What is a trigger point?

A trigger point is a knot in a band of muscle tissue, where several fibers are in a state of permanent contraction. Typically a trigger point is about the size of a pea, but it can also be as small as a pin-head. A trigger point keeps a muscle continuously under tension. In most people dozens of trigger points can be found and often you do not notice them at all in all day life.

How do trigger points develop?

The most frequent cause for a trigger point to develop is the overuse or overload of a muscle. Stress is often a contributing factor. A trigger point is the last resource available to the body to contract a muscle when there is no energy left. Another frequent cause is tissue damage. By tensing certain muscles, the body tries to protect the damaged spot. The brain infers from messages from the nervous system, that something has been damaged. Unfortunately those messages are not always reliable. Therefore trigger points can also be the consequence of a disturbance in the nervous system. Trigger points can also induce new trigger points themselves, as explained later on this page. It is not always possible to find out why a trigger point has developed. Sometimes trigger points continue to exist when the reason for them has already disappeared.

Trigger points and pain

Trigger points can arise from pain and can cause pain themselves. As a rule the pain is felt at a distance from the trigger point. The trigger point itself hurts only when you press firmly on it. As an example, the following drawing shows the pain pattern of a certain trigger point in the front of the neck. The black cross is the position of the trigger point, the red area and the red spots are possible places where the trigger point can send its pain. This is one of the body's worst trigger points, because it is situated so close to big nerve routes. Fortunately trigger points are usually latent, meaning that they shorten the muscle in which they reside but do not refer pain. On the other hand, an active trigger point radiates pain and can baffle patients as well as physicians, because nothing special can be found at the painful place itself.

[Scalenus trigger point, Travell & Simons Vol. 1 Figure 20.1A]
Source: Travell & Simons, Myosfascial Pain and Dysfunction — The Trigger Point Manual, Volume 1, Figure 20.1A.

Other effects of trigger points

Trigger points can also influence the autonomous functions of the body, such as the digestion, the circulation, the sweat secretion, the sense of balance and the vision. Because they disturb the balance between synergists (muscles that contract together to accomplish the same body movement), trigger points can also lead to misalignment of limbs and incorrect movement patterns, which in turn result in wear and tear in joints. The tension in muscles harboring trigger points can overload other muscles and in this way induce new trigger points. New trigger points can also develop in the area to where the trigger point sends its pain, for instance because the brain interprets the pain as tissue damage.

Trigger points can manifest themselves in still many other ways. Most of the ailments mentioned on my page Mobilising massage can be caused by trigger points. For further information I refer to the links in the last section of this page.

Although it is impossible to tell in advance if a certain condition is really caused by trigger points, it is always worthwile to try trigger point therapy, provided there is no indication of a serious injury or disease which would require immediate medical intervention: A trigger point treatment is reasonabley priced, safe and without adverse effects.

Treatment of trigger points

If a trigger point causes pain or other annoying symptoms, it makes sense to treat it. Generally, when a client comes to a therapist, the trigger points will have spread already as a long chain over the body. Treatment of a single trigger point in the chain makes no sense. Without treatment of the whole chain, the trigger point will return in no time.

There are many ways to deactivate trigger points. Generally a therapist will select the applied technique in accordance with his or her education. Techniques to release trigger points include, among others, injection of an anesthetic, stimulation by insertion of an acupuncture needle (dry needling), compression and deep tissue massage. The “Swiss approach” utilizes a combination of four special massage techniques to release stubborn trigger points. However, in my experience, the most important part of trigger point therapy is to trace and — as far as possible — treat the cause of the trigger point. If the cause continues to exist, the trigger point will return or it will not release at all.

All techniques that are directed directly to the trigger point hurt, including deep tissue massage. Nevertheless a correctly applied trigger point massage feels relieving at the same time. Conventional muscle stretching will not make trigger points disappear. However, a "fresh" trigger point can sometimes be deactivated by bringing the muscle in which it resides into a state of complete relaxation. Unfortunately this "soft" method has seldom an effect on old trigger points.

Further information on triggerpoints

The best place to learn more on trigger points is the web site of The Trigger Point Therapy Workbook by Clair Davies. At the moment, this is the most comprehensive book on trigger points written for laymen. Although this book is very well written, learning to find your way in your own body is not an easy task and it is possible that you will need additional guidance. When I started studying trigger points, I used the Trigger Point Self-Care Manual by Donna Finando as an additional resource. In the future, the position of Davies' trigger point book may get challenged by Valerie DeLaune's Pain Relief with Trigger Point Self-Help, which has been released in autumn 2011. Other useful places for general information about trigger points are Devin Starlanyl's web site and the site of the NAMTPT. There are also books available for the self-treatment of specific conditions, such as frozen shoulder, headaches and leg and foot pain.