Trigger Points What Are They?

By Angela M. Homer, PTA, LMT, NASM-CPT

Have you gone to see your massage therapist because you are stressed and have pain in your neck and shoulders? Maybe you have even experienced a headache or two. Your skilled therapist immediately clunks over the terrain of your shoulders and upper back and you ask “What is that?!” That is the million dollar question. It is a trigger point.

Trigger points are described as hyper-irritable spots in skeletal muscle that are associated with palpable nodules in taut bands of muscle fibers. The nodules are said to be small contraction knots and a common cause of pain. Compression of a trigger point may elicit local tenderness, referred pain, or a local twitch response.

The theory is that usually an event of muscular overload causes a prolonged release of calcium ion (Ca2+) from the sarcoplasmic reticulum (storage unit for the muscle cell) which results in a sticking of the untrained or overloaded cells. This leads to a compression of capillaries and results in as increased local energy demand and local ischemia (loss of blood circulation) to the area. This “energy crisis” causes the release of chemicals that augment pain activity. Since an involved muscle is weakened by this theorized sustained shortening, surrounding muscles themselves may develop trigger points in a compensatory fashion.

Today, much treatment of trigger points are handled by massage therapists, acupuncturists, physical therapists, osteopaths, some naturopaths, chiropractors and other hands on somatic practitioners who have had experience or training in the field of neuromuscular therapy (NMT).

It was, however, an American physician, Janet G. Travell, who was responsible for the most detailed and important work. Her work treating U.S. President John F. Kennedy's back pain was so successful that she was asked to be the first female personal Physician to the President. She published more than 40 papers between 1942 and 1990 and in 1983 the first volume of The Trigger Point Manual appeared; this was followed by the second volume in 1992. In her later years, before her death, Travell collaborated extensively with her colleague David Simons. Her books have been used by many bodyworkers and physical therapists alike.