September/October 2006

journey in health

Put pain under pressure
with Trigger Point Therapy

BY CHRIS O'BRIEN

A hundred years ago, in a typical day, the average man or woman chopped wood, carried water, hauled rocks and hoed rows and rows of vegetables. And even though they didn’t have treadmills or trainers, they got plenty of exercise and stretching. Now, most of us sit at computers and in cars most of the day, with the occasional golf or tennis game on the weekend constituting our primary exercise. As a result, we’re likely to develop all kinds of repetitive motion problems and suffer a vast array of modern soft tissue challenges. Whether it’s carpal tunnel syndrome, a little whiplash from a car crash or back pain from that golf swing, most of the discomfort related to these conditions can be connected to trigger points.

“When you overuse a muscle, or do something that forces it to shorten for an extended period, a trigger point can get created,” says Mark Durham, LMT, NMT, primary technique instructor at Colorado Institute of Massage Therapy in Colorado Springs. “This is a point of neurological hyper-irritability in the soft tissue that refers pain to another part of the body.”

For example, say you have one of those throbbing headaches right over your eye, and nothing you do seems to help. This could be an irritated nerve in the soft tissue of the neck. By soft tissue, we mean muscles, tendons and fascia, the web of thin connective tissue that holds everything together in the body.

That trigger point in the neck could have been caused by many things including a blunt injury such as a fall or car accident, or a repetitive motion injury, like cradling a telephone against your shoulder or sitting hunched over in front of a computer. Eventually, stress and strain in the soft tissue affects the nerves in a way that results in pain—your body’s way of letting you know something’s wrong. But the pain isn’t always located in the same place as the trigger point. A trigger point in the neck can cause a headache; a trigger point in the back may created pain in the legs or other areas of the body.

“And a trigger point might not just be causing referred pain,” says Blane Hurie, MsT, teacher at the Connecticut Center for Massage Therapy. “It may also cause other kinds of autonomic nervous system imbalances, such as nausea and pins and needles.”

A trigger point therapist locates the point of origin for the neurological signal of pain, attempts to alleviate that neurological imbalance using various techniques, and allows the soft tissue to return to a better or normal state.

“Trigger points can be latent, meaning you don't know they are there until someone presses on one, or active, meaning you are feeling pain now,” says Durham. “We find the muscles and the spots in the muscles that are referring pain to the body, and work the trigger points by compressing and manipulating those areas.” The ultimate goal is to relieve pain and restore or increase function or mobility of that part of the body.

How it works

All trigger point therapy involves placing some kind of pressure on the point. The technical term for this is “ischemic compression,” which means putting pressure on the point to reduce or cut off the blood flow for a period of time. This temporarily takes the central nervous system’s attention away from that point of neurological imbalance and, combined with soft tissue manipulation, gives that area of the body a chance to return to a normal, balanced state.

“There are many different techniques for applying pressure, some which seem to contradict each other,” says Hurie. “These have come from the different innovators in the field. But they all have the same goal: to help the neuromuscular connection affect a release of the negative neurological pattern.”

Some practitioners like to stretch the muscle first (“stretch on”), some like it relaxed (“stretch off”). Some apply hard pressure, others light. And pressure can be held for two to three seconds or up to 90 seconds. It’s really a matter of schooling and training.

Some of the conditions best suited for trigger point therapy include head, back and other body aches and pains, both chronic and acute, and repetitive motion traumas such as cramps, stiffness and immobility. Trigger point therapy may also be used to treat fibromyalgia, a chronic disorder of pain and tenderness in the muscles and joints. While trigger point therapy can help with this condition, because of the intense pain associated with fibromyalgia, it’s usually not an effective treatment on its own. Rather, depending on the person, a combination of trigger point therapy and some kind of myofascial therapy usually works best.

The actual therapy can be a little uncomfortable because the pressure process involves activating those pain-causing points. However, this discomfort is typically temporary and affects lasting relief. Usually, a neuromuscular therapist will say something like, “On a scale of one to 10, 10 being the original/worst pain, don’t let me go past a six or seven.” This is important, because activating severe pain can actually be more damaging than therapeutic.

If you’re seeking trigger point therapy, your best bet is to find a neuromuscular therapist (NMT) who’s also trained in trigger point therapy. Other kinds of body workers, especially licensed massage therapists (LMT), physical therapists (PT) and chiropractors, may have trigger point therapy training as well. In most cases, the actual trigger point therapy is generally part of an overall treatment that would also include massage, chiropractic adjustments or some other form of body work; pressing trigger points isn’t something you’d want to endure for an hour, nor are long sessions necessary.

Because there are many different schools of practice for trigger point therapy, no official certification standards exist. However, you can look for practitioners trained in the practices of the field’s leaders. One of the leaders, and founders, of trigger point therapy was Janet Travell, author, practitioner and pioneer in the study of myofascial pain. She and her associate David Simons introduced the idea of manipulating trigger points to relieve referred (elsewhere-located) pain.

Another current leader in the field is Judith Walker, LMT, founder and director of the International Academy of NeuroMuscular Therapies, a certifying body that sets standards for the training of healthcare professionals in the use of NMT. Her trigger point therapy techniques are taught at the Colorado Institute of Massage Therapy in Colorado Springs.

When you’re selecting a trigger point therapist, start with a quick interview to find out where they’ve trained, what kinds of conditions they’ve worked on and what kinds of results they’ve achieved. You might also ask for a reference from a former or current client.

Because the trigger point therapy is woven into a traditional bodywork session, expect to pay what you normally would for a massage or similar treatment, about $50 to $90 an hour. You should expect to see results fairly quickly, depending on the condition, and you may be asked to make some behavior changes, especially in the case of a repetitive motion trauma.

Chris O'Brien is a freelance writer and consultant in the areas of health, wellness and personal success.

Resources for Trigger Point Therapy

• Travell & Simons' Myofascial Pain and Dysfunction: The Trigger Point Manual,
   by David G. Simons, Janet G. Travell, Lois S. Simons and Barbara D. Cummings. (Lippincott Williams & Wilkins, 1999)

• The Trigger Point Therapy Workbook: Your Self-Treatment Guide for Pain Relief,
   by Clair Davies, Amber Davies and David G. Simons (New Harbinger Publications, 2004)

• Soft-Tissue Manipulation: A Practitioner's Guide to the Diagnosis and Treatment of Soft-Tissue Dysfunction and Reflex   Activity, by Leon Chaitow (Healing Arts Press, 1987)

• www.mamashealth.com/fibromyalgia.asp; Quick definition of fibromyalgia
• www.mamashealth.com/massage/trigger.asp; Quick definition of trigger point therapy
• www.myofascialtherapy.org/advisory.html; National Association of Myofascial Trigger Point Therapists
• www.naturalhealers.com/qa/triggerpoint.shtml; Trigger point Q & A and national school directory
• www.thebodyworker.com/triggerpoint.htm; Definition, overview and more web resources
• www.triggerpointbook.com/index.html; Online workbook and info about Janet Travell