The trigger points are localized points in the muscle whose palpation evokes a stinging and annoying pain . They appear as “knots” of muscle and fascial tissue.
The human body is made up of 400/600 muscles (depends on the authors). Each muscle has an origin and insertion except the tongue. The muscle contraction allows the two leaders to approach, this entails the movement of the joint or body segment which is part of the muscle. For example, the contraction of the biceps allows the forearm to come closer to the shoulder.
Muscles are wrapped in fascia (as are many other structures in the body), which is essentially a supporting connective tissue. To give an idea, imagine you are wearing a very tight jumpsuit that covers the entire body, that’s the band .
So, if you pull a corner of the suit (trigger point, myofascial problem), you will unbalance yourself with the weight towards the direction of the pull. This is because the fascia is part of our self-support system called the “ tensegrity system ”, which is capable of self-regulating and modifying the structure with the aim of maintaining balance. However, on the other hand, trying to maintain balance, tensions could be created in areas far from the tension zone(trigger point). In this case we are talking about referred pains.
Hence, treating trigger points has become important to improve the effectiveness of the musculoskeletal system and the body as a whole. This is because, in addition to being painful in some cases, they can lead to pain in other parts of the body.
Trigger points: what they are
The term comes from English and literally means: ‘trigger’ (trigger, detonator) and ‘point’ (point). So, figuratively speaking, the point from which a blow starts, a pain, in this case, and from which it spreads.
Triggers indicate a clinical condition that consists in the continuous contraction of some muscle fibers , we are talking about activity on a microscopic scale.
An injury to the sarcoplasmic reticulum, a system of membranes within muscle fibers, can disrupt the balance of calcium ions resulting in excessive release . An excessive and prolonged release of calcium ions leads the muscle fibers to a prolonged contraction .
The consequences of this situation negatively affect the microcirculation, compressing the vessels that vascularize the muscle itself and therefore limit the correct supply of oxygen and consequently the blood supply. So nutrients hinder healing and this is how the muscle can become sore over time.
the trigger can be defined as a sore spot in the muscle tissue not caused by trauma, inflammation or any pathology.
A differential history is important to rule out any neurological problems .
The trigger point is painful on palpation and reproduces the sensation of pain that the patient complains. Be careful, because pain can be referred and not limited to the palpation area.
In addition, the pain may refer to a pinpoint nodule or to the entire contracted fascia.
On palpation you can appreciate a real “knot” , that is a small defined area where the density of the tissue increases.
Trigger point map
Types of trigger points
Trigger points can be active or latent.
The latent point is not symptomatic and does not cause referred pain . However, pain can be evoked by the therapist during trigger pressure. If from the point of view of pain perception, the latent trigger point can be seen as a less disabling problem in the short term, from that of therapy it can instead become a problem because total asymptomatology would delay the consultation of the therapist.
Instead, active pain can generate referred pain without being stimulated. For example, “I have a headache near the eye and when I massage the trapezius I also feel very localized pain”. Therefore, the referred pain, in the active trigger point, does not require stimulation, while the trigger point will be painful only on palpation.
Trigger point: causes of pain
Muscle overload remains among the most likely causes of the trigger point. As seen in the previous chapters, the impairment of the microcirculation does not allow the muscle to heal and the contracture is prolonged over time .
The limitation of nutrients, oxygen and energy leads to what is called the “energy crisis”.
Hence, intense physical activities and prolonged postures over time can lead to the development of trigger points, as well as direct trauma.
The pain, initially acute, tends to become chronic in subjects with incorrect daily habits such as:
- insufficient hours of sleep
- high psychophysical stress, etc.
Furthermore, the chronicity of pain triggers a self-powered circuit that will be all the more difficult to resolve the longer the curative intervention is delayed. Therefore, the trigger point can be defined as resolved from the moment it is “deactivated” , ie it is painful to palpation, and not only when the symptoms disappear.
Trigger Points : Symptoms
The main symptom complained by the patient in the event of an active trigger point is that of a deep puncture-like “stab type” pain that can worsen with certain movements. While a latent one, locally asymptomatic, could lead to limited pain in different areas of the body (referred pain).
Other associated symptoms can be muscle weakness and impaired function of the affected area.
The trigger pain changes a lot based on its location. For example, a trigger in the cervical area can lead to more important systemic symptoms such as headache and dizziness .
Therefore, it is not possible to generalize about the type of pain and symptoms caused by the trigger points.
Trigger points treatment: how to treat pain
The treatment of trigger points is useful both in the field of well-being and in the field of performance.
Generally, it is important to examine and treat them when musculoskeletal problems arise such as:
- muscle trauma
- joint overload.
But, the treatment doesn’t stop at musculoskeletal problems alone. In fact, it can be very useful to “deactivate” them even in cases such as:
- incorrect postures
- perception of lack of strength, for example ‘I feel my arm heavy’.
Furthermore, some points can affect the functioning of the autonomic nervous system , which is responsible for regulating basic and unconscious vital functions.
Therefore, it is important to underline that the treatment of trigger points must only be performed by therapists who plan, after a careful medical history, the ideal therapeutic path for solving the problem .
From a practical point of view, the treatment aims to promote the flow of blood and nutrients to the affected area .
The therapist locates the trigger point and puts pressure on the point creating a temporary ischemia (lack of oxygen) and releasing in order to increase the flow of blood (and therefore oxygen) to the area.
The technique is repeated until the perception of pain drops to satisfactory values.
Muscle energy techniques
The muscle affected by the trigger point is stretched and contracted while the therapist offers resistance. At the end of the contraction, the therapist uses the refractory moment of the muscle to increase the elongation .
By repeating several times, the technique aims to release the contracted muscle tissue.
It is a technique similar to acupuncture . It involves inserting a needle into the contracted muscle area with the aim of creating inflammation of the tissue with a consequent increase in blood flow.
Other methods to be used independently are active recovery, that is, an aerobic activity at a slow pace to improve the oxygenation of the muscles and eliminate waste.
In addition, the foam roller and other self-massage tools are recommended . In fact, these simple tools allow the patient to work independently on the painful area and treat the trigger points.