Therapies... - Massage - Myofascial Trigger Points

Myofascial Trigger Points

A myofascial trigger point has been defined as "a hyperirritable spot in skeletal muscle, associated with a hypersensitive, palpable nodule in a taut band of muscle" (Rattray). This spot is painful on compression and may give rise to characteristic referred pain or tenderness, motor dysfunction, and autonomic phenomena. (There are other types of trigger points, for example, periosteal or ligamentous, but for the purpose of this section, I will refer to myofascial trigger points as trigger points.) This may all sound severe and perhaps unusual. Although the pain caused by trigger points can be debilitating in some cases, they are very commonplace. In fact, Dr. Janet Travell and her colleagues estimate that trigger points become a painful part of nearly everyone's life at one time or another. Yet, trigger points receive very little, if any, consideration as a major source of pain and dysfunction in conventional western medicine. Often, when unrecognized, the symptoms of trigger points are diagnosed as neurotic, psychogenic, or behavioural in nature.

The symptoms of trigger points can manifest anywhere between painless restriction of movement to incapacitating pain. It usually presents as a poorly localized, regional ache in muscles and joints. Pain often refers toa distant site in a pattern that is characteristic of each muscle (referred pain pattern). Occasionally, there is numbness or paresthesia instead of pain. Trigger points can also lead to disturbances of autonomic functions such as abnormal sweating, persistant lacrimation and or acute rhinitis, excessive salivation, pilomotor activities (hair standing on end), vertigo, blanching of the skin over the injured muscle, and itchiness or nausea.

A trigger point is begun as an initial irritation of the muscle. After this trauma, the trigger point becomes symptom-free until a second perpetuating factor causes its reactivation. This secondary factor is usually some type of mechanical abuse via either an acute, sustained, or repetitive overload of the muscle. Leaving the muscle in a shortened position, as may occur during sleep, or secondary to another injury (arm in a cast) can also activate a trigger point. They can also be triggered by fatigue, stress, referred pain (from other trigger points), cold drafts, direct trauma, electrolyte imbalances, nutritional deficiencies, visceral disease, arthritic joints and joint dysfunction, anemia, chronic infections, emotional distress, and radiculopathy.

The pain elicited by trigger points are often mistaken for other conditions such as cardiac pain, appendicitis, toothaches, or fibromyalgia (note that fibromyalgia and trigger points are not the same thing but can occur concurrently). Trigger points in several different muscles are implicated in tension headaches. Therefore, rather than using analgesics to reduce pain, a massage that addresses the trigger points causing the headache can provide drug-free relief.

Hydrotherapy and stretching are often employed to help treat trigger points. They can also be treated using ischemic digital compressions, stretch-hold-relax technique, muscle stripping, and spray and stretch. They can also be treated through injection of the trigger point, however, this is out of the scope of massage therapy. All of these techniques cause a reduction of pain by inactivating the trigger point. Complete and effective treatment also requires dealing with the cause of the trigger point, identifying and correcting or eliminating any perpetuating factors, and helping to restore or maintain the muscle's normal function. A relaxation massage would also help in reducing the symptoms of trigger points. This is because their dysfunction is modulated by the sympathetic nervous system.