What is Trigger Point Therapy?
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Each muscle when it gets over-contracted has a release point
or trigger point. It is usually somewhat tender and can sometimes
radiate to other spots or regions above or below the trigger
point being treated. Janet Travell, MD in her classic two
volume set entitled
Myofascial Pain and Dysfunction
- The Trigger Point Manual
describes in detail not only what these points represent,
but how to locate the points and treat them. The superb illustrations
make finding the points a breeze. This two-volume set is a
must for the professional therapist! In addition, we offer
Acupressure's Potent Points and Acupuncture With Your Fingers
each good for point location based on symptoms.
What we as therapists see when we treat patients with active trigger
points are specific spots or points in a given muscle that when pressed
elicit some pain or discomfort and often but not always induce the characteristic
referred pain patterns. When the patient is able to relax into the discomfort
and utilize long slow breathing techniques the release that occurs can
often be dramatic and feel to the therapist like a "melting" away.
Instant relief is very common when the therapist hits and releases
an active trigger point. The therapy combines the release with a stretch |
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| How Are The Pressure Points Treated? |
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The amount of pressure used depends on the musculature of
the person being treated and upon how sensitive the person
is to pressure that elicits some discomfort. Someone who is
small framed and delicate might require much less pressure
than a heavier, muscular person. Communication with the patient
being treated and the resistance you feel will tell you if
the pressure is appropriate. Facial expression is another
indicator of how the amount of pressure is affecting the patient.
A patient with an acute condition could be more sensitive,
therefore less pressure might be appropriate. If I'm in doubt
about the pressure, I'll ask the patient on a scale of one
to ten if one is I can't feel it and ten is I can't stand
it another second, we need to work in the 5-7 range. I tell
the patient that if we extend beyond the 7 range to let me
know. Some of the athletes require the maximum pressure I
can apply to get the release while with others slight pressure
is adequate. There should be some discomfort when the pressure
is first applied then it should decrease or disappear as the
area releases. The best rule of thumb is to start out with
light pressure until you have a sense of what pressure is
appropriate for the patient you're treating.
Pressure should be applied from 10-45 seconds. In many cases
the therapist can feel the release take place. If the point
doesn't release you may want to go back later in the session
and retreat. The therapist should ask the patient being treated
if the discomfort has increased, remained the same, or decreased.
When the muscle releases there should also be a corresponding
reduction in the level of pain. Communication and participation
of the patient are paramount in determining if you're right
on the spot or point and if it has released or not. The therapist
can suggest the patient focus on releasing the muscles that
are holding the pain there |
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Another important concept to understand in this work is referred
pain. Each specific point has its area of referral, for instance
when compression is applied to the upper trapezius muscle
many patients feel the referred pain up and around the ear.
Each trigger point has its referral area and when the patient
experiences this it's important that the therapist assure
the patient that the referred pain is a normal response to
the treatment. The
2 sets of laminated wall
charts
that we offer provide an excellent referral resource for the
location of the points and the referred zones!
As with all deep therapy techniques, the therapist should
encourage the patient to take long slow deep breaths when
the discomfort is in the 5-7 range. The natural response is
to hold your breath when you feel the discomfort, therefore
the therapist must recognize this and encourage the patient
to breathe. The muscle release comes with the exhale. There
should be a significant reduction in the pain level! Keep
motion in the joint with stretches and activity!
A Typical Treatment Protocol For Low Back Pain
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To illustrate how to treat the points, I'll give you an
example of how I might treat someone using this therapy. For
reference and help in locating the particular points for each
muscle refer to either Myofascial Pain & Dysfunction,
Dr. Travell's books, or the trigger point wall charts
(see our book/charts page).
I have chosen low back pain as an example because so many
suffer needlessly. I begin by checking hip height and rotation,
then the same with the shoulder. From a supine position,
I palpate and release the psoas and ilicias. Prone, I would
start with palpating the erector spinalis muscles in the
lumbar region. From there I work toward the costal attachment
of the quadratus lumborum which is perhaps the most overlooked
muscle in cases of lumbar back pain. Proceeding to the gluteals,
checking each, paying particular attention to the gluteus
medius releasing the trigger points as you go. I then check
the sacral attachments of the piriformis and palpate carefully
on two points located in the belly of the piriformis which
are often active. It's also a good idea to check the insertion
of the piriformis at the superior end of the greater trochanter
of the femur as this is often involved. Cross fiber friction
massage works well here. The final area where active points
are often found are on the tensor fascia latae and its tendon
on the iliotibial band. It would be most unusual for someone
exhibiting low back pain not to have active trigger points
in one or more of these muscle groups. There are of course
other muscles involved in back pain, these are the ones
I check first. Immediate relief can often be the result!
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How I Use These Techniques Without Injuring Myself? |
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We must address the issue of protecting ourselves as therapists
in doing this work. Occupational injuries to therapists most
often involve damage to the hands, wrists and arms. This issue
came up for me after only two years of working. I developed
tendonitis in my thumb. Injury is one reason many shy away
from doing deep work, even though they know the effectiveness
of it. There is now a tool that was specifically designed
to allow therapists to do trigger point work and not injure
themselves. The
Thera*Press
enables the therapist to keep the wrist in neutral and allow
the pressure to be applied using the upper body. I will never
treat another piriformis without it!
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