Trigger points are painful points in muscles that are tight, injured, or over-worked. Often described as “a knot” in the muscle, these focal points of tenderness will usually cause a deep ache and can radiate pain out to other areas in a somewhat predictable pattern. Trigger points are theorised to be local areas of contracted fibres within a muscle. The chronic tightening is thought to lead to reduced blood flow which in turn contributes to a build up of waste products, such as lactic acid, and increased sensitivity of the muscle which in turn leads to more muscle tightening and reduced circulation, eventually the area runs low on energy making it hard for the muscle fibres to then release – a situation classed as motor endplate energy-crisis phenomenon. This cycle builds: a painful muscle contains trigger points and trigger points lead to further muscle pain.
As well as causing sensitivity and playing a role in muscle stiffness it is thought that trigger points can inhibit antagonist muscles, e.g. a tight triceps may inhibit the function of the bicep, or tight hip flexors can inhibit the hip extensors. The presence of trigger points within certain muscle groups has helped to give rise to certain syndromes such as the common postural problem of upper cross syndrome first described by Vladimir Janda. Upper cross syndrome is often found in people who, for example, work at desks frequently for long hours resulting in overuse of muscles around the shoulders and neck lead to tightening and stiffness of the chest, upper trapezius, scalenes and SCM. These tight muscles are thought to contribute to part of the weakening that then occurs in the deep neck flexors and shoulder blade stabilisers. The result can be the gradual onset of neck pain, mid back pain, shoulder pain or headaches all things we see a lot of at Duston Chiropractic Clinic. Although there is no such thing as perfect posture, prolonged positioning such as with desk posture can lead to multiple symptoms and often trigger points can be found in the affected muscles.
Trigger point therapy is a frequently used treatment method within chiropractic, physiotherapy and other manual therapy groups. It consists of pressure being applied with a thumb, finger or sometimes a tool to the trigger point. This is often accompanied by a deep ache or pain which may or may not refer. Trigger points around the neck can often refer up into the head (sometimes the cause of cervicogenic headaches) and trigger points around the gluteal muscles and piriformis can refer pain that mimics sciatica. When receiving this type of treatment, it’s important the any discomfort is well within your tolerance. It is NOT a case of no pain, no gain. The more it hurts the more the body may tense up, so a general rule of “no more than 6-7/10 on a pain scale” should apply. It usually eases off within a minute or so. If these areas are too sore to trigger point then there are lots of options for techniques that are more comfortable.
The research behind trigger points is mixed, from debate as to whether they even exist, whether they can be reliably diagnosed and whether or not treatment is effective. Like with most things in the body, there is a benefit to blending the art and the science. Like with most effective intervention in the body, there is a benefit to blending hands on treatment like massage, stretching, acupuncture alongside regular exercise and the occasional activity modification. In the case of desk posture, regular breaks, changing positions, keeping on top of hydration, stress, sleep and physical activity will all help the body look after itself. If hands on treatment is needed, then it should always accompany a good self-care plan which your chiropractor can help you with.
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Nick has been treating patients for over 11 years. He currently works Duston Chiropractic Clinic