Massage Therapy: Trigger Point Massage Therapy

What are Trigger Points? Trigger Point (Myofascial)

• A trigger point is an area of hyper-irritability, within soft tissue structures characterized by local tenderness and sometimes referred phenomena. These referred sensations can include pain, tingling, numbness, burning or itching.
• Not all trigger points refer pain, some are just localized. Each person is different depending on his or her life history.
• Localized areas of deep tenderness and increased tissue resistance that often produce referred pain.
• The origin of the trigger point is thought to be changes in the chemical balance in a local area, irritating the sensory systems.

Active trigger point : Cause of the immediate pain, prevents muscle from fully lengthening and sometimes weakens.
Latent trigger point : Unnoticed by the person until pressure is applied, not actively painful. Usually, feels dense and fibrous.


• Trigger points may be associated with Vitamin B-6 and other vitamin deficiencies. Usually, after a trauma or stressful event, the body is lacking in B-6, magnesium or Vitamin C and trigger points are more likely to develop. Trigger point is usually bilateral, with one side being more symptomatic than the other. Both sides need to be treated.

• Trigger points may be a result of underlying visceral disease, arthritic joints, or other trigger points.

• The most tender trigger points are usually, not the source of the problem. Other areas need to be treated like the referral area and the surrounding tissue. Look for tight stringy band in small supporting musculature. Trigger points can cause referred pain, but not always.

• The referral patterns are not the same in any two people.

• Referred pain does not follow segmental, scleratomal or dermatomal patterns. May cause pain and stiffness especially, after periods of inactivity such as sleeping or sitting for a while.

Possible Causes

• Acute overload, overwork, fatigue, direct trauma, chilling skeletal asymmetry such as short leg or pelvic imbalances.
• Other trigger points can cause new points to occur.
• Arthritic joints can cause trigger points.
• Visceral diseases such as ulcers, renal colic, myocardial infarction, gallstones, kidney problems, irritable bowel syndrome can cause trigger points.
• B-6, magnesium, vitamin C, folic acid deficiencies, which are common after injuries or trauma may cause trigger points.
• Hypoglycaemia.
• Chronic infection from a viral or bacterial disease.
• Food allergies or intolerances. Wheat and dairy products should be checked first.
• Toxicity due to exposure to organic chemicals or heavy metals. Location

Trigger points may develop anywhere in the body, but are most commonly found at the sites of the greatest mechanical and postural stress.

Hints for Locating Trigger Points :

• Look for changes in thickness of tissue, resistance to gliding strokes, lumps or strings.
• Immobility.
• Oedema.
• Pain or tenderness.
• Temperature changes-area is usually colder.
• Colour – most often somewhat, pale and unhealthy looking.
• Muscle shortening with weakness.
• Occasionally, increased perspiration in reference zone.
• Hypertonicity.
• Ischemia.

Factors that can Worsen Trigger Points :

• Fatigue, improper sleep.
• Chronic infection.
• Severe stress (mental, emotional, physical).
• Nerve entrapment, compression.
• Postural imbalances.
• Nutritional health of the tissue.
• Food allergy, inhalant allergy.
• Visceral (organ) disease – gall bladder problems, ulcers, kidney problems.
• Irritable bowel syndrome.
• Exercise may worsen an active trigger point, but helps heal a latent trigger point.

Signs of Trigger Points :

• Restricted movement, stiffness of muscles.
• Weakness in muscles.
• Passive or active stretching increases pain.
• Resisted contraction causes pain.
• Subcutaneous tissue feels coarsely granular, ropy, knotty.
• The person “jumps” when pressure applied to trigger point.
• Deep tenderness and paresthesia.
• Person may feel “Numb” but sensation is normal.
• Dizziness.
• Taut palpable band in the affected muscle.
• Exercise makes the pain worse, when there are active trigger points, but helps heal the latent trigger points.
• Hyper-rritability, increased metabolism, decreased circulation.

Thing to Pay Attention to :

What layer of tissue are you working on?
How can you work more efficiently?
What does the tissue feel like? How does it change?
What other areas may be associated with the trigger point?

Cautions :

• Trigger point therapy can relieve the pain of angina, myocardial infarction and acute abdominal disease.
• Refer the person to physicians, when necessary.
• Rule out such conditions as : Tendonitis, bursitis, giant cell arthritis, neuralgia, infection (both viral and bacterial), neuropathies, disc problems, disc herniations.
• Check for thyroid malfunction, anaemia, hypoglycaemia and vitamin deficiencies.

Trigger Point Treatments

Firm digital pressure causes hypoxia and reactive hyperaemia that clears the trigger point. Reconditioning the muscle, after the pain is reduced, makes latent trigger points less prone to reactivate.

Treatment Method I:

1. Treat superficial trigger points first, applying 8-30 seconds or until the pain is gone as much as the person permits. Notice changes in feel and pain intensity (ask him for feedback regarding pain intensity).
2. Are there any referral patterns?
3. Flush the area with deep effleurage, petrissage or friction.
4. Return to same trigger point and repeat treatment, 3-4 times removing as much of the pain as possible.
5. If the pain intensifies, just hold for a few more seconds and go back later.
6. You can vary the intensity of pressure gradually, moving with the point as it changes and releases.

Advanced Technique : Treat as many trigger points as you can in the area and related area throughout the body.

Caution :

• Do not do this unless you know how to ground the person properly.

• Watch for sweating palms or feet, feelings of nausea or dizziness. This indicates sympathetic over stimulation.

• Emotional release may also be triggered with such intense work.

• Pulling the fingers and toes should be done after such intense treatments, for grounding. Hold the wrist with one hand and grab little finger with the thumb and forefinger, wrapping the hand around the little finger.

• Gently, but firmly begin pulling the little finger and let go of their wrist and continue pulling finger until you snap off the end. Grab the wrist again as you complete the snap to hold the hand up (do not let the hand/arm fall)

• Continue with ring finger, middle finger, index finger and thumb. Repeat as necessary.

• Repeat with toes, pulling each toe and releasing. The pull must come from your centre and be pulled from the person’s centre (abdominal area). Can you see the abdomen move when you pull the fingers or toes?

• Ice can be applied after session or recommend that ice be applied at home.

• The person must follow up with high intake of water to flush the toxins and a detoxification bath consisting of 1 cup Epsom salt, 1 cup sea salt and 1 cup baking soda, (or walk in the ocean or other salt water body). This will eliminate symptoms such as headaches and fatigue.

• Also following up with movement, exercises will integrate the changes into the nervous system.

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