What are Trigger Points?

Have you ever had a charlie horse or a muscle cramp?
If you have, then you know that they can be excruciatingly painful, and the pain can radiate over large regions of your body.

Although not precisely the same, I find it helpful to tell people that trigger points are like micro-charlie horses. Imagine that many of the muscles in you body have tiny little cramps in them. Under normal circumstances, you may not even notice these little cramps, but if you ever press on one the pain will explode and it will feel like its larger cousins.

A trigger point is essentially a painful tiny knot in the fibers of a muscle.
All of the muscles in your body are made up of bundles of fibers. The contraction of these fibers shortens your muscles and pulls on the bones of your body. The coordinated actions of muscles pulling on your bones is what makes it possible for you to walk, talk, cough, etc.

When a muscle receives a nerve impulse it contracts. When the nerve impulse goes away, the muscle stays contracted unless something pulls it back to its resting length. That's very important to realize; unless something pulls on a muscle, it stays contracted.

For reasons that are not precisely known, a single fiber of a muscle may stay contracted when the rest of the muscle has been pulled back to its resting length. I've simplified the anatomy somewhat, but that's essentially what happens, and the result is a trigger point.

Once you've practiced awhile, you will be able to feel many trigger points with your finger tips. A trigger point feels like a taught band in a muscle. Remember that all muscles are bunches of fibers. When the muscle is at its resting length, most of the fibers will be relaxed, but the "triggered" fibers will be tight since they didn't "let go".

Some of these taught bands will be very painful if you press on them, but not all. Whether painful or not, they are all interfering with the ability of your muscles to do work; if part of the muscle is always contracted, it can't perform as well as it should.

Trigger points often refer pain to other regions of your body.
This is very important to realize. For example, trigger points in your neck muscles can cause shooting pain behind your eyes.
If you have shooting pain behind one of your eyes, then you may find that the most effective treatment is to apply a cold pack to your neck.

I know this sounds counter-intuitive. If you head hurts, then surely you should apply the cold pack to your head... but that's not the case when the root cause is a trigger point in your neck.

If this sounds to you a bit like voodoo, rest assured that trigger point therapy is firmly based in Western Science.

Trigger point therapy evolved from the work of Dr. Janet Travell. Beginning in the 1940's, Dr. Travell conducted research on trigger points and referred pain. Her success led her to the post of White House physician for her successful treatment of John Kennedy. Dr. Travell's research, along with that of her colleague Dr. David Simons, has been published in the two volume set Myofascial Pain and Dysfunction: The Trigger Point Manual.

Travell and Simon were able to map where trigger points occur on most people. They were also able to map the areas of the body where pain is referred by each trigger point. The result is an accurate and repeatable guidebook that has proved its usefulness for countless patients.

Dr. Travell and Dr. Simon developed a treatment regimen for trigger points that required injecting each point with a painkiller, followed by passive stretching and the use of cooling spray.
Bonnie Pruden, an exercise and fitness guru, was the first to discover that trigger points can be "released" simply by pressing on them.

Pressing on a trigger point hurts. In some case pressing on a trigger point can hurt so much that it brings tears to your eyes and you jump up off the table. But pressing on a trigger point can also release them, eliminating the pain and muscle tension that they caused.

Learning to release trigger points effectively takes practice, but almost anyone can master the skill. Bonnie Pruden once taught a class of six-year-olds the basics. There's just no excuse not to try to learn yourself.

What to expect from a Trigger Point Session

Dealing with trigger points (TrPs) is a collaborative process. A good TrP therapist can locate and release your trigger points, but they will need your help to be most effective.

On your first visit your TrP therapist will ask you a lot of questions:

• Your TrP therapist will ask you questions about your medical history, particularly if you have had any accidents or surgeries
• Your TrP therapist will ask you about your occupation, recreational activities and other pastimes
  
• Your TrP therapist will ask you if you are under a lot of stress

The reasons for these questions are to help your TrP therapist determine what may have caused your chronic muscular pain and to safely find and release your trigger points.
Chronic muscular pain can be brought on by stress. The stress may be emotional, physical, or a combination of both. Knowing about your stresses helps your TrP therapist develop a plan of action.

Once you and your therapist have discussed your condition, the treatment will begin.
Depending on the areas of you body that need to be worked, you may be asked to disrobe partially or completely. During the session, you will be draped by sheets or towels to protect your modesty and to keep you warm. Draping is very difficult for some areas of the body, so in some instances you may be asked to wear running shorts, a jog-bra, or tights.

Your TrP therapist will begin by performing a seeking massage to locate your areas of muscular tension. Although your TrP therapist will be able to feel many of the taught bands that accompany TrPs, you will be asked to provide feedback. As your therapist palpates your body, you will be asked if the area is tender, and in many cases how you would rate the pain at a specific spot. Communication is very important. If you can help guide your therapist to the source of your pain, your therapist will be more effective in releasing the pain.

Your therapist will apply pressure to trigger points as they are located. This will most likely be painful, and in many cases the pain will "refer" to other parts of your body. Be sure to tell your therapist as soon as you feel any pain or discomfort; The pain is an indication that the therapist has found the right spot. The good news is that the pain should begin to fade as the therapist works the spot, and the result should be a release of your chronic pain.

TrP pain can be quite intense; many have described it as exquisite tenderness. If the pain becomes too intense, tell your therapist immediately to "back off" or stop. You are always in control. You are the best judge of the proper amount of pressure that your therapist should apply.

Your TrP therapist will also gently stretch your affected muscles and teach you corrective exercises to do at home. While you may find the exercises painful at first, they need to be done several times a day to be effective. Your TrP therapist can help release your trigger points, but only you can keep them from returning. Your health is your responsibility and your TrP therapist will encourage you to exercise more, eat a proper diet, and be conscious of the stresses in your life.

Unfortunately, TrP therapy is not a silver bullet, and a single TrP session will probably not dispel your chronic muscular pain. Your pain developed over time, and it will take time to reverse the process. Most people need about five sessions to feel better, but if you suffer from fibromyalagia or other myofascial pain syndromes, you may need regular treatments over a much longer period of time. Your TrP therapist should be able to tell within a few sessions whether or not you will benefit from further sessions. If you do not respond to the therapy, your TrP therapist will recommend treatment from other health care professionals.

book... Travell & Simons: Myofascial Pain and Dysfunction: The Trigger Point Manual

These volumes are "the Bible" for trigger point therapists. If you get really serious about treating trigger points, you'll buy these books, but there are less expensive options to start your studies. Janet Travell pioneered the medical discipline called trigger point injection therapy. Along with David Simons, she filed these volumes with the results of 40 years of clinical research.

book... The Trigger Point Therapy Workbook

Clair Davies book The Trigger Point Therapy Workbook is the product of a man on a mission. A master piano tuner for most of his adult life, Clair Davies developed chronic, unremitting pain to the point that he could no longer work. After a frustrating search for relief, he stumbled on to volumes 1 & 2 of Myofascial Pain and Dysfunction: The Trigger Point Manual, by Janet Travell and David Simons.

Through study of Travell and Simon's writings, Clair Davies was able to heal himself. The experience was so overwhelming that he gave up his job, entered massage school, and dedicated himself to spreading the word that people do not need to live in pain.

If you are going to purchase one book on trigger points, this is the one to buy. Clair covers all of the major trigger points of the body in a clear and easy to comprehend manner. This book is used by many massage schools, including the Texas Healing Arts Institute, to train trigger point therapists, yet it is designed for the individual. This book will teach you how to take care of yourself and your friends (It's the book that I give to my friends and family).

book... Pain Erasure the Bonnie Prudden Way

I first learned about trigger points when I came across a copy of the book Pain Erasure The Bonnie Pruden Way. Although somewhat dated since its first publication in 1980, this is a great book. I don't remember why I picked up the book, but I do remember my astonishment when I discovered my own trigger points, how much they hurt when I pressed on them, and how good it felt when they released.

Bonnie Prudden has probably done more to "spread the word" that people can treat their own trigger points then any other individual.

In 1976, Bonnie Prudden was working in conjuction with Dr. Desmond Tivy to help people who were sufferering chronic muscular pain. At that time, Dr. Tivy was offering the standard treatment option to his patients, trigger point injection therapy.
Trigger point injection therapy involves locating trigger points and injecting them with a solution of saline and procaine. This is a very effective treatment, but it requires a visit to the Doctor's office.

Prudden would assist Dr. Tivy by locating and marking trigger points on her clients before sending them for treatment. Purely by chance, Bonnie discovered that simply appying specific pressure to a trigger point can relieve the pain.

This serendipitous discovery led Prudden to begin teaching others how to locate and release trigger points, a modality she dubbed Myotherapy.

book... Tsubu: Vital Points for Oriental Therapy

Katsusuke Serizawa published this book on pressure points to demonstrate that Oriental medical science is a rational system substantiated by 3000 years of practical experience. The corellation between Tsubu pressure points and the trigger points mapped by Travell and Simons is significant.

John T. Reynolds: MSCSE, BSEE, NCTMB, RMT

I am a clinical myotherapist.

I am also a software engineer and I have a degree in electrical engineering.

This combination may seem like an odd combination, but when you consider the similarities between finding bugs in programs and tracking down the hidden causes of myofascial pain, the combination won't seem so jarring.

I like to solve problems, and when the solution to a problem frees someone from chronic muscular pain, so much the better.

I learned about trigger points several years ago through Bonnie Prudden's book on Pain Erasure. I was amazed to learn that chronic muscle pain could be relieved through such simple techniques.

My original training in massage therapy was through the Lauterstein-Conway School of Massage in Austin, Texas. David Lauterstein and John Conway are inspirational and caring teachers. I am very grateful for their help.

I continued my training in trigger point therapy at the Texas Healing Arts Institute, also in Austin, Texas. Studying under Dr. Kirsten Kern (Stan) and Dr. Eri Weinstein helped me to reach new levels of competence and skill. They're both simply awesome teachers and role models.

I currently offer Pain Management Massage at the Texas Healing Arts Institute in central Austin, Texas.