Trigger points are an often referred to and discussed concept in the world of soft tissue therapies and training. Over the next few posts I will review symptoms, assessment procedures and relevant clinical information with regards to trigger points.
A trigger point is typically defined a hyperirritable spot within a taut band of skeletal muscle or fascia. This may be associated with localized ischemia, changes in physiology and/or shortening of local sarcomeres.
There are many different types of adhesions in the body. The body can bind fascia, restrict joints capsules, lay down excess bone or produce collagen during the inflammatory response. All of these can be palpable adhesions in the body. In saying that not every palpable adhesion contains a trigger point.
In the Trigger Point Manual-Myofascial Pain and Dysfunction Travell and Simmons explain in detail characteristics of myofascial trigger points:
1. Myofascial trigger points refer pain along specific patterns. Pain is typically dull and achy, and is generally increased or produced by applied pressure to the trigger point once found. This does not mean that because pain is present in the posterior aspect of the shoulder a trigger point will always be present. Trigger points do not always follow a dermatological pathway, and therefore are not directly related to neurological compromise.
2. Trigger points are activated by acute load, overwork fatigue, direct trauma or chilling. The most important thing to recognize out of this statement is overwork fatigue. When a trigger point is present, a muscle is tired and frustrated. Overworked muscles carry the load for typically weaker, lazier synergistic muscles. For example it is not uncommon to get a rectus femoris trigger point from an under worked psoas major. In these instances treating the trigger point solely, will not resolve the condition.
3. Trigger points can be activated by other trigger points, disease, stress or other dysfunctional physiology. This means symptoms are held in the soft tissue, but this may not be the direct cause. Always question hydration, medication, diet, stress levels and sleep wake cycles with your athletes.
4. Trigger points vary in intensity and frequency from person to person. Don’t treat every athlete the same, the more athlete centered your programs and treatments the more effective you will be at elminating trigger points.
5. Trigger points can exist in a latent fashion. The threshold of circumstance by which trigger points become active varies from person to person but is largely related to tissue quality (related strongly to point #3).
6. Symptoms of a trigger point long outlast the mechanism of injury. The body is very intelligent, post trauma trigger points can develop in healing tissue to help “guard” or spasm against re injury. Control and removal of perpetuating factors (posture, work modification) can quickly result in their latency or resolution. Always analyze movements mechanics, posture, duties at work and activities of daily living!
7. Trigger points may cause autonomic phenomenon. This may include sweating, vasoconstriction, pilomotor activity or trouble swallowing. If present treatment of trigger points and appropriate structures may reduce or eliminate symptoms.
8. Trigger points cause pain and weakness in the involved muscle. Again this means that the trigger point causes a muscle to become weak, this does not mean the muscle was weak to begin with. Muscular weakness can also be caused by neurological comprise, under conditioning, or lack of joint mobility. Take these into account when examining your athletes.
In the next blog we will discuss common ways to determine whether or not your athletes are suffereing from trigger points and what to do about it.Email This Post