TRIGGER POINTS

Trigger points refer to an irritable nodule that occurs in taut muscle tissue. An Active trigger point means it causes spontaneous pain where the nodule is located and pain in a specific referral pattern in nearby areas of the body (see picture below). This pain can be replicated when we press on this active nodule - and it can be pretty intense! For instance, a nodule in your mid back, when pressed may cause pain all over your shoulder and neck. Latent trigger points are ones that don’t cause pain unless they are pressed on - they may be there, but you wouldn’t notice it until we find it!

These trigger points can be responsible for symptoms such as pain or soreness, muscle stiffness, and restricted range of motion. We all have them to some degree, they just don’t always elicit pain or dysfunction.

Why do trigger points occur? 

This is a great question - and it’s a bit unclear. There are a few theories that stem at the level of the muscle.

One theory originates from the idea that trigger points arise from the overload and overuse of muscles (say, lifting something too heavy, and/or too often). This is especially true if we lift very heavy and don’t allow the micro-traumas to recover. Don’t forget about rest!

Another interesting theory is called the Cinderella theory - where muscles recruit certain fibers under moderate or low load activities (static postures that are often used by office workers, dentists etc.) These smaller fibers are then overused, and under-rested - leading to them being susceptible to forming trigger points. This leaves our larger muscle fibers under utilized and not taking their share of the load. Lack of exercise can be a factor in trigger points too!

One experiment demonstrated that 30 minutes of typing (and the low level muscle contraction involved in this action) can lead to trigger points in office workers.

Moving off of this idea - the low level contraction of cervical muscles (in our neck that keep our head stable) and postural muscles (that keep us standing) can be overused via daily activities and sedentary work. Often a lot of these muscles are required in precision tasks, and, like the Cinderella theory, we disproportionately rely on these muscles, causing changes at the cellular level of the fibers. This can lead to pain and trigger points.

How do I deal with my trigger points?

The major treatment protocols that have been used in the history of treating trigger points include local anesthetic, stretching, massage, saline injections and dry needling.

As NDs, we often use acupuncture and the technique of dry needling (inserting an acupuncture needle into the trigger point to elicit a “twitch” tells us the trigger point has been released) combined with cupping therapy (similar to massage, with silicone cups). 

As with any treatment focused on our muscular system, strengthening, stretching and resting the affected areas are always important. Focusing on strengthening and activating some of our bigger under-used muscles (especially in posture). These big, strong muscles can take some load off our smaller postural muscles. And don’t forget to move around often! Shift your posture/take a walk/stretch throughout your day.