FAQ

What are Trigger Points?

Myofascial trigger points are a very common cause of pain. Trigger points are tight contracted areas in muscles that are stuck in a feedback loop of having pain, then being tight, then continuing to have pain. Trigger points are painful when pressed on and can cause a shortening of the muscle fibers. Trigger points have a special property in that they can refer pain or sensation to a different area from where they are located.

For example, there is a muscle at the top of your shoulder called the trapezius. When that muscle has an active trigger point you can refer sensation up the side of your neck into the side of the head and the temple causing a headache. Many muscles in the neck are the most common sources of headaches. There are even trigger points that could be found in the abdominal muscles in the front of the body, That can refer to strong pain in the back of the body and into the lower back and buttocks.

A trigger point is a tight, contracted area in muscles stuck in a feedback loop of having pain, then being tight, then continuing to have pain. Trigger points are painful when pressed on and can cause a shortening of the muscle fibers. Trigger points have a unique property in that they can refer pain or sensation to a different area from where they are located.

What is Trigger Point Therapy?

Trigger point release or trigger point pressure release is one portion of the manual therapy techniques that can be applied when utilizing the full and complete seven-step protocol for myofascial trigger point therapy. Trigger point pressure release is the pressure that is applied to an area in a muscle that has been identified as denser or more painful than the surrounding areas of a muscle. The trigger point areas have been mapped out for us by doctors Travell and Simons. Trigger point pressure release is applied most often with the client or patient having the area and a gentle stretched and supported position. Trigger point pressure release is a specialized massage therapy technique that is used with other techniques including contract-relax, PNF, stretch relax and hold, and muscle activation techniques. The therapist remains in constant dialogue with the client so that the trigger point pressure release remains below a discomfort level of a 6 out of 10 on the analog Pain Scale in which 10 is the most severe pain a person has ever felt.

During the trigger point pressure release the myofascial trigger point therapist will ask questions of the client as to the intensity of the discomfort, as well as we'll ask if this pressure is eliciting and he referred sensation to another location. Very often this referred sensation is quite familiar to the client and that is part of their referred pain pattern.

What does a Trigger Point feel like?

A trigger point can feel like a dense hyperirritable area within a muscle or group of muscles. A trigger point can feel very painful when it is being pressed on and has a unique quality called referred pain. Dr. Janet Travell and Dr. David Simons mapped out these referred patterns in the body.

What is Trigger Point Release?

Trigger point release or trigger point pressure release is one portion of the manual therapy techniques that can be applied when utilizing the full and complete seven-step protocol for myofascial trigger point therapy. Trigger point pressure release is the pressure that is applied to an area in a muscle that has been identified as denser or more painful than the surrounding areas of a muscle. The trigger point areas have been mapped out for us by doctors Travell and Simons. Trigger point pressure release is applied most often with the client or patient having the area and a gentle stretched and supported position. Trigger point pressure release is a specialized massage therapy technique that is used with other techniques including contract-relax, PNF, stretch relax and hold, and muscle activation techniques. The therapist remains in constant dialogue with the client so that the trigger point pressure release remains below a discomfort level of a 6 out of 10 on the analog Pain Scale in which 10 is the most severe pain a person has ever felt.

During the trigger point pressure release the myofascial trigger point therapist will ask questions of the client as to the intensity of the discomfort, as well as we'll ask if this pressure is eliciting and he referred sensation to another location. Very often this referred sensation is quite familiar to the client and that is part of their referred pain pattern.

What causes Trigger Points?

Many possible mechanistic situations can lead to the development of myofascial trigger points. Most often it is habitual, unconscious low-level muscle effort. This is the type of chronic, low tension effort in muscles that we don’t even know that we are holding. This could be a low-level tension in the upper shoulders (trapezius and levator scapulae muscles) that keeps our shoulders up towards our ears. After many hours and hours of this unconscious tension, trigger points develop in these muscles to conserve energy that is being used by them being held “at work” all day. Over time, the muscle fiber bundles undergo chemical changes that keep the contractile elements of the muscle cells stuck in the “contracted” position. (actin and myosin remain in the coupled position and are unable to relax due to a chronic shortage of ATP (adenosine triphosphate). ATP is the gasoline the cells use to fuel their ability to work and to relax. Since it takes 30% more ATP to RELAX a contracted muscle cell than to contract it, you can see how easily a shortage of ATP can prevent the muscles from fully relaxing.

Other reasons TrPs can form could include direct trauma to the muscles like with a blunt force, automobile accident, sports impact. Overload of muscles is also a mechanism of TrP formation. Carrying a heavy purse, lifting a heavy box in an awkward posture, or lifting a grandchild who is heavier than we think all could be examples of muscle overload.

We all have key postures that we live and work in. Postural stress is one of the most common ways TrPs can form. Poor sleep, work, gaming, sitting, and relaxing postures can leave our muscles stressed out and in chronic shortening or stretching. Sleeping on the stomach, for example, requires the neck muscles to be unnaturally twisted to one side as the head rests on one side. This places unnecessary stress on the stretched side, and also on the shortened opposite side. Hunching over at the computer on a poorly fitting chair, or flexing the neck far forward while texting or gaming on a phone also can create TrPs in the neck and chest muscles.

Unconditioned muscles are ripe for the formation of TrP.s One might think that laying around all day would leave the muscles nice and relaxed. On the contrary. Muscles need to have regular exercise; lengthening and shortening. Joints must be taken through a full range of motion (ROM) to ensure the health of the fascia as well as tendons, ligaments, and muscles. This ensures adequate blood flow and the exchange of waste and metabolic byproducts. Participating in unaccustomed activities can create muscle soreness. Painting an entire apartment could lead to pain or discomfort in the shoulder and arm muscles for a person who only paints walls two or three times in a lifetime. This new activity can lead to trigger point formation in the key shoulder and arm muscles. 

Reaching beyond our usual ROM can cause an overload of muscles and thereby formation of TrPs. After a full reach (like reaching from the driver’s seat for a briefcase in the back seat, can cause an eccentric contraction that we are not used to of the arm and shoulder muscles. As we return the briefcase to the front seat, we can feel pain or sensation in the muscles that just got used. 

What does it feel like when a Trigger Point is released?

During a full and comprehensive myofascial trigger point therapy session, there will be many types of Applied manual therapy including standard massage, trigger point pressure release, pmf, stretch, and relax. All these techniques are intended to normalize be contracted area within the muscle bundle that is stuck in any trigger point complex.

The application of trigger point pressure release can be mildly discomforting, but with two-way communication between the practitioner and the client, over a series of relax and hold technique as well as stretch techniques, many people report that the release of the trigger point feels like a warming sensation or the feeling of relaxation to a muscle that previously just could not relax. Many people report a feeling of relief as they have finally been restored to the full range of motion in an area that was held they contracted State due to the trigger points.

What happens when a trigger point is released?

When a trigger point has released the area of muscle tissue that has been stuck in the shortened or chemically contracted state finally has the ability to stretch and be fully relaxed. In this way, the contractile elements of the muscle bundle, specifically actin and myosin, are finally allowed to unlock and allow the contracted circle mirrors in the muscle cell to go back to normal resting length. If a trigger point is released there also is a new influx of chemically neutral blood into the muscle allowing a more normal function of the entire muscle.

What are the benefits of massage to the body?

There are very many benefits of Massage to the body as well as our overall health and well-being. It has been proven that applied massage therapy can reduce blood pressure, can reduce inflammatory and excitatory chemicals,. Massage therapy can reduce stress levels and can increase the feel-good chemicals like serotonin and dopamine. Since myofascial trigger point therapy utilizes many techniques from massage therapy, as well as creating lasting change within the muscle fibers, trigger point therapy also provides the same health benefits to the body as massage therapy does, but we can make lasting changes into the muscles and eliminate pain and dysfunction. 

Can myofascial pain syndrome be cured?

Myofascial pain syndrome is a multifactorial chronic pain state., and yes it can be cured. Many thanks to Devin Star lanl and her outstanding book myofascial pain and fibromyalgia. She has provided for us a road map identifying the medi perpetuating factors there can read to a myofascial pain syndrome. By following the 7-step comprehensive trigger point therapy protocol, a well-trained practitioner can work with the patient or client to uncover any of the key perpetuating factors that seem to be sustaining the myofascial dysfunction. Partnered with excellent well-trained applied myofascial trigger point therapy, the person suffering from myofascial pain syndrome is empowered with home care activities. 

They will be able to eliminate their chronic muscle tension, tight fiber bundles, and begin to restore normal function in muscles. With careful applied home trigger point pressure release using a variety of tools and techniques, followed by the complete range of motion as well as dynamic stretching activities, chronically tightened and dysfunctional muscle, tissue can be trained to be more normal and subsequently less painful Overtime and with repeated careful and gentle movement and applied home healthcare, we can down-regulate the central nervous system, reduce sensitivity to pain, and reduce the overall painful Sensations that are felt. In this way over time a person can be cured of myofascial pain syndrome, by learning how to better relax their muscles, how to sleep in better posture, how to live, and work in a better posture to keep the muscles in the best most highly functional shape.

What is the best treatment for neck and shoulder pain?

The best treatment for neck and shoulder pain is the 7-step comprehensive trigger point therapy protocol. The well-trained myofascial trigger point therapist will be able to identify that many muscles are found in the shoulder and mid-back that can create neck pain as well as shoulder pain. (See the illustrations here) The levator scapulae is a neck and shoulder muscle that can cause strong pain in the back and give us the feeling of a "stiff neck". Utilizing the road maps and the referred pain patterns that have been provided to us by Dr. Travell and Dr. Simons, a trigger point therapist will easily be able to identify muscles that can cause referred pain or sensation to the neck or shoulder area. Then by applying trigger point release techniques, stretching techniques, massage techniques, the trigger points in the identified muscles can be released. Here is a simple home care video for you to release the Trigger Points in the Levator Scapulae to relieve neck pain.

Why is my lower back pain worse in the morning?

Lower back pain can be worse in the morning probably due to five key factors. 

1. Stomach sleep posture during the night. Sleeping on the stomach can be the number one cause of low back pain upon waking up in the morning. This sleep posture puts the abdominal muscles in a stressful stretched position and can arch the low back, causing those muscles to be chronically shortened all night.

2. Side sleeping posture with one leg twisted over the other. This sleep posture can be a major contributor to lower back pain because it increases the torque or twisting forces in the low back, especially in the multifidus muscles.

3. The fetal position when used as a sleep posture, can chronically shorten the abdominal muscles. Keeping the knees up in the Torso scrunched forward chronically shortens not only the rectus abdominis muscles but also the psoas muscle which is a deep abdominal hip flexor. The abdominal muscles what harboring trigger points can cause low back pain that goes across the little back from one side to the other.

4. Sleeping flat on the back for some people can cause them to have lower back pain when they wake up in the morning. It is best when sleeping on the back to have a pillow underneath the knees providing a slight amount of knee and hip flexion allowing the abdominal muscles and hip flexors to be relaxed.

5. An old mattress: A mattress that is too old or too soft can certainly contribute to having lower back pain when waking up in the morning. Without proper support, the muscles in the lower back or abdomen can become stressed and chronically contracted, causing lower back pain in the morning. 

What are the first signs of frozen shoulder?

The first signs of a frozen shoulder: The first sign of a frozen shoulder is usually a slight discomfort or a feeling of weakness in the shoulder. Shoulder pain can be easy to ignore. Most people ignore this first sign and write it off as, "oh I did a little bit too much with my shoulder and now it's just a little bit sore". One of the other first signs of a frozen shoulder includes a slight loss of range of motion in the shoulder. That means the person is not able to move the shoulder as freely as they always have been able to, but again this first sign is usually overlooked as a temporary loss of a small amount of their function in the shoulder. As days move on, the shoulder loses more of its ability to function, and most importantly usually loses its ability to be raised out at the side, abduction, and also the shoulder usually loses its ability to be rotated either inward or outwardly. As the shoulder loses more and more function, (becoming a frozen shoulder) the person realizes that they can't do their standard activities of daily living including clasping a bra strap behind the back, reaching back and put on their coat, reaching outward to pick up things, place things on a shelf, or inside a cabinet in the kitchen. For this reason, it is extremely important to contact a trained myofascial trigger point therapist and get in for treatment as soon as the first signs of "frozen shoulder" start to appear.

What causes shoulder pain that radiates down the arm?

Shoulder pain that is felt radiating down the arm can be caused by the scalene muscles that are located on the front side of the neck. (See the illustration of this muscle's pain pattern here) The Scalene muscles, when harboring trigger points, can refer pain, or other types of sensation into the front of the shoulder, into the back of the shoulder, into the front of the chest, into the area between the same side shoulder blade, or all the way down the arm into the thumb and first two fingers. The Sensation that is felt into the shoulder and down the arm can be felt as pain, or a shallow nagging sensation, or like tingling, or like a sense of numbness, or it can be felt is a sense of weakness, or it could be felt like a deep aching within the shoulder radiating all the way down to the arm. Six other muscles can radiate into the shoulder and down the arm, including the serratus posterior superior, the pectoralis major, and the pectoralis minor, the infraspinatus, the subscapularis,. These muscles, when harboring trigger points, can refer to sensation down the arm, into the hand and fingers. 

What are the side effects of a deep tissue massage?

The side effects of deep tissue massage can vary from person to person. This can depend on the depth of pressure or can depend on the health or wellness of the person receiving the treatment. For an athlete or exerciser, often the side effects are minimal. Those people are used to exercising their muscles and usually tolerate deep tissue massage well. For persons who may not be healthy or fit, deep tissue massage can leave them with a feeling of soreness in the muscle areas worked on. While myofascial trigger point therapy is considered a specific type or technique within the massage therapy field, myofascial trigger point therapy is different from what is currently termed "deep tissue massage". Myofascial trigger point therapy is a complete and comprehensive 7-step protocol involving clinical reasoning, history, applied techniques client education, and Home Care education. Deep tissue massage is often thought of as a deep stroking massage that can be used to be applied using the elbow to forearm, wrist, or hands. Deep tissue massage is usually characterized by very high painful pressure and using moving strokes or needing techniques to almost assault the soft tissue of the body. Side effects of deep tissue massage can include post-session soreness, slight bruising, a sense of feeling like you just got hit by a bus, a little bit of increased pain, or sensation during active movement. Some people may be sore from deep tissue massage for up to five to seven days. In contrast, there are few if any side effects to myofascial trigger point therapy.

How long do trigger points take to heal?

Myofascial trigger point therapy is comprehensive and complete. The seven-step protocol includes clinical reasoning and history taking. The time that it will take for trigger points to heal can vary depending on the completeness that a practitioner has undertaken to include all steps of the full treatment protocol. Trigger points can heal quicker when the client is engaging in-home applied self-care including trigger point pressure release. This trigger point myofascial release can be performed with gravity using tools such as a tennis ball, a backnobber, a Tigertail handheld foam roller, a 5-inch football. These tools will be used to apply trigger point pressure release to the tight fiber bundles in the muscles. After the application of this technique at home, each person can utilize full active stretching and dynamic range of motion two more normalized the relaxing state of the tight fiber bundles. Does Homecare could be applied as many as three to five times per day up to 4 to 7 times per week. When a home care regimen is performed by the client or patient, trigger points can heal much more rapidly than just with the in-clinic applied trigger point therapy protocol. When a person has actively engaged in their case management, trigger point areas can heal much more quickly.

Where are trigger points?

Trigger points are taut areas of muscle tissue locked in the contracted state which can cause referred pain or sensation. The key is that the cause of the pain, or the trigger point, can be found at a site that is in a far-distant muscle from where you actually feel the pain.
So, just focusing on where it hurts doesn't get to the source of the problem or the trigger point causing the pain. Because myofascial trigger point therapists are experts in identifying where the trigger points are located based on your pain or symptoms, we can treat the contracted muscle that is dysfunctional, thereby relieving the pain at its source and restoring full-function in the muscle.

What is myofascial pain?

What is myofascial pain? Myofascial pain is a type of sensation that is caused by tight bands in muscles called Trigger Points. Myofascial Pain Syndrome is a group of symptoms or "syndrome" in which myofascial trigger points can cause a cascade of problems and dysfunction in many muscles and many areas of the body. These problems cause loss of function, reduction in strength or endurance, and can wake us up at night or cause disrupted sleep.
Myofascial pain can be felt in many ways. It is a referred sensation that is caused by a primary trigger point, a tight contracted area within muscle fibers. Myofascial pain can be described as dull or aching, deep, or burning, or tingling, or as a sense of numbness, or as a sense of weakness, or as a combination of all or some of the above sensation and problems.
When a trained trigger point therapist creates a comprehensive treatment plan, to identify, treat, and restore the full function of two muscle groups, then myofascial pain can be eliminated.

To make full and lasting changes in muscle function, it is important that the client also performs home self-care to keep the areas relaxed and free of trigger points.

What does it feel like when a knot releases?

Many people refer to trigger points as "knots" that can be felt bunched up in the muscle. Some people describe them as feeling like; "the muscles are so tight, they are tied up in knots!" What we really know now based on the scientific research, is that those tight areas that feel like they are tied up in knots are actually contracted fiber bundles that are stuck in a shortened state, preventing the muscle from relaxing, preventing the muscle from working very well, and causing pain or various types of sensation.

After these areas are identified and treated using trigger point pressure release, it can feel like a sense of tremendous relief! Some people feel like a warm, but most people don't feel anything at the exact moment, but after the therapist encourages the area to be stretched and fully lengthened and moved, people, report happiness because they are able to use that area without any pain.