Time Out for Trigger Point Therapy

Trigger Point Therapy is one of the things that convinced me to become a massage therapist. I had always appreciated the relaxation and feeling of well being that comes with a good Swedish massage but had no idea how much change a massage could make in every day health.

As many of you do, I worked at a desk for 8 hours a day. I spent a large part of that time on the phone, right shoulder cocked up to my ear holding the receiver in place while I typed on my keyboard. Or with my hand on the mouse. I had no idea the damage I was doing to my body on a daily basis. One morning I woke up after sleeping on my arm wrong with serious pain in my shoulder. And it just kept getting worse and worse. After numerous trips to the doctor and then the physical therapist I got the pain to manageable through icing and Advil. And it stayed that way for a long time.

I would like to say I am the only person in the world who thinks manageable is an acceptable level for pain, but I see it time and time again. We all do it. We get to the point where it hurts just a little less, where we can function again and then we leave it at that. This is really not okay. If your body is hurting it's trying to tell you that something is wrong.

Eventually I found an acupuncturist who specialized in what she called mousing shoulder. And she did a great job. What she explained to me is that I had trigger points in my back muscles and that they were causing the pain in my shoulder and my arm. She would place the needles directly in these trigger points that that would help them to feel better. This was my basic understanding of the procedure. Now, I had no idea what a trigger point was, but what she was doing was helping more than anything anyone else had done.

After starting treatment with her I had a massage scheduled at a local spa. During the intake interview the therapist saw that I had recently received acupuncture. I explained to her why and what it was doing and she let me know that she did trigger point therapy as well and asked if I would like to try. By this time I was open for anything that would make the pain completely go away so I said sure, have at it. And have at it she did. And that day getting off the table I had full range of motion back in my arm for the first time in years! It was amazing.

So when I started school to become a therapist I was very excited to learn how to do trigger point therapy and made sure it was one of my specialty classes.

So now you are probably wondering, what exactly is trigger point therapy? First off I am going to explain (very basically) how a muscle contraction works. Here we go...

When you think of your muscles you probably think of them as a whole, your biceps, your quadriceps, your triceps, your abdominals. Now as we have talked about before what you think of as your main muscles are most often individual muscle groups. And each one of those groups breaks down further into fascicles (or bundles of muscle fibers) and then the individual muscle fibers themselves. The contracting (or working) part of the muscle fiber is called the sarcomere. And the sarcomere is made up of actin and myosin strands. The actual muscle contraction is when the actin and myosin pull together (sort of like an elastic Velcro) and then when they release the muscle relaxes. Aren't you feeling smarter already?

So...trigger points what are they? Sometimes when the actin and myosin are supposed to release, they don't. Imagine a long thread of Velcro hook and eye closures. In the middle of that strand one or two don't come unattached when they should. In our example this thread was also elastic so now to reach the two anchor spots the thread has to stretch to reach meaning there is extra strain on the strand. Now imagine a small bundle of those threads all bunching up at the same spot. The rest of the group keeps doing its job, closing the gap, opening the gap, but this little bunch stays stuck. That's a trigger point.

Trigger points are different from your normal muscle soreness in a few ways. One is that they stay sore. If you have a workout and you work your muscles in a new way you expect to be sore for a few days afterward and then you get better. With a trigger point, that soreness doesn't go away. The most defining part about a trigger point is referred pain. A trigger point in one part of your body doesn't necessarily cause issue in that part.

Remember my shoulder and arm pain? It was caused by trigger points in my back. Specifically in my serratus posterior superior, supraspinatus and infraspinatus. Or my shoulder blade area (just showing off there!) The pain from those groups of trigger points caused pain in my deltoids (top of the shoulder) and down my biceps and triceps. During physical therapy I was receiving treatment directly in those areas and it did very little good. Both my acupuncturist and my massage therapist being familiar with referred pain patterns treated a completely different area of the body and brought relief.

So treatment of trigger points, what can you expect?

Trigger point therapy is a specialty subset of deep tissue massage. It's just more targeted. The particular type of trigger point therapy I learned relies on a large amount of muscle warm up. The reason is that trigger point therapy hurts. A lot. That therapeutic pain we talked about with deep tissue? Well if you are thinking in levels of pain, that's about a 4-5 and what we are looking for in trigger point is a good solid 7. We don't hold at that 7 for long, but we really want to reach it. The more I have warmed and prepared the muscle tissue the fewer times I have to go back to that 7 for the trigger point to release.

If you are coming in for trigger point therapy we are going to talk about what hurts. What you have done for treatment in the past and how long it's been an issue. I have a great series of charts we can use together to pin point where your areas of concern are. Then we start the massage. It works the same in the beginning as Swedish or deep tissue. Just warming the tissue. Then I will look for the trigger point. There is a line along the muscle tissue where the trigger point will most like form. When I feel what I believe is the trigger point I will ask for your feedback. When I apply pressure do we replicate the symptoms you were having? For instance, if you were to press on the trigger point in the top of my shoulder blade I would feel pain in my shoulder and my elbow. Referred pain = trigger point.

So now we have a trigger point that needs treated. I am going to go over the area a few times using a variety of strokes progressively working deeper into the muscle tissue. Then I will stop and apply direct firm pressure over the trigger point. This is where you breathe deeply and we count. Know that I won't hold that spot for longer than 6-8 seconds at a time. Then I will smooth the muscle out and do some light Swedish type strokes on the muscle (I call this making nice) and we will try again. Sometimes the spot is already gone, sometimes we need to repeat one or two more times. Sometimes you will feel the trigger point release and sometimes only I do and all you feel is the lack of referred pain when I press on the area again.

When we are done with an area I will finish some more nice work to smooth and sooth the muscles and most likely do some passive stretching to get the muscle thinking about how to work properly again.

Another thing to keep in mind with trigger points is that I can help get rid of them, but if you don't change the behavior that is causing them they are going to come right back. My shoulder issue? The entire time I had the job where I spent most of the day on the phone or mousing it kept coming back. As long as I kept on treatment for it, it never got as bad as the first time, but until I stopped that abuse on my body, my body kept reminding me it wasn't a good idea to sit like that!

So treatment is a partnership. I can help you feel better and I can give you suggestions on how to stay that way, but you have to do your part as well. Drink your water, ice the area we worked on, let's make a follow up appointment and I will see you again soon!

Trigger Point Therapy. It's amazing.