, strains, joint problems, etc. Pain creates a neuromuscular response, and the muscle around the pain site tightens, "guarding" the hurt area. An active TrP not only hurts when it is pressed but it "triggers" a referred pain pattern not at the site of the trigger-point origin, but remote from it. The pain is often described as spreading or radiating. A latent trigger point does not cause spontaneous pain, but may restrict movement or cause muscle weakness. This is not a onetime fix and is an intervention of treatments by a skilled trigger point therapy specialist. How many treatments depends on how long you have had the pain and how your body responds to the therapy. You may feel sore the next day after therapy and may even feel worse before you start to feel better. The therapy is intense and painful for most but in order to become pain free and manage the pain, you must be patient with your body’s response and attend regular sessions as suggested by the trigger point therapy specialist. The minimum is once per week and depending on the severity of the pain more sessions per week may be required. The more aggressive you are with the treatment in the beginning of therapy, the quicker the results. Then a maintenance schedule of one to two times per month should be followed. You will want to insure the pain does not return and make the appropriate changes in your lifestyle and avoid those indicators that have caused the trigger points. If physical therapy and other pain management protocols have not worked to resolve your pain, then the trigger points likely were never addressed.
Reid Medical Massage specializes in Myofascial Trigger Point Therapy and Thai Massage for deep and effective healing of chronic and nagging pain. Workers' comp, auto accidents, and Blue Options accepted.
