What Are Trigger Points?

“Trigger points” are areas of cells in the muscle that are locked in a dysfunctional cycle – blood flow has been reduced, and metabolic wastes are not being exchanged for oxygen and nutrients. If enough trigger points are located together, these form the “knots” that you can feel when they are being pressed.

Muscle is the largest organ in the human body, and accounts for about 50% of its weight. There are approximately 400 muscles (there are individual variations), and any one of those can develop trigger points which can refer pain and cause dysfunction. Symptoms can range from intolerable agonizing pain caused by “active” trigger points, to painless restriction of movement and distortion of posture from “latent” trigger points.

What is Referred Pain?

Approximately 75% of pain is caused by trigger points. Trigger points may refer pain both in the local area and/or to other areas of the body, and the most common patterns have been well documented and diagrammed. These are called referral patterns. Approximately 74% of the time, trigger points are not located in the same place where you feel symptoms. This means that if you only work on the areas where you feel pain, you probably won’t get relief. In my books and webpage, you’ll find illustrations of common pain referral patterns that you can compare with where you feel pain, and this will help you figure out where the common trigger point or points causing your pain are located. Unless you know that you need to search in that location, you probably won’t resolve your pain. For example, trigger points in the upper portion of the trapezius muscle (between the neck and the shoulder) can cause headache or migraine pain in the temples, the base of the skull, in the angle of the jaw, and possibly above the ear and over the eye.

What Causes Trigger Points?

Trigger points may form after a sudden trauma or injury, or they may develop gradually. Common initiating and perpetuating factors are mechanical stresses, injuries, nutritional problems, emotional factors, sleep problems, acute or chronic infections, organ dysfunction and disease, and other medical conditions.  To get long-term relief from trigger points, you need to eliminate the perpetuating factors that cause and keep trigger points activated.  Both books contain extensive sections on identifying and resolving these crucial perpetuating factors.

What Happens When You Leave Trigger Points Untreated?

When people first develop some kind of pain problem, they usually wait to see if it will go away. Sometimes it does, and sometimes it doesn’t. The problem with “waiting to see” is that when trigger points are left untreated, muscles can be damaged, and eventually changes to the central nervous system can lead to a vicious cycle of pain.

What are Trigger Point Self-Help Techniques?

You can easily treat trigger points yourself by applying pressure using your hands, laying on a ball (such as a tennis ball), or using a tool \.  Gentle stretches also help.  Both books available on this website guide you through these safe, effective techniques to lead you to .

 

More Trigger Point Information

•  When pressed, trigger points feel like “knots” or tight bands in the muscle, and are usually very tender. Healthy muscles usually do not contain knots or tight bands, are not tender to pressure, and when relaxed, they feel soft and pliable to the touch, not hard and dense, even if you work-out. When trigger points are present, on the microscopic level, part of the muscle fiber is contracted into a small thickened area, and the rest of the fiber is stretched thin. Several of these muscle fiber contractures in the same area are probably what we feel as a “knot” in the muscle. These muscle fibers are not available for use because they are already contracted, which is why you cannot condition (strengthen) a muscle that contains trigger points. The sustained contraction probably leads to the release of sensitizing chemicals, producing the pain that is felt when the trigger point is pressed. Eventually some of the structural changes may be irreversible if trigger points are left untreated for long enough. The contractile portions of the fiber in the middle of the knot may separate and retract to each end, leaving an empty portion of the cell in the middle.

 

• Trigger points may refer pain both in the local area and/or to other areas of the body, and common patterns have been well-documented and diagramed. These are called “referral patterns.” Approximately 74% of the time trigger points are not located where you feel symptoms, and working on the area you feel symptoms does not give you relief. These referral patterns do not necessarily follow nerve pathways. Pain levels can vary depending on the stress placed on the muscle and any of other the perpetuating factors that keep trigger points activated. Tingling, numbness, or burning sensations are more likely due to nerve entrapments, which may be a result of trigger points entrapping the nerve.

 

• If the trigger point is “active,” it will refer pain or other sensations. If it is “latent,” it may cause a decreased range-of-motion and weakness. Active trigger points often start with some impact to the muscle, such as an injury, poor posture or body mechanics, repetitive use, or a nerve root irritation. Any of the perpetuating factors can also indirectly activate trigger points and make you more prone to developing trigger points that are initiated by impacts to muscles. Active trigger points may at some point cease causing pain, and become latent. Latent trigger points can easily return to being active trigger points, often leading the patient to believe they are experiencing a new problem, when in fact it is an old problem being re-aggravated. Latent trigger points can be reactivated by overuse, over-stretching, chilling, or any other of the perpetuating factors.

 

• In a study of thirteen healthy individuals with the same eight muscles being examined in each subject, two people had latent trigger points in seven of those muscles, two people had latent trigger points in six muscles, three had latent trigger points in five muscles, two had latent trigger points in three muscles, two had latent trigger points in two muscles, two had latent trigger points in one muscle, and only one person didn’t have latent trigger points in any of the eight muscles! This means that most people have at least some latent trigger points, which could be easily converted to active trigger points. This also means that some people are more prone to develop problems with muscular pain than others.

 

• With pressure on the trigger point, you can often reproduce the symptoms, but being unable to reproduce the referred pain or other symptoms by applying pressure does not rule out specific trigger points. I still work on the trigger points that could be causing the problem, and if my patient improves, even temporarily, I assume that one of the trigger points I worked on is indeed the source of the problem. For this reason, I don’t work on all the possible trigger points in one session, since I won’t know which trigger point treated actually gave the patient relief.

 

• Trigger points can cause symptoms not normally associated with muscular symptoms, such as sweating, ringing in the ears, dizziness, urinary frequency, buckling knees, and tearing of the eyes.

 

• Trigger points may cause other muscles fibers to contract. They will also cause weakness and loss of coordination of the involved muscles and an inability of the muscles to tolerate use. Many people take this as a sign that they need to strengthen the weak muscles, but unless trigger points in the affected muscle are inactivated, strengthening (conditioning) exercises will likely encourage the substitution of other muscles, further weakening and de-conditioning the muscle with the trigger points.

 

• Trigger points limit range-of-motion due to pain. Some muscles are more likely to have a larger degree of restriction than others. Once trigger points are relieved, range-of-motion is restored.

 

• Muscles containing trigger points are fatigued more easily, and don’t return to a relaxed state as quickly when use of the muscle ceases.

 

• Patients are often surprised that the same area on the opposite side is also tender, since that side isn’t causing them pain. Over half the time, the opposite side is actually more tender with pressure. Unless it is a recent injury, usually both sides eventually get involved (i.e., if the right mid-back is painful, there are also tender points on the left mid-back). For that reason I almost always work on both sides and tell patients to do the self-help on both sides. One possible explanation is that after the initial increase in sensitivity with trigger point activation, and the problem becomes chronic, the body releases pain-masking chemicals and numbs the side of the original pain out somewhat (hypoesthia), and that has not yet happened on the opposite side.

 

• Women are more likely than men to develop trigger points. I have noticed this is particularly true in menopausal women. Some teenagers (of both sexes) going through puberty also seem to have a tendency to develop trigger points, leading me to believe there is a connection between hormonal changes and one potential cause of trigger points.

 

• People who exercise regularly are less likely to develop trigger points than those who exercise occasionally and overdo it.

 

• Part of the current hypothesis about the mechanism responsible for the formation of trigger points is the “energy crisis component.” The sarcoplasmic reticulum is a part of the cell responsible for storing and releasing ionized calcium. The type of nerve ending that causes the muscle fiber to contract is called a “motor endplate.” This nerve ending releases acetylcholine, which tells the sarcoplasmic reticulum to release calcium, and then the muscle fiber contracts. If it is operating normally, when contraction of the muscle fiber is no longer needed, the nerve ending stops releasing acetylcholine and the “calcium pump” in the sarcoplasmic reticulum returns calcium into the sarcoplasmic reticulum. If a trauma occurs or there is a marked increase in the nerve endplate release of acetylcholine, an excessive amount of calcium can be released by the sarcoplasmic reticulum causing a maximal contracture of a segment of muscle, leading to maximal energy demand and impairment of local circulation. If the circulation is impeded, the calcium pump doesn’t get the needed fuel and oxygen to pump calcium back into the sarcoplasmic reticulum, and the muscle fiber continues to contract. This vicious cycle continues until there is outside intervention that stretches the contracted portion of the muscle fiber. The areas at the ends of the muscle fibers (either at the bone or where the muscle attaches to a tendon) also become tender as its attachments are stressed by the contraction in the center of the fiber.

 

• For a list of things that cause and keep trigger points causing pain and other symptoms, see the page on perpetuating factors.

 

This Website

Originally I wrote a book-on-CD ROM with much of the self-help techniques now found on this website.  As technology changed, videos needed to be changed to MP3, many laptops no longer had CD drives, and FlashPlayer no longer worked on all browsers.  So I finally moved to a membership website so that technology could be updated as needed, and new information could be added as it became available.  You may still purchase a Flashdrive option and other books on specific areas of the body (see the Store) rather than use the membership website.  Several sections of the website are free, and are noted in the page titles in the menu on the left.

To use the self-help techniques found on this membership website, first sign up here.  After becoming a member, go to the Pain Guides page and locate the areas of the body you feel pain and other symptoms, and click on the corresponding lists of muscles that may harbor trigger points.

There are two demo pages in the Pain Guide samples below – one for the trapezius muscle and one for piriformis pain.  For the full Pain Guides, go to this page.

 

“Thank you Valerie for a truly informative and valuable webinar.  Once I saw the advertisement for the webinar I looked at Valerie’s books and bought all of them from Amazon – they are fantastic!   I was also impressed to read the endorsement from Steve Lavitan… – that convinced me to buy the books but once I received them I have to say that they are filled with valuable information.  I not only found lots of new information but will recommend that many of my patients purchase their own copies as they are so useful.  I’ll be looking for a live conference in the Philadelphia area (sooner or later you’ll get here).  Best wishes to you Valerie.
Thanks again.”

MaryEllen Velahos, L Ac., Dipl. Ac.
The Center for Acupuncture and Traditional Medicine