Trigger Points: What Are They and How Do I Get Rid of Them?
Many of us have heard of the term, Trigger Point (TrP). We go into our massage session and complain of a sore or painful area in our muscles and our massage therapist finds what they call a TrP. When they touch it, sometimes it refers pain to other areas and sometimes the pain just increases at the local level. But what does that term actually mean?
At the most basic level, a TrP is an area of tight tissue that is shortened such that it has an increased diameter, which makes the muscle tissue bunch up, or feel like a knot. This bunched up muscle is actual shortened portions of the muscle fiber that has been overused or injured.(1)
An injury is pretty self explanatory, but what counts as overused? Sometimes, overused muscle tissue is an area that is contracted at its maximum force. Other times, overuse is from a low level contraction (10-15% of max force) for long periods of time. I have a couple of examples to explain both of these situations.
For a muscle that gets overused from contraction at its maximal force, think lifting a heavy object, like a couch or chair in the living room that needs to be rearranged because during this pandemic you just need a change of scenery! :) If the furniture is heavier than your muscle capacity is able to handle, you can develop a TrP in your biceps brachii, your pectoralis major or your quadratus lumborum (in your low back) because you are lifting something that is heavier than you are normally able to handle. (Please lift with your legs!)
For a muscle that is overused from low level contraction, think sitting at the computer and typing or mousing for long periods of time. Or doing needlepoint, knitting or holding your phone while reading social media. Even though normally holding the mouse or having your arms in front of you to type on the keyboard isn’t too much work, when you do this for hours a day, your muscles get tired and TrPs form in the tight muscle. Usually these TrPs are felt in your upper back or in your neck, sometimes even in your forearms.
When muscles are overused, there is an underlying situation that occurs that we don’t normally consider. Blood flow. Normal, healthy muscle contraction that is within our capability and done for an amount of time that allows the muscles to rest creates a muscle pump that delivers fresh nutrients to the area. This scenario is how the muscle organ stays healthy. But when the muscle is overused, the blood flow can be inhibited, partially slowing this muscle pumping action that then decreases the amount of fresh nutrients to the area.(1) So a cycle of dysfunction is created. Muscle overuse causes a decrease in blood flow and an increase in TrP formation, which creates pain at rest or while moving. Usually, this causes us to move the area less and then the tautness of the area increases because the muscle pump action isn’t being used to clear the area and bring in enough fresh nutrients. We call this the Pain-Spasm-Pain cycle.
So what are we to do when we get into this cycle? Well as luck would have it, massage therapy is excellent at inhibiting this cycle. Massage is designed to help the body release taut bands of tissue (contracted muscles) and thus increasing circulation in the area. In addition, proper stretching can also help in recovering from an overused muscle contraction. These two practices can help us all get out of the acute pain phase of TrP creation. But how do we keep TrP formation at bay?
When we think of muscle overuse, perhaps the right answer for decreasing the development of TrPs is to rest more, not do as much… In the short term, during the acute phase, some rest is absolutely what the doctor ordered. But if all we do is rest, our muscles will get weaker and the overuse pattern will actually happen sooner the next time we return to our normal activities.
The key to reducing muscle overuse is to become stronger. Specifically, to increase strength in our muscles. Which means lifting heavy things. But lifting heavy things caused a hyper contracted muscle in the first place! What are you talking about?! The reality is we have to lift heavy things that are already in our capability first to build up our capacity to lift heavier things next month. Describing weight lifting exercises is beyond my scope as a massage therapist. But, one thing I can say, is that if we start at too high a capacity, we will injure ourselves. We must start slowly and increase the weights slowly, so that our body can build strength in its natural time frame. This takes longer than you may think, but if we follow a program for 3 months, we will be stronger at the end of that 3 months. Then 3 months later, we will be even stronger.
And, miraculously, when we sit at a computer and type for 3 hours, we will have less pain in our upper backs and neck because the exercises we chose helped strengthen these areas. Our capacity, our strength, allows us to keep doing our jobs with less pain. Think what could happen if you build strength and you love running… More on that in another newsletter.
Carel Bron and Jan D. Dommerholt, “Etiology of Myofascial Trigger Points,” Current Pain and Headache Reports 16, 493-444, (October 2012) (https://link.springer.com/article/10.1007/s11916-012-0289-4)