Pain stemming from stiff, unresponsive muscles is part of your daily patient routine, but what do you when trigger points inhibit patients? Not only do trigger points sometimes misrepresent the actual location of pain in a patient’s body, but they are stubborn, relentless knots that can impede quality of life. Help restore movement in a patient by learning basic trigger point therapy techniques that can be helpful in solving location and pain frequency.
When massaging a patient pre- or post-rehabilitation treatment, you may come across muscles that feel dense, hard and non-pliable. If you probe the site further and find any pea-size or shape muscle knots, then you have most likely stumbled across a trigger point.
Created from muscle overload, a trigger point is a localized spasm in the muscle fiber. When your patients experience one of three types of muscle overload—acute, sustained or repetitive—a chemical reaction with acetylcholine and calcium in the sarcomeres signal increased muscle contractions in the affected area. This unnecessary tension in muscle fiber causes the sarcomeres to shorten via contractions while contraction knots grow tighter and develop into trigger points.
“They are often referred to as ‘the great mimickers’ because they do just that—mimic pain,” Heather Watson, a Rehab Specialist at Sport Spine and Rehab clinic said of trigger points. “If a trigger point is acute or active, it can be incredibly painful, and also refer pain elsewhere in the body.”
To further complicate trigger point treatments, where the patient feels the pain is not always where the trigger point is located. Many case studies have shown that patients can feel pain throughout entire muscle groups while the root cause is a single location behind a joint or buried deep in the tissue. Sciatica, plantar fasciitis, low back pain, trigger finger and frozen shoulder are all examples of chronic conditions worsened by trigger point pain.
“A trigger point in the upper trapezius can refer pain into the occipital muscles and cause a headache. Sometimes, the pain a patient feels is coming from an entirely different area than we thought” Watson said.
What can you do to alleviate some of this pain? Manual massage with digital pressure techniques has been proven to restore muscle function and dispel trigger points.
“Massage helps tremendously with trigger point treatment because it allows blood and oxygen into the surface tissue and reduces some of the inflammation trigger points cause” Watson said.
Make sure to use a smooth, consistent massage cream that penetrates muscle fibers without wearing out your hand strength when you tackle trigger point pain. When working on an affected area, apply consistent digital pressure, constantly checking with your patient about your pressure levels and pain levels. When you find the site of the trigger point, press into the knot for 30-90 seconds or until you feel the tissue change. Release all pressure once you feel the muscle tissue change, but you may still massage around the spasm site to re-lengthen the sarcomeres and reduce muscle tension.
You can further help patients reduce muscle tension and alleviate trigger point pain at home with select self-massage tools that promote myofascial release. These handheld tools can provide immediate relief and help patients maintain movement between clinic visits. From your massage therapy treatment to these at-home massage tools, your non-invasive healing will reduce muscle tension and assist with your overall physical therapy goals.
Watson herself knows firsthand how difficult it can be to locate and effectively treat a trigger point: “I had a colleague work on both of my upper traps before. He tried some myofascial release because I was just too tight to handle any deep tissue. The tissue was like a rock, and I was too tender for bodywork altogether,” Watson said of her personal experience. “With time he was able to get oxygen flowing and I felt a lot better. Admittedly, it was incredibly painful at the time, but caused amazing relief.”
1: Bond, Christian. “Massage + Trigger Points.” American Massage Therapy Association. AMTA, 2 Mar. 2015.