As a Registered Massage Therapist, the number one thing I treat are trigger points.

A trigger point (TP) is a hyperirritable spot, usually within a tight band of muscle tissue, or what we sometimes refer to as a “knot." The whole muscle is not irritated, just one part, and depending on the muscle, the knot can be small or large. The cause of these TPs can be injury, overuse, stress, chill to the muscle, illness, or prolonged shortening of the muscle (where a limb is immobilized or during sleep).

The reason only part of a muscle is affected can be explained by the physical aspect of the muscle. Each muscle is made up of many motor units. A motor unit consists of a group of muscle cells and a nerve ending that supplies those muscle cells. The number of motor units in each muscle differs from hundreds to millions depending on the size of the muscle and the muscle’s function. When there is an injury or other trauma to the muscle, the affected motor units will spasm. The spasm will trigger pain, which is a protective response, and inform us that something is wrong. This prevents the whole muscle from going into spasm which would be very painful, and still allows some function.

Trigger points can be divided into two categories: active and latent, but there are some common characteristics between the two. Both types prevent full lengthening of the muscle, weaken the muscle, and cause pain and tenderness when pressure is applied. The difference is an active trigger point is one that causes sharp pain, even without pressure. This is usually the time that people seek treatment. It must be stated that a latent TP can be activated with cold, trauma, overuse, or overstretching. What this means is that time does not heal a TP, it just allows it to be quiescent until such a time as it is activated. This could be days, months or even years.

One other aspect of trigger point pain is that it can be felt in an area other than the muscle itself. This is called referral pain. This is usually a dull aching pain, and each muscle has a specific referral pain pattern. An example of this is found with the iliopsoas, a muscle that flexes the hip. With an iliopsoas spasm, muscle pain will be felt in the abdomen, but referral pain can be felt in the lower back. A second example of this is a tension headache. Headache pain felt in the forehead or over the ears can be a result of a trigger point in the tiny muscles at the base of the skull.

Treatment of a trigger point is best done with direct pressure. This accomplishes two things. First, with direct pressure there is an occlusion of some of the blood vessels in the muscle. With a reduction of blood flow, there is less oxygen reaching the muscle, which is necessary for the muscle to contract, and therefore the muscle relaxes. As well, there is a protective response through the nervous system and the brain orders the muscle to relax. Once the muscle relaxes, there is a large decrease in pain, increase in the range of motion, and then the cause of the trigger point can be addressed.