Tips for working on Trigger Points
You are certain to encounter patient after patient with complaints of “muscle knots”. Muscle knots are trigger points believed to be created by a contracted muscle but in a small patch of muscle tissue. There is also the theory that with the contraction the muscle tissue may also contain waste metabolites due to the lack of blood circulation in the area. This means there is a build up of toxins in the trigger point. When there is more than one trigger point it leads to Myofascial Pain Syndrome (MPS) and whether they have one muscle knot or a series of them the resulting pain can prove to be quite troublesome for patients.
Three Results of Trigger Points
Trigger points can affect a patient in three ways. First it can cause pain, second it can complicate an existing condition or issue and third they can mimic other problems. A trigger point always causes pain in theory, but when you have a muscle injury the addition of muscle knots can amplify pain and in some cases end up being worse than the original injury. The third affect is perhaps the most troubling as it a trigger point is misread it can then be mistreated. Therefore it is important to take caution when working with a patient to determine the causes of pain to ensure a trigger point is not misdiagnosed.
Not only can trigger points mimic the symptoms of other common issues they can also be at the root of referred pain. A common complaint your patients might have such as sciatica is often believed to be a result of referred pain from piriformis or other gluteal muscles as opposed to the nerve itself. Other common referred pain caused by trigger points include tinnitus, tension headaches, TMJ pain, lower back pain and a decrease in range of motion in the legs and sometimes arms (due to shoulder pain). Fibromyalgia (FM) is often confused with MPS due to the tender points associated with FM which differ from the trigger points of MPS.
Diagnosing Trigger Points
With all of these challenges how is it possible to diagnose trigger points? Many would argue it is not an exact science but there are some commonalities you will see with a true trigger point issue. In general, the physical finding of a trigger point is feeling a hardened nodule with palpation of the area. Palpation should also result in pain directly in the area of the nodule which can also radiate out from the nodule and in some cases cause twitching.
Treating Trigger Points
When treating trigger points the lack of circulation in the area plays a key role. It is important to return blood circulation to the area and sustained pressure can be effective in urging the blood flow to resume as well as in releasing the muscle fibres. Deep stroking is also effective especially in assisting returning blood flow. Deep tissue massage can also be used as it can aid in removing metabolic waste believed to build up in trigger points. Trigger point therapy can be the saving grace for patients who have suffered from chronic pain that has not been diagnosed properly and therefore never resolved.