What are trigger points and how can we recognise them?

Of all the approaches we take at the Wells Clinic, trigger point therapy has to be the most versatile because it can be done pretty much anywhere!

We obviously use a massage table, but it’s by no means essential and you can even carry out trigger point therapy through your clothing. It works really well on its own and can be used with other modalities — such as myofascial release and therapeutic hot stone massage — to greatly enhance their effectiveness.

But let’s start at the beginning: what is a trigger point and what actually triggers it? It’s an area of irritation found in muscular tissue and the associated fascia that is painful when compressed. It typically causes referred pain — that is, discomfort experienced somewhere else in the body — and it’s most usually found in a taut band of skeletal muscle.

In a nutshell, trigger points keep muscles shortened. Get rid of the trigger points, and the muscles lengthen naturally and regain their normal range of motion.

You can develop a trigger point as a result of muscle trauma, after a car crash, for example, or a fall, or after suffering a sports or work-related injury. Other trigger point triggers include muscle strain caused by repetitive movements (repetitive strain injury,(RSI)), poor posture — sitting in front of a screen for hours is a common culprit — stress, and some allergies.

A single event — often unremarkable at the time — can set off a trigger point that can haunt you for life if you don’t get it properly treated. This is because the body’s instinctive reaction is to protect itself by altering how you move, sit or stand and this puts abnormal stress on your muscles, tendons, ligaments and joints. In turn, this can restrict your blood flow and once that happens your body starts sending out ‘referred’ pain signals, making assessment and treatment even trickier.

SCM trp colourfulAmong the trigger points we most often see are those associated with the sternocleidomastoid — the large muscle that runs up either side of your neck to your skull — which commonly cause headaches and jaw pain. Trigger points in the piriformis, found, deep in the buttocks, can cause pain down the leg that’s often confused with sciatica, while quadratus lumborum — the deepest of our abdominal muscles — is often the cause of pain around the sacrum (the triangular bone between the hip bones), and can feel like sacroiliac pain.

You can experience trigger point pain as a dragging, stabbing, tingling, or burning sensation, or just as dull discomfort. You can feel it superficially or deep inside the muscle or joint.

Trigger points can also be at the root of what’s known as ‘autonomic referred phenomenon’, that is they cause symptoms you would never imagine originated in your muscles. Ringing in the ears (tinnitus) and dizziness can, for example, be triggered by the sternocleidomastoid muscle. It’s unfortunately not uncommon for such conditions to be misdiagnosed and lead to unnecessary tests and worry for the patient.

I will look at how trigger point therapy works in my next post.