Getting the Point?

(Soft tissue Injuries, part three of a three part series)

Victoria L Magown, CMTPT, LMT, RMTI
and George S Pellegrino, LMT, CMTPT, RMTI

A growing number of people in pain have heard of “trigger points” or “Myofascial Release”. Many have even received “Trigger Point Work” or “Myofascial Therapy” but failed to benefit while others have received substantial or complete relief.

What exactly is a trigger point and how do you get them? And, why is there such a wide margin between success and failure when treating trigger points?

In Part 1 and 2 of this series we looked at the mechanism of persistent pain following a whiplash or soft tissue injury. The explanation offered was “pain chemistry”. Let’s take a closer look.

Trigger points can occur in any soft tissue of the body. Myofascial trigger points are points that spontaneously trigger pain. They form in “myo”, Latin for muscle and “fascia” which is connective tissue that includes tendons and ligaments.

We commonly use the term “pulled muscle” for a pain that occurs after playing sports vigorously or lifting a heavy box. The injury is the same weather it’s caused by a car accident, golf swing, gardening, musical instrument, computer work for hours at a time or holding a cell phone between your ear and shoulder when your hands are busy.

The painful injury is the development of a myofascial trigger point in the muscle or related soft tissue. The net result is pain we describe with a variety of terms such as tennis elbow, pulled muscle, sprained back, charlie horse, calf cramp, whiplash or a host of other colorful and descriptive language. They all have one thing in common; a point that triggers pain found in muscle or other soft tissue.

trigger point diagrams When found in muscle, a myofascial trigger point is identified as a painful knot. More specifically, it is a hypersensitive, self-sustained contracture. The contracture is a bunching-up of muscle fibers which, in turn, causes a taut band within the muscle from end to end. The taut band pulls relentlessly at the attachments causing a tearing we often describe as tennis elbow, shin splints or bursitis.

Taut bands produce and trap chemicals responsible for pain. This contributes to what we call “muscle memory”. When the contracture is stimulated by movement or pressure, pain is referred in predictable patterns, usually away from the trigger point. That is, there is usually no pain at the trigger point! The pain travels or more specifically, is referred elsewhere. (See illustration)

When searching for the “problem” at the referred pain zone, one rarely finds something to treat. This all too often leads to the assumption that the pain must be “all in your head”. Another aspect of trigger points is that they do not show up on an X-ray or MRI. As a consequence, David Simons, MD, internationally renowned physician and expert in the field of muscle pain said, ”Myofascial pain is the most common overlooked diagnosis in chronic pain”.

So why is there such a wide margin between success and failure when treating trigger points? The answer lies in the variance of training. Until recently, a standard for treatment of trigger points has been nonexistent. Working with educators from the United States and Europe including physicians and researchers specializing in the field of myofascial trigger points, the American Institute for Myofascial Studies has developed a standardized course of study and a protocol for treating trigger points.

Practitioners certified in Manual Trigger Point Therapy, including physicians, physical therapists, massage therapists, nurses and other licensed healthcare professionals receive specialized training in the identification, treatment and elimination of this elusive source of pain and suffering.

While most training focuses attention on modalities and techniques, the elimination of this ubiquitous source of pain requires an understanding of the neurobiology and pathophysiology of trigger points and the application of an entire treatment protocol. The application of the Manual Trigger Point Therapy Treatment Protocol by a certified clinician has become the most significant factor in a successful treatment.

< Part 2

If you’ve made a few ‘points’ of your own lately, come to MyoRehab. Getting to the ‘point’ is our specialty. Our phone number in Albuquerque is 505-872-3100.