More About Muscle Trigger Points

Trigger points can be found in muscles, connective tissue(tissue that holds us together), and periosteum (the thin sheet-like covering on bones) and manifests as pain. This point of pain is caused because the demand of blood supply is much higher than the actual blood supply to that area.

In 1973, Awad examined biopsy tissues from “muscle trigger points” using an electron microscope and found serotonin and histamine in excess in trigger point areas. This is the result of an increase in platelets and mast cells in the area in response to the body’s demand for increased blood supply. This in turn is a response to increased or heightened activity in a muscle(s) or internal organ(s), i.e. viscera or emotional turmoil that is manifested as:

  • muscle strain or spasm,
  • viscerospasm, e.g. spasm of the gall bladder or kidney, or
  • heightened psychogenic neuromuscular mechanism.

In the first case of muscle strain or spasm, reflex low grade tension in the muscle results. According to histologically conducted studies  by Heine, 1997 and Gogoleva, 2001, “low grade tension in the skeletal muscles and fascia are responsible for the low grade inflammation around the terminal parts of the sensory and motor neurons which end in the soft tissues. This inflammation activates the local fibroblasts, which deposit collagen around the nerve endings forming so-called “collagen cuffs”. This additional irritating factor triggers an afferent sensory flow to the central nervous system which is interpreted by the brain as pain. This mechanism partially describes generation of pain in the area of muscle trigger points.”

In the case of trigger points in the skeletal muscles which are developed as a result of chronic visceral disorders. In 1955 Dr. Glezer and Dalicho proposed that “patients with cardiac disorders exhibit active trigger points in the trapezius, levator scapulae, rhomboideus muscles. In such cases the end-plate abnormalities do not have anything to do with formation of trigger points in the skeletal muscles. They are the result of the phenomenon of convergence of pain stimuli within the same segments of the spinal cord which are responsible for the innervation of both the affected inner organ and skeletal muscles.” To that end they have been successful in developing and proposing maps of reflex zone abnormalities in skin, fascia and muscles, including trigger point development.

In the case of psychogenic neuromuscular responses the explanation for their development mimics the cause of trigger points as in muscle strain or spasm.

Muscle trigger  points can typically be found easily. The video below describes how this can be done.

Treating muscle trigger points is mandatory because of the vasomotor response. For example, according to Lyn Paul Taylor, A.A., B.A., M.A., R.P. “trigger point formations housed in the upper trapezius and scalenus muscles may, through this developmental process, precipitate a shoulder-hand syndrome (reflex dystrophy) as muscle splinting and vascular changes progressively involve the whole upper extremity.” Very important is also the fact that primary and secondary trigger points exist. Treatment of the primary muscle trigger point is obviously the only successful method.

Muscle Trigger Points

Muscle trigger points can be a source of sometimes debilitating pain. These trigger points may feel like tiny pea-sized indurations inside muscles or may sometimes even be as large as your thumb. The pain you feel may vary from low grade to severe and may occur at rest or only on movement. It is often felt like a dull aching steady pain that lies deep inside a muscle. Very often the pain or tenderness may be felt far away from the actual causal site. These muscle trigger points are very tender that can make you wince with pain and pull away when pressure is applied to these spots.

Trigger points can occur in any muscle, but is usually found in muscles that are used the most or repetitively. Our neck and low back muscles are very susceptible to the development of muscle trigger points, as are the muscles of the shoulder blades, In our fast paced life of today, finding quick and easy relaxation methods is a boon. Below is a video that demonstrates a simple method, using tennis balls, to help you get rid of those muscle trigger points in your body, especially those that are located in the shoulder blades and low back.

Muscle trigger points are not the same thing as a muscle spasm. A spasm involves a violent contraction of the whole muscle, whereas a trigger point is a local contraction in only a small part of a muscle. A strain or tear involves physical damage to the muscle or tendon fibers. Such damage has not been demonstrated in studies of trigger points.  However, such injuries may predispose one to developing “muscle trigger points”.

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Integrative Healing Dynamics for Myofascial Release

Fascia is the soft tissue fabric that holds us together. It provides support and protection for all the structures within the human body and knits and connects these structures into the form that we are. It extends without interruption from the top of the head to the tip of the toes. Recently, some evidence even suggests that fascia may be able to actively contract in a smooth muscle-like manner and consequently influence musculoskeletal dynamics.

This fascial tissue can become restricted due to psychogenic disease, overuse, trauma, infectious agents, or inactivity often resulting in pain, muscle tension, and corresponding diminished blood flow. This is an inflammatory response in the body that can result in tensile pressures of approximately 2,000 pounds per square inch on pain sensitive structures. Unfortunately this does not show up in many of the standard tests (x-rays, myelograms, CT scans, electromyography, etc.). As in most tissue, irritation of fascia or muscle causes local inflammation. Chronic inflammation results in fibrosis, or thickening of the connective tissue, and this thickening causes pain and irritation, resulting in reflexive muscle tension that causes more inflammation. In this way, the cycle creates a positive feedback loop and can result in ischemia and somatic dysfunction even in the absence of the original offending agent. Myofascial techniques aim to break this cycle through a variety of methods acting on multiple stages of the cycle.

Although fascia and its corresponding muscle are the main targets of myofascial release, other tissue may be affected as well, including our vital organs and nerves by virtue of their connectivity by the fascial system. Basically all muscle stretching is myofascial stretching. Myofascial stretching in one area of the body can be felt in and will affect the other body areas. Therefore release of myofascial restrictions can affect other body organs through a release of tension in the whole fascia system.

Myofascial release has also been loosely used for different manual therapy techniques, including

  • Soft tissue manipulation work such as connective tissue massage,
  • Soft tissue mobilization,
  • Foam rolling,
  • Structural integration, and
  • Strain-counterstrain techniques.

Myofascial techniques generally fall under the two main categories of:

  • Passive (patient stays completely relaxed) or
  • Active (patient provides resistance as necessary), with direct and indirect techniques used in each.

The DIRECT MYOFASCIAL RELEASE (or deep tissue work) method works on the restricted fascia. Practitioners use knuckles, elbows, or other tools to slowly stretch the restricted fascia by applying a few POUNDS of force. Direct myofascial release seeks for changes in the myofascial structures by stretching, elongation of fascia, or mobilizing adhesive tissues. The practitioner moves slowly through the layers of the fascia until the deep tissues are reached.

Dr. Ida Rolf developed Structural Integration, in the 1950s, a holistic system of soft tissue manipulation with the goal of balancing the body by stretching the skin in oscillatory patterns. She discovered that she could change the body posture and structure by stretching the myofascial system. Rolfing is the nickname that many clients and practitioners gave this myofascial release that can be painful.

Michael Stanborough has summarized his style of direct myofascial release technique as:

  • Land on the surface of the body with the appropriate ‘tool’ (knuckles, or forearm etc)
  • Sink into the soft tissue.
  • Contact the first barrier/restricted layer.
  • Put in a ‘line of tension’.
  • Engage the fascia by taking up the slack in the tissue.
  • Finally, move or drag the fascia across the surface while staying in touch with the underlying layers.
  • Exit gracefully.

The INDIRECT METHOD OF MYOFASCIAL RELEASE involves a gentle stretch, with only a few OUNCES of pressure, which allows the fascia to ‘unwind’ itself. This essential “time element” has to do with the viscous flow and the piezoelectric phenomenon: a low load (gentle pressure) applied slowly will allow a viscoelastic medium (fascia) to elongate. The gentle traction applied to the restricted fascia will result in heat and increased blood flow in the area. This allows the body’s inherent ability for self correction to return, thus eliminating pain and restoring the optimum performance of the body. This concept was suggested by Paul Svacina to be analogous to pulling apart a chicken carcass: when it is pulled apart slowly, the layers peel off intact; too fast, and it shreds.

The indirect myofascial release technique, according to John Barnes, P.T. is as follows:

  • Lightly contact the fascia with relaxed hands.
  • Slowly stretch the fascia until reaching a barrier/restriction.
  • Maintain a light pressure to stretch the barrier for approximately 3–5 minutes.
  • Prior to release, the therapist will feel a therapeutic pulse (or heat).
  • As the barrier releases, the hand will feel the motion and softening of the tissue.
  • The key is sustained pressure over time.

SELF-HELP MYOFASCIAL RELEASE: Independence through education in proper body mechanics and movement, self treatment instruction, enhancement of strength, improved flexibility, and postural and movement awareness is always advisable.

For self-treatment you will need a foam roller(approx 6” in diameter). You can get these from any store that sells sports medicine or physical therapy supplies. You could also buy them online. Foam rollers are essentially a poor man’s massage therapist. The techniques are simple: use the roller to apply pressure to sensitive areas in the muscles. The method requires that you place the roller (or any applicable tool) under the painful area and allow yourself to roll over it much like a rolling pin rolls over dough, almost as if you were ironing out the “kinks” in the fascia. The roller is used to apply longer more sweeping strokes to long muscle groups like calves, adductors, quadriceps and the back. You can use small directed force for areas like hip rotators and the gluteal muscles

Other household items such as a tennis ball, rolling pins and bouncy balls can be used to target other muscles such as in the neck, forearms, shoulders, triceps and feet.

General Guidelines: Do this 1-2xdaily:

  • Spend 1-2 minutes per self myofascial release technique and on both sides of the body (when applicable).
  • When a painful area or trigger point is found, hold the position for 30-45 seconds or until pain decreases by 75%.
  • Keep the abdominal muscles tight to stabilize the lumbo-pelvic-hip complex during rolling.
  • Remember to breathe slowly to reduce any tense reflexes caused by discomfort.
  • Remember any tissue release causes the release of toxins in your body. Drink plenty of water to flush these away.

You can also use this self help method of stretching as recommended by John F. Barnes, P.T. on the video below.

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