What's Triggering Your Pain?
A question we are often asked during a massage treatment - especially when working on the back, around the shoulders and between the shoulder blades is: ‘What are those tender, painful things you keep pressing on?’ - The answer is: They are, in fact, trigger points.
So, what are trigger points?
Trigger points are nodules or lumps that are found in tight bands of muscles. They can be the size of a small pea, a marble or even a small pebble. They often feel painful and tender to the touch and can be accompanied by a warm feeling around the area. They often restrict normal muscle function, leading to pain, muscle spasms and restricted movement. In some cases, trigger points put pressure on the nerves causing numbness or pins and needles.
There are 2 types of trigger point; ‘passive’ and ‘active’. When a trigger point is pressed and the reaction stays local, this is classed as passive. Active trigger points on the other hand, send a referral pain somewhere else in the body. For instance, when compressed, an active trigger point in the upper trapezius muscles of the neck can cause a sensation of pain in the forearm, hand and fingers as shown in the diagram below..
In the early 19th century, a physician named Balfour is credited with the first reference to ‘thickening in muscles, with local and regional muscle pain’.
But the actual term ‘trigger point’ was coined in 1942 by Dr. Janet Travell. She was renowned in the medical profession for her pioneering techniques in the treatment of skeletal muscle pain. This led to her being appointed as John F. Kennedy's personal physician, making her the first female physician to a President. Her life’s work in this field culminated in the publication of ‘Myofascial Pain - The Trigger Point Manual’, which she co-wrote with David Simons in 1983. This textbook for Practitioners is still regarded as the gold standard in it’s field.
What are the effects of trigger points on the body?
Muscle pain can happen for a number of reasons; our jobs, doing sports, bad posture (I think we’re all guilty of this one at times), emotional or physical trauma, repetitive movements, stress and anxiety. Even a poor diet and dehydration can cause issues.
When we are in pain, we can become vulnerable to other injuries. Our body is clever, it will protect those areas and start using other muscles to compensate. This will work in the short term but, in time, those compensatory muscles won’t be able to work as efficiently as they should.
There are many ways in which we try to solve the problem, such as applying heat and cold packs, stretching, going to yoga or pilates classes etc. If it gets really bad we may go to the doctor and have blood tests and scans, possibly being prescribed painkillers and anti-inflammatories. These can temporarily mask the pain, but the discomfort invariably comes back, in some cases just as bad and sometimes even worse!
We all know pain is not nice when it happens, but it is the body’s way of telling us something is not right. When the muscle pain fails to improve after the initial cause has resolved itself, we often find that trigger points are the underlying cause of the persistent pain.
How are trigger points treated with Massage?
During a massage treatment we can mix in trigger point therapy to help loosen tight muscles. We firstly work to identify the point of pain and then gently apply pressure to it using elbows or thumbs. Depending on how stubborn the trigger point is, we hold pressure from 10 to 100 seconds, until we feel a dispersal or breakdown (like popping bubble wrap). Some trigger points disappear quickly and some we need to be patient with. If this is the case, working on another area and then coming back to it can really help.
The use of trigger point therapy is very beneficial in treating persistent muscle pain. The pressure applied to the trigger point temporarily cuts off blood circulation to the area. This triggers the body to release Nitric Oxide which signals the body to open up the microcapillaries and increase blood flow to break the muscle spasm cycle.
This can also help to remove a build up of toxins like lactic acid. Good blood flow also helps to bring oxygen and nutrients to the area, relieving the pain and increasing range of movement.
We find that once a chronic pain issue is resolved in this way, patients feel more able to resume their daily activities. This is an important part of the recovery process as our body is designed to move. Unfortunately, sometimes we spend too much time sitting, especially when we are in pain, which actually makes the problem worse.
To stay healthy and strong our muscles need to be exercised. So, go for that walk, join that (virtual!) fitness class, whatever form of exercise appeals to you, just do it! In the long run your body is really going to appreciate it and so will you.