08 Dec Trigger Points: A Revolution Waiting to Happen
Often in human history, the significance of a major discovery hasn’t been appreciated until a much later date. Sometimes the one who made the discovery died before the world recognized their achievement. One such discovery, still awaiting the widespread recognition it deserves, is the concept of myofascial trigger points.
The Pioneering Work of Janet Travell, MD
Janet Travell, who coined the term “trigger point,” was born in 1901. She graduated with honors from the medical college at Cornell University in 1925. In the following decades, she became interested in muscular pain, and began to develop new techniques for treating it. In 1955, she was called on by John F. Kennedy (a senator at the time) for help with debilitating back pain due to injuries he sustained in World War II. Travell cured Kennedy’s pain, and after he won the presidency, he made her the first woman to hold the post of personal physician to the President. He later credited Travell with saving his political career, which he and his family felt would have been otherwise derailed by his pain.
What Are Trigger Points?
In 1983, Travell and colleague David Simons, MD, published the first volume of an opus on the subject of muscular pain. In this book, Myofascial Pain and Dysfunction, Travell and Simons explore the phenomenon of trigger points. (Not to be confused with acupuncture or acupressure points, though they do share many of the same locations.)
They define a trigger point as a highly irritable nodule of tissue that occurs in a taut band of muscle. Often the muscle feels like it’s incapable of relaxing and softening, because the trigger point causes the muscle’s fibers to become chronically shortened. Trigger points tend to form in predictable places and produce predictable patterns of pain.
A trigger point’s pain pattern is often much broader than the irritable region itself. Especially interesting is that in many cases, the pain occurs at a different place than where the trigger point is located. There may be no pain at the trigger point itself. This is why Travell and Simons’ work was so groundbreaking. Before these maps were developed, almost nobody would have thought to investigate, for instance, the front of the neck as the possible origin of pain in the upper back.
An Unrecognized Epidemic
In my experience (and that of many other medical professionals), the vast majority of chronic pain is due to trigger points. Besides pain, trigger points cause a wide range of other symptoms that usually aren’t suspected to come from our muscles. Trigger points in the back, shoulders, and neck frequently cause numbness and tingling in the arms and hands. Trigger points in the neck can cause nasal and sinus symptoms that mimic allergies or a sinus infection. They can also cause migraines, earaches, jaw problems, vision changes, hearing loss, and coughing. Frequently, the symptoms of trigger points are misdiagnosed as problems with the internal organs. For instance, trigger points in the chest muscles can produce pain like a heart attack, and trigger points in muscles of the abdomen or lower back may seem to be disorders of the intestines or reproductive organs.
Trigger points form as a result of muscle abuse, and there are many ways to abuse muscles. Some of the most common are repetitive motions (such as typing, mousing, clenching tools, and other occupational tasks) and extended time in an unnatural position (such as holding a phone between the ear and the shoulder, or sleeping in a car). Also common are accidents, athletics, poor posture, tightening due to stress, and carrying bags. Immobility could also be considered a form of abuse, as a lack of stretching and exercise makes our muscles more prone to damage.
Travell and Simons mapped out all the major sites where trigger points occur and explained what kinds of symptoms each one produces. It’s been over 25 years since their first book was published, yet this information has been mostly ignored by the medical mainstream. I have seen hundreds of patients with chronic pain who have taken painkillers or have been to pain specialists, surgeons, and other healthcare practitioners without getting any real improvement.
When I examine their muscles, I find trigger points – almost without exception. About nine times out of ten, when the trigger points are released, there is significant, if not total, relief. I don’t mean to imply that the practitioners my patients saw before me aren’t good at what they do; just that they either didn’t consider trigger points or didn’t know how to treat them. Neither is it my intention to toot my own horn when I say that I was able to help these folks get relief when other doctors weren’t. There is certainly skill involved in effectively releasing trigger points, and my technique has improved over the years, but I am simply utilizing an understanding of basic human anatomy and the maps developed by these groundbreaking doctors.
Our Overlooked Muscles
As Dr. Simons points out, despite the fact that muscles comprise so much of the human body and have so many functions, there is no field of medicine that focuses specifically on them. This honor is left mostly to acupuncturists, massage therapists, and physical therapists.
Travell and Simons initially deactivated trigger points by either injecting them with a small amount of a numbing agent or spraying them with a coolant and then forcibly stretching the muscle. However, it was later discovered that a trigger point can be mechanically released by probing at it in a certain manner with an acupuncture needle, even without injecting anything into it. This practice was readily adopted by acupuncturists, who use fine needles that can be maneuvered with great precision.
Travell and Simons also discovered that certain massage techniques are highly effective at releasing trigger points. While most acupuncturists, massage therapists, physical therapists, and chiropractors have some familiarity with trigger points, if you decide to see someone for trigger point release, ask if this is something they specialize in.
Finding Trigger Points
Finding trigger points takes practice and sensitivity, but I believe that anyone who is willing to thoroughly investigate their body can hone in on the source of the problem, with the help of trigger point charts and a friend (or some basic tools). Travell and Simons’ books are wonderfully comprehensive, but not really accessible for the average reader.
If you don’t have much experience, the key is to feel all the possible regions where trigger points may occur that could potentially produce the pain you’re experiencing. I developed a tool for this on the site of the pain patch I developed. You can click HERE to go to the site – then click on Pain Expert in the menu bar. When you discover a trigger point, pressing on it will sometimes, though not always, elicit a pain in the place and manner that you’ve been experiencing. What is more common is that the trigger point itself is just very tender and uncomfortable to work on. Later, after you’ve treated it with massage, acupuncture or the Imbue Pain Relief Patch, your pain will feel better. With more practice, you will begin to feel that a trigger point usually feels like a small lump or grain in the muscle. The muscle a trigger point occurs in will sometimes feel stringy, like one or more cords, rather than a smooth, pliable, and cohesive mass of muscle. When the taut muscle is “plucked” by strumming a finger across it, you will often see a twitch that extends a few inches from where you plucked it.
Managing Your Own Pain
Much of the work of managing trigger points can be done by you at home. Balls are my favorite tool for self-treatment of trigger points. You can lie on a ball in just the right spot, or you can stand with a ball between your body and a wall, to deliver pressure at a rate you can control. (Lying on a ball delivers more pressure than leaning on a ball against a wall.) Tennis balls are decent, especially if the area you’re working on is very tender. I usually prefer a solid ball, such as a lacrosse ball or high bounce ball. Larger balls are usually too wide to really get into trigger points, although they can be good for stretching larger areas. Yamuna balls, used in Body Rolling, are fantastic maintenance tools, and can also work at releasing trigger points (especially the small ones). There are also a number of tools, such as the Thera Cane, that can make it easy to access areas that are otherwise difficult to get to. While I own and use these tools, I feel there’s no substitute for getting worked on by another human being, so I strongly recommend also utilizing acupuncture and massage.
If lying on a ball to treat part of your back, you’ll usually have your knees bent and your feet flat on the floor. If you want to get more pressure on the spot you’re working on, you can lift your buttocks off the floor. Whether using a ball, a tool, or another person’s hands or elbows, the idea is to exert deep pressure on the trigger point, but not to the degree that you tighten up or brace against this pressure. In this state of deep pressure on the trigger point, breathe deeply, especially accentuating and lengthening your exhales as you aim to consciously relax into the pressure. Imagine you are fully allowing the ball/tool/hand/elbow to enter into your body, as if opening your muscles. The point can be held in this way for anywhere from about ten seconds to a couple minutes. It is important to learn to feel your limit. You don’t need to withstand sharp, burning, or intense pain – this is usually inadvisable anyway. If you overdo it, you can cause yourself more irritation.
If you simply hold a trigger point in this way, and relax and wait, this is often sufficient to get it to release. However, because our muscle cells have “memory,” they may return to a semi-contracted state within hours or days. You may have to repeat this procedure several times to break the muscle’s habit of re-tightening at this spot. Also, if you continue to overdo the same movements or postures that led to the trigger point in the first place, this practice may need to be an ongoing part of your self maintenance. Sometimes the practice can be more subtle, yet just as effective. One can get a trigger point to release with light pressure or even with no pressure at all – simply by consciously relaxing and lengthening the affected muscle. (Some find it’s easier to get a muscle to relax if they tighten it first.) But most people get faster results with fairly deep pressure. Occasionally, adding some movement to the pressure produces even better resolution of the problem.
There are two primary forms of movement to try. The first is to move slowly along the muscle in the same direction that its fibers run. For instance, if working on the forearm, these muscle fibers all run more or less parallel to the length of the bones (that is, basically from the elbow toward the hand). For example, if you found a trigger point in the meaty area of the upper forearm, just below the elbow, you would first apply pressure by slowly entering the muscle (with a thumb, a ball, a Thera Cane, etc.) as deeply as is comfortable. Then, while maintaining this pressure, glide very slowly down the forearm a few inches (toward the hand). If this is done without any oil or lotion, you will not be sliding over the skin, but instead moving the skin over the underlying muscle. You can do a stroke like this several times and then give the muscle a rest.
The second form of movement is referred to as “cross fiber,” because it entails moving side to side, back and forth across (or perpendicular to) the direction the muscle fibers run. This is often a more painful form of massage, and it definitely has the potential to leave a muscle irritated, but it sometimes helps release a very stubborn trigger point. (For this reason, body workers occasionally recommend application of a cold pack after this kind of work, to reduce the potential for provoking inflammation.) You won’t always know which direction a muscle’s fibers run unless you look at a diagram of it. However, most of the superficial muscles of the body run longitudinally – that is, parallel to the vertical axis and long bones of the body. The muscles of the neck and back run mostly parallel to the spine. The muscles of the arms and legs run mostly from the shoulders to the hands and the hips to the feet.
The only drawback to using balls, tools, and massage to release trigger points is that it can be somewhat painful work. But in my opinion, a few minutes of pain in order to alleviate a persistent problem is a very reasonable trade-off. After you work on one point, move on to the next tender spot you find. To make progress on significant or longstanding pain, you need persistence and patience.
The key to lasting relief from trigger points is using our bodies in a smart fashion. Pay attention to ways that you perform motions repetitively or utilize muscles unevenly. If you’ve ever worked with a trainer, you know how important good form is when exercising. Poor form is the main cause of athletic injuries, and the same is true in everyday life. Our daily activities – gardening, painting, operating cars and machinery, picking up children – frequently constitute an all-day workout. Yet, few of us tend to our bodies as if this were the case, by stretching, hydrating, taking frequent breaks, getting massage, etc.
If your business offers a consultation with an ergonomics specialist or occupational therapist, take advantage of it. If you spend much time working at home, do an ergonomics assessment of your home desk. Resist the temptation to work on your computer while slumped on the couch. Adjusting your work station to minimize postural stress can make a huge difference in how you feel at the end of the day. Although maintaining perpetual awareness of how you’re using your body may seem a daunting task, the good news is that as you work out your trigger points and return to balance, you also become more conscious of when you’re using your body in an unhealthy way. As with President Kennedy, trigger point treatment may be the key to resurrecting a life that seems doomed to be painful.