Trigger Point Therapy

A Method To Relieve Myofascial Pain

By Mahnoush Rodriguez
Last Updated: September 9, 2018

❯ Pain Management

Trigger point therapy is a method for treating muscle pain and myofascial pain syndrome.

In this article, you will get an overview of what myofascial pain syndrome is, what the trigger points are, how trigger points differ from tender points in Fibromyalgia syndrome, and how trigger point therapy works.

Important Note

DoctorsConvey does not provide medical advice, diagnosis or treatment. Never disregard professional medical advice or delay in seeking it because of something you have read on this website. Learn more

CONTENTS

Muscle Pain

Almost everybody experiences muscle pain at some point.
The pain can be the result of an injury, trauma, overuse, or strain.

Muscle pain often goes away by itself or with treatment in a few weeks.
But in some cases, the pain lasts long after the underlying cause has been resolved.¹

This changes the muscle pain into chronic pain.
When pain becomes chronic, it transforms into a disorder by itself and requires treatment.¹

Myofascial pain is often such a chronic disorder. It is one of the frequent reasons people visit their doctors or pain clinics.¹

Myofascial Pain Syndrome

Myofascial pain syndrome, also known as chronic myofascial pain, involves the muscle and its surrounding connective tissue.¹

The pain in myofascial pain syndrome:

  • is believed to be originated from myofascial trigger points.²
  • can be acute or chronic, however chronic pain is more common.¹·³
  • can be localized or widespread.³

There is a lot of confusion surrounding this condition.

For example, there is no agreed upon definition for myofascial pain syndrome in the medical field, and there are no definitive diagnostic criteria for it either.⁴

In short, the mechanisms that cause and perpetuate body pains in myofascial pain syndrome is not fully understood.

What does myofascial mean?

“Myo” means muscle and “fascia” refers to a sheet of connective tissue underneath the skin that encloses the muscles and separates them from each other.

The term myofascial refers to both muscle and fascia as likely contributors to the symptoms of this condition.¹

Myofascial trigger points

Myofascial trigger points play a central role in myofascial pain syndrome.
These points are sensitive spots in the muscles of the skeletal system.³

myofascial_trigger_points_taut_band_nodule

Trigger points are usually within the taut band of a muscle or in the muscle fascia.⁵

  • Taut band

A taut band is formed when a strand of fibers in the muscle becomes tight. Taut bands may also limit your ability to stretch the muscle fully.

The trigger points are associated with nodules in the taut band.³

  • Nodule

A nodule is a small amount of tissue that abnormally grows in the taut band. You may be able to feel it if you touch the skin carefully.

If you press the nodules, they may cause local pain, referred pain or a visible muscle twitch.³

❱ Local pain
Local pain is limited to a particular region of the body and felt only in the surrounding area of the trigger point.

❱ Referred pain
A referred pain is like a radiating or spreading pain that is felt far from the site of the trigger point.⁶

However, the presence of trigger points doesn’t necessarily mean the person has a myofascial pain syndrome.¹

Types of trigger points

Based on symptoms, trigger points are classified into two groups:

  1. Active trigger points
  2. Latent trigger points
① Active trigger point

An active trigger point is sensitive to touch and compression. If you press an active trigger point, it can cause local pain in the surrounding area.⁶

The pressure can also cause referred pain. In this case, you can feel the pain in another part of your body remote from the location of the trigger point.⁶

Sometimes, active trigger points cause pain at rest.⁶

However, there is no definitive evidence that active trigger points are the cause of myofascial pain syndrome.

② Latent trigger point

A latent trigger point is a trigger point that is physically present but does not cause spontaneous pain. However, it can cause local pain if you press it.¹

Both latent and active trigger points can cause muscle weakness, movement restrictions and limited range of motion.¹

Myofascial pain treatment

Medical professionals use several methods to treat myofascial pain syndrome.

Common treatment options include:⁵

  • Physical therapy and manual manipulation
  • Transcutaneous electrical nerve stimulation (TENS)
  • Frequency-modulated neural stimulation
  • Ultrasound
  • Massage
  • Injections
  • Acupuncture
  • Dry needling
  • Combined techniques (such as spray and stretch)

However, there is no substantial evidence to favor any particular treatment approach.⁵

Regardless of pursued methods, the primary treatment goals are to improve symptoms and function by:¹

  • Reducing pain and tenderness
  • Increasing range of motion


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Fibromyalgia Syndrome

Fibromyalgia syndrome should not be confused with myofascial pain syndrome.

Fibromyalgia syndrome (FMS) is a chronic condition with widespread muscle pain and increased pain sensitivity.⁷

The cause of fibromyalgia is unknown, but it seems to be a combination of genetic and environmental factors.

Some symptoms of this condition include:⁷

  • Aches, muscle tenderness, and stiffness
  • General fatigue
  • Sleep disorders
  • Cognitive decline
  • Mood changes

Some facts about Fibromyalgia syndrome:⁷

  • It affects 2–8% of the adult population.
  • It is the most common cause of widespread musculoskeletal pain in women between the age of 20 and 55.
  • It can co-occur with myofascial pain syndrome.

Tender points

In Fibromyalgia syndrome, 18 spots (9 pairs) on the body are defined as tender points. These tender points tend to be painful if pressed.

In the past, Fibromyalgia syndrome was diagnosed if the individual had widespread pain for 3 months or more in at least 11 out of 18 tender points.⁷

► Trigger points versus tender points

Myofascial pain syndrome and its trigger points are different than fibromyalgia syndrome and its tender points. Unlike trigger points, tender points don’t cause referred pain when compressed.⁶

Individuals who have both conditions may show overlapping symptoms that can make differential diagnosis difficult.⁶

Trigger point therapy only focuses on myofascial trigger points.


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Trigger Point Therapy: Self-massage

The majority of information in this section is based on the book by Clair Davies, and Amber Davies called The Trigger Point Therapy Workbook: Your Self-Treatment Guide for Pain Relief.⁸

It is one of the best books in trigger point therapy which I’ll explain more in just a bit.

Trigger point therapy is a type of deep tissue massage that alleviates pain by pressing or rubbing trigger points.

shoulder_trigger_point_release

You can get this message from a therapist specialized in this massage technique, or you can do it yourself.

Finding the source of pain

Trigger points can cause local pain where the trigger point is located, or referred pain somewhere remote from the trigger point.

Because of this characteristic of trigger points, it is essential to find the real source of pain.

In other words, you should figure out if the pain you are feeling is local or referred.

If you massage the spot where you feel the pain, and the pain is referred pain, then you are wasting your time and may even cause irritation in that spot.

This book can help

Below book is an outstanding resource for self-applied trigger point therapy and how to locate the source of pain.

the_trigger_point_therapy_workbook

The Trigger Point Therapy Workbook: Your Self-Treatment Guide for Pain Relief (A New Harbinger Self-Help Workbook)


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In addition to a thorough explanation of trigger point therapy, this book provides a detailed guide for a self-massage.

In the book, you can find the list of muscles with trigger point maps that show you which trigger points cause pain at a particular location of the body.

Using that you can discover the real source of pain.


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Trigger Point Release Techniques

Before you start the therapy, make sure you have a good understating of its safety measures.

leg_trigger_point_release

In addition to being safe, you should do the message effectively to see results.

Below are some techniques to make the therapy more effective:

  • Take a conservative approach
  • Do the massage strokes right
  • Use trigger point massage tools
  • Apply correct amount of pressure
  • Be mindful of the treatment duration and frequency
  • Prioritize trigger points for treatment

► Conservative approach

In a self-massage, a conservative approach with gradual improvement over time is the best bet. If you do the massage aggressively and force a release, there is a chance you hurt yourself during the process.

► Massage stroke

It is better to perform the massage in a series of short strokes across the trigger point nodule. Applying short, repeated strokes instead of static pressure is a better approach since it can cause less irritation and pain.

The massage strokes are done slowly and from one side of the tender spot to the other and preferably in one direction.

► Trigger point massage tools

The self-massage can be tiring and exhaust your arm and hand quickly. There are also some trigger points that you can’t reach with your hands.

Below trigger point tools can solve these problems for you:

  • Trigger point self-massage tool
  • Lacrosse balls
  • Massage stick
  • Foam roller
  • Deep tissue body massager

“I’m in pain all the time,’ I said, ‘and if I gave into it, then I’d do nothing.”

Bernard Cornwell, English author

girl_with_shoulder_pain

Buy one of the below tools for the therapy and manage your pain before it manages you.

Trigger point massager

trigger_point_self_massage_tool

Body Back Buddy Original Trigger Point Therapy Self Massage Tool


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This S-shaped massage tool has knobs placed in specific locations to let you massage trigger points all over your body.

By changing its angle and direction, you can reach and massage places like your back without exhausting your arms and shoulders.

Trigger point massage ball

lacrosse_balls

Kieba Massage Lacrosse Balls


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A lacrosse ball helps you release trigger points and tension by simply leaning on it. This way you can use your weight instead of your hands.

You can use the balls while you are sitting on a chair, laying in bed or on the floor.

These rubber balls are usually smaller than a tennis ball. You can take them with you wherever you go and use them whenever you feel the need.

Trigger point massage stick

massage_stick

Original Tiger Tail Massage Stick


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You can use this massage stick on trigger points that your hands can reach like your legs.

To use this hand-held foam roller, you simply rub it against the trigger point.

This stick enables you to apply a consistent pressure during the massage.

Trigger point foam roller

foam_roller

TriggerPoint GRID Foam Roller


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You can use this foam roller by rolling it over your muscles for trigger point release.

It comes in several sizes, and you can massage different parts of your body all at once.

For example, to massage your upper back, you can lay on top of it and use your legs to roll over it.

Deep Tissue Body Massager


deep_tissue_massager

RENPHO Rechargeable Hand Held Deep Tissue Massager


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You can use this hand-held deep tissue percussion massager to release trigger points.

It comes with different massage-heads that let you experiment to see which one works better for you.

It is also cordless with a built-in rechargeable battery.

► Pressure level

Feeling pain during massage is common.
A pain level of 5 on a scale of 1 to 10 is what the therapy aims for.

The pressure put on the trigger points shouldn’t be so firm that creates an intolerable pain.
Such pain is a signal from the body that something is wrong.

If you don’t pay attention to these signals, you may end up hurting yourself.

Remember, more pressure doesn’t translate into faster recovery.
In fact, it may even cause damage than healing.

The body has to take its natural course to heal and doesn’t respond to a forceful treatment.

► Duration and frequency

In general, each trigger point needs less than a minute of massage. Longer treatment is not necessary.

Ten to twelve slow strokes per trigger point for three to six times per day can do the job.

► Priority

If you have pain all over, try not to treat the trigger points all at once.
It is better if you give priority to the ones with the most pain.

As you experiment, you can learn more about your body reactions to the therapy.
When you see improvements, you can add new points gradually.


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Trigger Point Therapy Safety

No medical study has been conducted so far to assess the effectiveness or safety of trigger point therapy.
However, many people find pain relief through this therapy.

Still, keep in mind:

  • This therapy may not relieve pain for everyone.
  • It may take longer to get rid of the chronic and persistent pain.
  • Untreated underlying causes of pain can result in recurrence of active trigger points.

When you are doing a self-massage, you have to be careful not to cause any damages to your body.

The book mentioned above includes some safety instructions that can help you do the massage safely. 
But always consult with your doctor before doing any home treatments.

This is to make sure trigger point therapy is safe for you and your body can tolerate deep tissue massage without causing complications.

Here are two example of safety measures:

  • Never massage a pulse

If the trigger point is close to an artery, first find the pulse with your fingers and then move to the side to avoid the artery.

  • Avoid the lymph nodes

If the trigger point is close to lymph nodes, avoid them and just gently massage the nearby muscles. Do not press or pinch your lymph nodes.

Keep in mind excessive massage can cause irritation and bruises in your muscles and nerves; something you don’t want to happen.

Gradual improvements and patience are the keys to success in this therapy.

Meanwhile, listen carefully to your body signals and if you feel something is not right, contact your doctor right away.


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Considerations

Please note that the information compiled in this article is from a variety of sources and it may not be complete or timely. It does not cover all diseases, physical conditions, ailments or treatments. Always seek the advice of a doctor or other qualified health providers with any questions you may have regarding a medical condition. Never disregard professional medical advice or delay in seeking it because of something you have read on this website. Learn more

REFERENCES

[1] Shah, J. P., Thaker, N., Heimur, J., Aredo, J. V., Sikdar, S., & Gerber, L. (2015). Myofascial Trigger Points Then and Now: A Historical and Scientific Perspective. PM&R, 7(7), 746-761. doi:10.1016/j.pmrj.2015.01.024

[2] Cojocaru, M., Cojocaru, I., Voiculescu, V., Cojan-Carlea, N., Dumitru, V., & Berteanu, M. (2015). Trigger points – ultrasound and thermal findings. Journal of Medicine and Life, 8(3), 315-318. PMCID: PMC4556911, PMID: 26351532

[3] Ge, H., Fernández-De-Las-Peñas, C., & Yue, S. (2011). Myofascial trigger points: Spontaneous electrical activity and its consequences for pain induction and propagation. Chinese Medicine, 6(1), 13. doi:10.1186/1749-8546-6-13

[4] Gerber, L. H., Sikdar, S., Armstrong, K., Diao, G., Heimur, J., Kopecky, J., . . . Shah, J. (2013). A Systematic Comparison Between Subjects With No Pain and Pain Associated With Active Myofascial Trigger Points. PM&R, 5(11), 931-938. doi:10.1016/j.pmrj.2013.06.006

[5] Fleckenstein, J., Zaps, D., Rüger, L. J., Lehmeyer, L., Freiberg, F., Lang, P. M., & Irnich, D. (2010). Discrepancy between prevalence and perceived effectiveness of treatment methods in myofascial pain syndrome: Results of a cross-sectional, nationwide survey. BMC Musculoskeletal Disorders, 11(1). doi:10.1186/1471-2474-11-32

[6] Alvarez, D. J., & Rockwell, P. G. (2002). Trigger Points: Diagnosis and Management. American Academy of Family Physicians, 65(4), 653-661.

[7] Theoharides, T. C., Tsilioni, I., Arbetman, L., Panagiotidou, S., Stewart, J. M., Gleason, R. M., & Russell, I. J. (2015). Fibromyalgia Syndrome in Need of Effective Treatments. Journal of Pharmacology and Experimental Therapeutics, 355(2), 255-263. doi:10.1124/jpet.115.227298

[8] Davies, C., & Davies, A. (2013). The trigger point therapy workbook: Your self-treatment guide for pain relief (3rd ed.). Oakland, CA: New Harbinger Publications.