Virtually all pain has some myofascial origins. It
may be the primary source of the pain or it may just be a contributing
factor. Either way the pain can be improved by controlling the
"...studies suggesting that trigger points are a
component of up to 93 percent of the pain seen in pain clinics, and the
sole cause of such pain as much as 85 percent of the time.
(1999:12;Gerwin 121;Fishbain 181 - 197)" (from The Trigger Point
Therapy Workbook pgs 17-18 2001)
In August 2004, my wife developed a severe
incapacitating headache. It was nonstop and after several days I
took her to the emergency room fearing a brain hemorrhage. The
excluded life-threatening causes, gave her narcotics, and said it was a
"tension" type headache. The narcotics did not work and put her
to sleep. We saw a neurologist who gave her too much ibuprofen.
The ibuprofen gave her a severe gastritis but no real headache relief.
Flexeril put her to sleep but not real pain relief.
We went to a chiropracter who gave her some significant
relief decreasing her pain from a 10 to a 4 or 5. The pain did
come back though. We went several times with some non-permanent
relief. We were on the right track but not precise enough.
We then went to a massage therapist and a physical
therapist/massage therapist with more relief decreasing the pain down
to a 2 - 3. My wife did the recommended stretching but no permanent pain relief and no temporary complete pain relief.
During this time we went to a pain management physician
who would inject a posterior occipital "trigger point". He could
not guarantee success so we held this treatment in reserve.
During all this, I was trying to duplicate daily/hourly
whatever good the various therapists seem to produce. I also
bought the trigger point manual as a guide. As we experimented I
seemed to be getting better results that lasted longer than any of the
Eventually, we did eliminate the headaches. My wife
still has neck / shoulder pain with terrible "trigger points" which we
can mechanically treat / stretch. Part of the time they cause
her no pain but they never disappear. She appears to store her
stress in these muscles and unfortunately life is not stress
free. We can keep the pain down and
do not let it reach the headache stage. She had headaches off and
on throughout her entire life. She no longer gets headaches.
Later I learned many of my physician colleagues believe
in "trigger points" and some do inject them. I believe they are
the most significant cause of pain over all other causes. I
improved my neck pain and hip pain. I improved my daughter's back
pain. "Lumbago" and "Sciatica" are commonly caused by "trigger
points". Many people suffer needlessly. The best reference
available is Myofascial Pain and Dysfunction - The Trigger Point Manual
Vols 1 and 2 by David Simon, Janet Travell, and Lois Simons. It
is expensive - about $200 for the two volume set. It will
probably confuse the novice and the The Trigger Point Workbook is a
better book to read first.
My "hobby" has helped several people and I hope the information on these web pages will do the same.
What is a "trigger point" ? Spot tenderness in a
muscle with usually a palpably tense band of muscle fibers. Pain
on compression can be excruciating. This local pain is one way to
recognize you are "on" the trigger point.
There are 3 signs and symptoms of active trigger points.
1 - referred pain, 2 - limited range of motion, 3 - muscle
weakness. Referred pain means the pain induced by trigger points
usually does not occur near the trigger point but at a more distant
site. If you work / massage the area that hurts, it will never
get better as it usually is not the trigger point. The only way
to successfully deal with trigger points is with a map of trigger
points, muscles, and pain locations. The other two symptoms are
more subtle and may not be recognized by the patient. They don't
realize how limited they are until they compare themselves with a
Many common pain syndromes may have an underlying trigger
point etiology. Claire Davies in The Trigger Point Therapy
Workbook says he had begun to wonder if "carpal tunnel" really existed
as he saw so many cases due to trigger points. An example list
from Travell & Simons is here.
Trigger points may be inactivated by several different methods listed below.
Push/compress the trigger point for 40 to 60 secs. Use enough
force to cause pain on a scale of 6 to 7 with 0 as no pain and 10 as
unbearable pain. This pain is short-lived and the relief provided
will last much, much longer. This should be done 5 to 6 times per
day. Or use as needed. Better results with more frequent
Compress the trigger point and stroke in one direction with short firm
strokes. Apply 10 - 12 strokes in one session. This should
be done 5 to 6 times per day. Same pain level.
Ple: Best reserved for a physician.
The material injected is not critical though many physicians use
xylocaine/lidocaine and possibly a steroid. Saline works just as
well. A dry needle also works. The tough part is
penetrating the trigger point with the needle.
Spray and Stretch:
Very effective but you really have to know what you are doing.
Use a cold spray to lightly anesthetize the involve muscle
(entire length) and then stretch through the trigger point.
Immediately reheat the muscle and move it through a full range of
motion. Effective but takes practice and Simon and Travells book.
Stretching with various techniques to assist:
Postisometric relaxation, reflex augmentation, reciprocal
inhibition, contract-relax, hold-relax. I have used postisometric
relaxation coordinated with breathing and it does work. On
inhalation, isometrically contract the muscle to be stretched, on
exhalation, stretch the muscle and trigger points. Take baby
steps and continually stretch the muscle gaining a little stretch with
Ischemic compression with concominant stretch:
My favorite. It takes no special tools or setup. I
believe ischemic compression gives the best, quickest short term pain
relief. However, not as long lasting as other methods.
Stretch gives the best long term relief and prophylaxis.
Stretching all your life is the best pain prevention.
Active trigger points cannot be stretched without some ancillary
help. Cold, compression, heat - all will enable stretching of
All of the above work. It depends on the practitioner and their individual preferences and skills.