Best Physiotherapy | Trigger Point Therapy at Synapse Rehab

What is Trigger point? 

A Trigger Point (TrP) is a hyperirritable spot, often felt as a palpable nodule within taut bands of the skeletal muscles’ fascia. Applying direct pressure or contracting the muscle can cause a jump sign, local tenderness, a local twitch response, and referred pain that typically follows a pattern distant from the trigger point itself.

Jump Sign

The jump sign is a characteristic behavioral response to pressure on a Trigger Point (TrP). Individuals often react strongly to the intense pain, wincing or crying out in a manner that seems disproportionate to the pressure applied by the examiner’s fingers. They may involuntarily move or jerk a part of their body, such as the shoulder or head, that is not being palpated. This reaction reflects the extreme tenderness of a TrP and is considered pathognomonic for its presence.

Local Twitch Response

This response is defined as a brief, visible, or palpable contraction of the muscle and skin when tense muscle fibers contract due to needle penetration or transverse snapping palpation.

Referred Pain

It is also known as reflective pain, referred pain is perceived at a location different from the site of the painful stimulus. This pain does not follow dermatomes, myotomes, or nerve roots and is reproducible without causing specific joint swelling or neurological deficits. Pain from a myofascial TrP follows a distinct, discrete, and constant pattern or map, with no gender or racial differences, and can reliably reproduce symptoms according to the referred pain map.

Types of trigger points 

Active Trigger Points

Active trigger points cause pain even without applying pressure. They are a common source of myofascial pain and can occur anywhere in the body. Examples include headaches, neck pain, back pain (including sciatica), and knee pain. In diagnostic imaging, an “X” marks the trigger point location, and the red area indicates the referral pain pattern.

Latent Trigger Points

Latent trigger points cause pain when pressed and often refer pain to another area. These points are precursors to active trigger points. If latent trigger points worsen through strain, they can become active, resulting in pain that typically requires intervention.

Satellite Trigger Points

Satellite trigger points are areas where pain is referred. For instance, if shoulder pain refers to the elbow, the elbow contains satellite trigger points. Treating these points is crucial as they are part of the overall pain pattern, highlighting the need to address more than just the painful area.

Factors Contributing to Trigger Points:

• Aging: The natural aging process can contribute to the development of trigger points.
• Injury: Sustained from falls, stress, or birth trauma.
• Lack of Exercise: Particularly common in sedentary individuals aged 27.5 to 55 years, with 45% being men.
• Bad Posture: Includes upper and lower crossed patterns, swayback posture, telephone posture, and cross-legged sitting.
• Muscle Overuse and Micro-trauma: Such as from weightlifting.
• Chronic Stress: Conditions like anxiety, depression, and psychological stress can lead to trigger points.
• Vitamin Deficiencies: Lack of vitamins C, D, B, folic acid, and iron.
• Sleep Disturbance: Poor sleep quality can contribute to the development of trigger points.
• Joint Problems and Hypermobility: Issues with joints and excessive mobility can lead to trigger points.

How to diagnose trigger points.

Diagnosing trigger points involves a comprehensive approach that combines patient history, physical examination, and specific diagnostic techniques. Initially, a detailed patient history is taken to understand the nature of the pain, including its location, duration, intensity, and any factors that alleviate or exacerbate it. The medical history review includes past injuries, surgeries, chronic conditions, stress levels, sleep patterns, and lifestyle factors such as exercise habits and posture. Understanding specific pain patterns, such as headaches, neck pain, back pain, and other referred pain areas, is crucial.

During the physical examination, palpation is used to feel for taut bands or nodules within the muscle tissue, identifying areas of tenderness and noting any jump sign, which is a sudden, involuntary reaction to pressure on the trigger point. A local twitch response, where the muscle and skin briefly contract in response to pressure or needle penetration, can further confirm the presence of trigger points. Observing referred pain, where pressing on the trigger point causes pain to radiate to a different area, is another key diagnostic criterion.

Functional assessment includes evaluating the range of motion (ROM) and stiffness in affected muscles and joints, as well as muscle strength testing to identify any weaknesses or imbalances. Postural analysis helps to detect any abnormalities or compensatory patterns. Although diagnostic imaging is not typically used for trigger points, it may be necessary to rule out other conditions. Techniques like dry needling can also help confirm trigger points by eliciting a twitch response and symptom relief. Throughout the diagnostic process, patient feedback is crucial in verifying the accuracy of pain replication and the effectiveness of the examination and treatment. By integrating these methods, clinicians can accurately diagnose trigger points and develop an effective, personalized treatment plan.

Symptoms of a Trigger Point

Trigger Point Characteristics:

• Location: The nodule or band felt is within a muscle, not on a bone or nerve.
• Referral Pain: Trigger point referral pain differs from nerve pain. When pressing on a nerve, the sensation is like an electric shock or pins and needles. In contrast, trigger point pain is a dull pain that radiates.
• Persistent Muscle Pain: Muscle pain that persists or worsens with movement or exercise.
• Chronic Muscle Pain: Continuous muscle pain that doesn’t resolve on its own.

Physical Symptoms:

• Muscle Weakness or Imbalance: There may be weakness or imbalance in the affected muscle or related muscles, often leading to altered motor recruitment.
• Changes in Range of Motion (ROM): Patients may experience restricted ROM.
• Painful Movement: Movements may be painful and sometimes exacerbate symptoms.
• Accompanying Symptoms: Conditions like tension headaches, migraines, tinnitus, and temporomandibular joint problems often accompany trigger points.
• Postural Abnormalities and Compensations: Patients may exhibit postural abnormalities and compensatory mechanisms.

How is the trigger therapy?

There are several methods for releasing a trigger point. The most common technique involves applying sustained pressure using fingers, thumbs, elbows, or a massage ball or tool. This sustained pressure helps to relax the muscle and alleviate pain. Another increasingly popular method is dry needling, where a thin needle is inserted into the trigger point to release tension and promote healing. The effectiveness of dry needling is becoming more recognized, leading to its broader adoption in trigger point therapy.

The benefits of trigger point therapy

1. Improved Circulation: Trigger point therapy can significantly enhance circulation. Tight muscles often restrict blood flow, leading to problems like fatigue, headaches, and dizziness. By releasing these tight muscles, trigger point therapy improves circulation, which can boost overall energy levels and well-being.

1. Reduced Tension and Stress: Tight muscles contribute to tension and stress. Trigger point therapy helps release these muscles, reducing tension and stress and promoting a more relaxed state.

1. Improved Mobility and Flexibility: Tight muscles can restrict movement and decrease range of motion, making everyday activities challenging. Trigger point therapy releases these muscles, enhancing mobility and flexibility, allowing for a greater range of motion.

1. Better Sleep: Tight muscles can cause pain and discomfort, disrupting sleep. Trigger point therapy helps alleviate muscle tightness, leading to improved sleep quality.

1. Relief From Headache Pain: Tight muscles in the head and neck are common sources of tension and stress, often triggering headaches. Trigger point therapy releases these muscles, providing relief from headache pain.

1. Improved Posture: Tight muscles can misalign the body, leading to poor posture. Trigger point therapy releases these muscles, improving posture and reducing the likelihood of injuries.

1. Reduced Muscle Soreness After Workout: Regular workouts can leave muscles tight and sore despite good stretching routines. Trigger point therapy helps release these tight muscles, reducing post-workout muscle soreness.

FAQs

1. What is trigger point therapy?

Trigger point therapy is a treatment that involves applying pressure to muscle knots (trigger points) to relieve pain and restore mobility.

2. How long does a trigger point therapy session take?

Sessions typically last 30 to 60 minutes, depending on the number of trigger points and the severity of the condition.

3. Is trigger point therapy painful?

Some discomfort may be felt during treatment, especially when pressure is applied to sensitive areas, but this is usually brief and followed by relief.

4. How many sessions are needed for effective relief?

The number of sessions varies depending on the individual, but most patients experience relief after 3 to 6 sessions.

5. Can trigger point therapy help with chronic pain?

Yes, trigger point therapy is highly effective in treating chronic pain by releasing muscle tension and improving circulation.

Conclusion

In conclusion, trigger point therapy is an effective method for relieving pain and improving overall well-being. Synapse Physiotherapy offers this service, and you can receive this therapy from our registered physiotherapists.