Have you ever experienced shoulder pain that no amount of rubbing seemed to help? Or a deep dull pain in the wrist and forearm? How about reoccurring tension headaches? If you suffer from any of these ailments chances are that a ‘Myofascial Triggerpoint’ is the cause of the problem. In a previous article we learned how to use a tennis ball to work on triggerpoints that refer pain to the low back, pelvis and legs. Quite often Bodyworkers and Massage Therapists will advertise that they offer ‘Triggerpoint Therapy’. Many even have special education as a ‘Triggerpoint Therapist’. But what is a Myofascial Triggerpoint and how can a Massage Therapist help?
Drs. Travell and Simons in their book ‘Myofascial Pain and Dysfunction The Trigger Point Manual’ defined a triggerpoint as “A hyper irritable spot, usually within a taut band of skeletal muscle or in the muscles fascia, that is painful on compression and that can give rise to characteristic referred pain, tenderness, and autonomic phenomena.” Referred pain and autonomic phenomena can include headaches, sweating, goose bumps, sensations of pressure, tooth and jaw pain, ringing in the ear, dizziness, as well as muscular weakness and dysfunction. While it is true that our understanding of how pain works is changing and being updated everyday, much of what these pioneers mapped out still holds true.
A triggerpoint in the upper back might cause pain in the neck, or one in the shoulder might cause headaches. Triggerpoints in the temple area can cause tooth pain and some in the back of the head and upper neck will cause ringing of the ear or even visual effects. What’s more is that these points can create a cascade of problems. For instance a point in the shoulder can cause pain in the upper arm, which then contributes to a new point in the forearm, which sends pain to the wrist. Like the domino effect, each point contributing in turn to a carpal tunnel syndrome issue.
Triggerpoints are caused by muscular tension and pain/spasm response. This can be by gradual onset from a chronic holding/movement pattern or it can be the result of a traumatic event like a car accident whiplash. A triggerpoint can become ‘latent’, meaning it doesn’t cause any pain until triggered, or it can cause a constant referral. Old injuries often will often create latent triggerpoints that are then later triggered during activity. Thus one ends up with a ‘bum knee’ or a ‘trick shoulder’ that only hurts when one ‘overdoes it’. Another example would be chronic tension headaches that began months after a whiplash injury and never seem to get any better.
Drs. Travel & Simons recommended ‘Stretch and Spray’ (numbing the area with a refrigerant spray and stretching the tissue so that the triggerpoint is torn apart), injection or dry needling (so as to break the point up from the inside), and ischemic compression (gradually stronger pressure which elicits the referral response and blanches the tissue white).
Your Massage therapist can treat these points by applying the compression method. Ischemic compression is followed by stretching and flushing the tissue. Sustained deep compression forces all of the chemical agents out of the area and mechanically breaks up the point. When the compression is removed blood rushes to the area clearing away the chemical components causing pain and contraction response. Stretching and flushing the band of muscle fibers serves to further clear the tissue of chemical agents and helps to restore normal movement function to the tissues. Other neuromuscular ‘tricks ‘ might also be used in order to facilitate normal function.Trigger point therapy is used in medical and Sports Massage sessions.
Several treatments may be necessary to restore pain free movement. For a longer lasting effect, treatments should include identifying and changing the movement patterns which created the triggerpoint in the first place.
If you suffer from headaches, TMJ syndrome, repetitive stress syndrome, sciatica, whiplash, or any type of Chronic Pain, there are probably triggerpoints involved that your Massage Therapist can help you by combining triggerpoint therapy with other Medical Massage techniques.