If the above image gives you the impression that a group of assassins are ready to fire on you, stay with that feeling. No one is immune. They hide in your muscles and sinews waiting for something or someone to activate them. Some gather in groups while others migrate to new territory, but more often than not they refer their pain elsewhere to trick you. They are trigger points.
A trigger point is defined as a hyper irritable spot within a taut band of skeletal muscle that elicits pain locally when compressed, but can also refer it elsewhere or be accompanied by muscle spasm. When touched, these spots can feel like hard nodules ( i.e. the “knots” we so often refer to in our backs and other body parts). It was Dr. Janet Travel, physician to the late president John F. Kennedy, that first came up with the term when she noticed that these points of pain tended to happen in predictable patterns that could be mapped out on the body. Her maps can be found in the 2 Volume book she wrote with David G. Simons, “Myofascial Pain and Dysfunction: The Trigger Point Manual.”
How do you know if you have one or more of these bad boys lurking in your tissues? There are a few characteristic symptoms which include sensitivity to pressure in a muscle, stiffness accompanied sometimes with a pulling sensation emanating from a particular point in the muscle, pain that refers from the point compressed to another area of the body and pain that has a dull, aching or burning quality to it. Other symptoms sometimes experienced are various autonomic phenomena like dizziness, sweating and fever as well as headaches, numbness, loss of range of motion and dysfunction of the muscle involved. While the cause of trigger points remains a much disputed medical topic, it is safe to say that they most commonly occur when muscles are chronically overloaded, as in the case with occupational and exercise overuse, injury and poor posture. Also, chilling of a muscle (i.e. catching a draft or having an air-conditioner blow on you) and the position in which you sleep can also create these points. Sometimes these points are even triggered by emotional and stress related events.
Any qualified massage therapist (ME!) possesses the skills needed to deactivate these points and treat the surrounding tissues. In my opinion, your first course of action should be massage therapy. Thereafter, if the points do not resolve within a few treatment sessions, you should be referred to a chiropractor, osteopath or physical therapist, all of whom employ more aggressive treatment measures. The protocol used to address trigger points via massage is a combination of sustained compression of the point followed by cross fiber friction and deep strokes in the direction of the muscle fibers to clear out metabolic wastes and encourage the flow of blood into the affected area. I am a huge fan of a myofascial technique known as skin rolling. It literally involves me picking up your skin and rolling it along different angles between my fingers, almost like cookie dough. This is an important diagnostic tool for me to find these stuck points, especially if a client is unsure of the location of their discomfort. The sustained compression of these points temporarily stops the pain signal coming from the brain and the flow of blood to the area, so that when it is released, blood literally floods the point and washes wastes away. The first compression is always the worst because the pain level will be greatest then. It is super important to breathe through the 8-10 second count, as the point is held. On a scale of 1 to 10, the pain/discomfort should be around an 8. With each subsequent sustained compression (about 4 in total) the pain level will dissipate while the force of compression stays about the same. During these compressions, many clients will break into a sweat or become hyperemic (flushed) in the area of the trigger point. Sometimes there are twitches in the muscle or surrounding tissues near the point being worked on. Even stranger, the point can move while I am compressing and I literally have to chase it through its migratory path until I shut it down. Once the compressions are finished, the point is rubbed vigorously in a cross fiber pattern between 1 to 5 minutes and then all the fibers of the muscle get treated to a nice and slow, deep rub down. I like to then apply a bit of heat in the form of a heated dry towel (no more than 10-15 mins on) or a topical irritant like Tiger Balm.
Best case scenario, trigger points will get resolved in one intense session, but more often than not, multiple sessions are needed to deactivate years of evil. It’s extremely important to assess what is going on or has happened in your life, both physically and emotionally that, although your brain might have dismissed, your muscles and tissues beg you to notice. This awareness will help you focus your attention back onto yourself and deal with the baggage at hand because trust me, your muscles have better, more productive things to do than carry the weight of the world in their nooks and crannies.
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NOTE **Read personal trainer, running coach and kayak instructor, Jeanne Andrus’s post about her experience with Trigger Points. I think it to be a helpful read: