Unraveling the Knots

Trigger Points Can Seem Like Modern Gordian Knots As someone who has performed self-massage – yes, that quick rub over the temples and neck counts, you have most likely come across the sore, pebble-like spots in your muscles. The aptly named knots. These little buggers are one of the biggest reasons people seek massage therapy: “Please help me get rid of these knots!” Since trigger points (maybe one of the few instances where the technical and the colloquial names are both accurate) play such a significant part in my clients’ pain, I wanted to share some research and current understandings. What Is A Trigger Point? A trigger point is defined as an exquisitely tender nodule within a hypertonic band of muscle that produces local or referred pain. Translation: it is a super tight spot in a muscle that is already tight and causes pain either in the area it is located or in another area of the body. What Effects do Trigger Points Have?

1. Pain. Some of this pain is obvious. The trigger point is situated right where your arm hurts, you release it, and the pain is gone! However, trigger point pain can also be sneaky. Can’t get rid of that headache you’ve had for three days no matter what you do? Squeeze and hold your upper traps and see what effects that has. It could be that there is a Trigger Point in your upper trap referring pain right behind your eyes.
   

2. Fatigue. Clench your fist as tight as you can and hold it. How long was it before your grip loosened? One minute? Two? Less? Now think of your fist as a muscle with a trigger point, only it can’t loosen up even when it gets tired. Energy that could go into exercising, digesting, concentrating or any of our other daily functions is being diverted to the knotted muscle so it says in constant contraction. Talk about exhausting.
   

3. Decreased Range of Motion. It is going to be pretty difficult to extend your arm the whole way if your triceps are pulling in the other direction, or to walk up stairs if your hamstrings aren’t able to relax enough to allow the leg to easily flex.
   

4. Increased Risk of Strain. Since your muscle is in a perpetual state of contraction, any increased pressure – picking up kids, bending to pick up a pen, typing, reaching for the soup can – is going to create an exponential amount of stress.
   

5. Bursitis and Arthritis. This theory comes from Claire Davies, the author of The Trigger Point Therapy Workbook. He notes that since muscles cross joints, contraction of a muscle lessens the space between the bones of that joint. The constant contraction caused by a trigger point, though initially slight, would leave that space perpetually shortened and cause increased friction which may lead to bursitis and eventually arthritis as the cartilage is affected.

Pathology or Symptom? Since Travel and Simons, the trigger point gurus, published their groundbreaking textbooks, the medical community has been trying to figure out if knots are a cause or an effect. Myofascial pain syndrome, or the widespread presence of multiple trigger points throughout the body, is thought to be a cause of fibromyalgia and chronic fatigue syndrome making them the cause of disease. However, there is plenty of evidence that trigger points form after unusual use or overuse of muscles and can result from the tension caused by certain pharmaceutical side effects making them a symptom. Still there are other theories that postulate that Trigger Points are a natural byproduct of the complexity and specificity of our muscles which can become symptomatic making them both. The understanding that makes the most sense to me is that trigger points are protective. When there is an instability in that joint, muscles that cross it will tighten in an attempt to provide stability. The longer the instability persists, the tighter the muscle becomes. Correct the misalignment in the joint and the trigger point has no further reason to exist. Why No Definitive Answers? Despite the fact that trigger points are pervasive, appear in approximately the same place in muscles on everyone, and produce the same relative pain patterns, they can be difficult to study. Looking at dead muscle tissue, such as in cadavers, has produced few conclusive results because dead tissue does not display the same properties as living tissue even if intentionally contracted. Studying living muscle doesn't yield many results either because trigger points do not show up on any of our current imaging techniques. Complicating matters further, some trigger points are active, producing pain all of the time, and some are latent, only eliciting pain when pressed upon. Then there are the hard, little spots that feel like trigger points and are located where a trigger point might be located, but produce no referred or local pain even when compressed. Trigger points are elusive. Okay, but Mine Still Hurt. How can I get Rid of Trigger Points?

1. Stretch. Having a good stretching routine can keep muscles from chronic contraction and prevent trigger points all together. Just be mindful not to overstretch as that can cause a whole different set of issues.

2. Mobilize. Mobilizing your joints can help make sure they remain optimally aligned meaning trigger points have no need to form in the first place.

3. Strengthen. When your muscles have ample resources to support your joints, they do not need to tighten unnecessarily to create stability.

4. Injections. Your doctor may be able to inject analgesics or saline directly into the trigger point which has been shown to greatly reduce painfulness.

5. Massage. Many different methods of massage can effectively release trigger points. (My preferred technique addresses both the muscle tension and joint misalignment with little to no pain.)

For more information on the history and evolution of trigger point research check out Myofascial Trigger Points Then and Now: A Historical and Scientific Perspective (2015). Comment or email me at info@philosophersbodywork.com if you have any trigger point or massage related questions.

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