I have tried to work my trigger point but I can 't seem to get any real relief?
All serious pain should first be evaluated by a physician to exclude and underlying treatable medical / surgical cause.
The number one reason that there is ineffective pain
relief is the pertinent trigger point is not being treated.
Locating trigger points is not easy and it took me months to
become effective after reading both references including several
anatomy books... and I am an MD. Initially, working with someone
who is experienced with trigger points will convince you they are the
problem and will show you how to effectively find and treat them. You
can do it on your own if you are doggedly persistent.
Many times more than one trigger point / muscle is involved. All must be inactivated for lasting complete relief.
The pain will return until the trigger point is
inactivated. The time is variably and is usually related to the
duration of the pain. The longer you have had the pain, the
longer to completely rid yourself of it.
My physician wants to put me on rest and non-steroidal pain medication. Is that sufficient?
This might work but it will be extremely slow relief with
extended incapacitation and will do nothing to prevent a recurrence.
Supplemental pain medication along with some sort of physical
therapy is the best route.
Physical therapy is wonderful and should eventually
provide relief but directly confronting the trigger point is much, much
quicker. I sprained my sacroiliac joint and underwent 8 weeks of
PT. It did work which for me was a miracle as I was flat on my
back at the beginning. However, knowing what I know now about
trigger points, I would recover now in under a week with trigger point
How do other methods of myofascial pain control stack up against trigger point therapy?
Narcotics - very ineffective. Myofascial pain
responds much better to nonsteroidal anti-inflammatory medication such
as ibuprofen. Pain medication should be supplemental only, and
not the primary treatment.
Rest - Muscle immobility does nothing to treat trigger
points. If may, in fact, induce trigger point formation.
Rest is useful if it corrects some ergonomic problem or stops
some irritating, repetitive activity. Rather than rest and
immobility, correct the ergonomic problem and stop or change the
Physical Therapy - very good as it promotes ergonomic
behavior and includes stretching. As a preventative, it can't be
beat. However, active trigger points cannot be stretched and PT
alone hits a dead end with some trigger point pain. Also, pain
relief is achieved much more slowly.
Chiropractic - very good tool for immediate help with
myofascial pain but not good for fine tuning or long term relief.
Most people can effectively treat their own pain over the long
term. My analogy would be a chiropractor has one tool - a sledge
hammer. He/She is very good with it, but that is the only tool
available and many times you need something smaller and more focused.
Therapeutic Massage - particulary useful if focused on
trigger points. Direct trigger point treatment is better.
Generic massage has little value in pain relief.
How do trigger points cause pain and other problems?
Trigger points cause pain, restricted range of motion,
and/or weakness in the involved muscle. The muscle cannot fully
expand/stretch or contract and thus inhibits other muscles. The
constant tension strains other muscles and joints with occasional
There may be nerve or blood vessel entrapment by the
swollen, contracted muscle. A classic example is sciatic nerve
compression by the pyriformis muscle.
The autonomic nervous system can also be affected and
cause peculiar symptoms. Proprioreceptors are present in muscles
and may be affected. An example is dizziness and vertigo caused
by trigger points in the sternocleidomastoid muscle. Two lists of unusual trigger point symptoms are listed here with their corresponding links.
What causes a trigger point to develope?
Trigger points are usually associated with some degree of
mechanical abuse of the a muscle in the form of muscle overload.
The overload may be acute, sustained, and /or repetitive.
Leaving the muscle in the shortened position can convert a latent
trigger point to an active trigger point particularly if the muscle is
contracted in the shortened position.
What is the difference between an "active" trigger point and a "latent" trigger point?
An active trigger point produces a clinical complaint,
usually pain, that the patient recognizes when the trigger point is
compressed. Latent trigger points produce other characteristic
effects including increased muscle tension and muscle shortening but no
spontaneous pain. Both can cause significant motor dysfunction.
Please describe the typical trigger point pain?
Poorly localized, regional, aching pain in subcutaneous tissue, including muscles and joints.
The pain is often referred to a distance from the trigger point in a pattern that is characteristic for each muscle eg. gluteus minimus
Sometimes numbness or paresthesia rather than pain
How do I use the body site pain diagrams on this website?
There are diagrams of a body regions broken down with
areas marked as pain sites. Find the area that best fits the
location of your pain. There is a corresponding page with these
pain sites listed followed by a list of muscles. The muscles are
ones that can cause pain within the area. The muscles are listed
in order of decreasing frequency of causing pain in this area. A
diagram of the trigger points of some of the individual muscles is also
available (not many now) which will further help localize the pain and
probable involved muscles. In the pdf files there are summaries
of all the muscles with brief information on all aspects including pain
location. The summaries are from Travell and Simons. The
books have an entire chapter devoted to each muscle with a summary page
at the beginning.
Do you follow the books step by step each time or do you have a quicker approach?
The more examples of people you see with similar pain
patterns, the more likely you know the primary muscles involved.
Although several muscles are listed as causing pain in a specific
area, the exact location, type of pain, mitigating factors - all help
eliminate some possibilites and point to the most likely culprit.
When in doubt, go by the books if your initial guesses were not
confirmed. I hope to add my own laundry list of muscles for
certain pain patterns to this website. Though all of the
treatment modalities for trigger points do work, in my hands, some work
better than others and it varies from muscle to muscle.
Are there any specific tools that are useful for trigger point therapy?
Everyone has their own personal favorites. I will
mention a few of mine and include photos and more information on a
tools webpage (yet to be created). A theracane is probably the
single most useful tool other than a tennis ball / hard rubber ball.
The theracane enables one to reach almost any point on their own
body and apply pressure to a trigger point. A device similar to
the theracane is a Backnobber II which is very portable as it breaks
down into two pieces which would fit into a briefcase. Balls of
various sizes are extremely useful for deep trigger point beneath or
within thick muscles. The ball is placed on a hard surface such
as a wall or the floor and the body is pushed into the ball with a very
effective stripping massage. Varying the ball size and hardness
will work on all of these deep trigger points. I have bought a
few specialty tools which looked good but don't seem to work as well.
I also made a few small simple homemade tools which also work
What do you think of the spray and stretch technique or trigger point injection for use by the average person?
My luck with trigger point injection has been poor.
I use needles every week in my profession sticking lumps in bumps
in patients who are referred to me for a diagnosis. These lumps
are much bigger and more discreet than the average trigger point.
Trigger points are often rubbery and very mobile. It it
just plain hard to skewer them with a needle.
Spray and Stretch does work but it is more cumbersome and
really takes two people. It is hard to correctly spray yourself.
A cold pack judiciously applied or a heat wrap also works.
You have to be careful with the spray so as to not frostbite the
skin. I would recommend heat or cold to aid in stretching trigger
points sometimes but each person will have to determine for themselves
the best ancillary tool to use.
Can trigger points really be cured or is it a lifelong project to manage your trigger points?
This is one of those trick questions as the answer is
both yes and no. Acute injuries with a short history can be cured
and really do go away for good. More chronic injuries, many of
which are due to years of poor ergonomics, may never completely go
away. The pain can be controlled and the disability minimized but
lifelong stretching may be needed along with occasional trigger point
work for acute flareups. Completely correcting poor ergonomics is
needed but seems impossible in many cases. I now have bifocals
and much poorer vision than when I was younger. When using a
computer screen (as I am doing right now), it is work to keep
everything in sharp focus (despite a 24 in lcd monitor) without tensing
my neck and shoulder muscles. When I use my computer a lot , my
neck and shoulder muscles / trigger points get irritated. I
stretch and manipulate my trigger points, but I don't give up my
What are common misconceptions about trigger points?
Simply treating the trigger point should be sufficient.
ANSWER - If the causing stress is not recurrent and if there are
no perpetuating factors, that may be true. After the trigger
points have persisted for some time, the muscle must be retrained to
normal function and full-stretch range of motion.
The pain cannot be as severe as the patient says and must be largely psychogenic.
ANSWER - Believe the patient. Patients have rated their
pain as severe as or more severe than pharyngitis, cystitis, angina,
herpes zoster, and rheumatoid arthritis.
Myofascial pain syndromes are self-limited and will cure themselves.
ANSWER - An acute uncomplicated trigger point may spontaneously
convert to a latent trigger point within a week or two if the muscle is
not overstressed and if there are no perpetuating factors.
Otherwise it might evolve into a chronic myofascial pain syndrome.
Relief of pain by treatment of skeletal muscles for myofascial trigger points rules out serious visceral disease.
ANSWER - Visceral pain may be referred and a vapocoolant spray or
local anesthetic injection into the the somatic reference zone can
temporarily relieve the pain of myocardial infarction, angina, or acute
abdominal disease with no effect on the visceral pathology.
What are the minimum criteria for identification of a trigger point?
The table below from Travell and Simons nicely lists the criteria.