"Muscle is an orphan organ. No medical specialty claims it.
As a consequence, no medical specialty is concerned with promoting funded research into muscular causes of pain, and medical students and physical therapists rarely receive adequate primary training in how to recognize and treat myofascial trigger points"
David Simon, "Myofascial Pain and Dysfunction: The Trigger Point Manual
It’s really not possible to write a blog about bodywork without mentioning trigger points. They are a very big deal for us therapists because they are associated with just about every problem we see in our practices.
A simple way of thinking about trigger points is to imagine a very small cramp or spasm in a muscle. These irritable spots get set up in our body for a variety of reasons but mostly to do with physical and emotional stress. Everybody has trigger points – well maybe not very young children but just about everyone else. One commentator I follow, Paul Ingraham, reckons that trigger points are just the price we pay for having complex bodies capable of such a range of movement and activity.
Check it out for yourself: reach over your left shoulder with your right hand and touch the top of your shoulder blade just at the corner where it goes from straight across your back to down towards your feet. If you’re in the right place, then it’ll probably hurt to rub this spot and you may even find that this pain seems to extend up the side of your neck. This is a trigger point that most of us have, and the sensitivity you are feeling illustrates two important properties of these points, namely that they are painful to touch and that this pain appears to radiate to a more distant part of your body.
Typically, trigger points, if they’re present at all, will be active or latent. Latent points still hurt when touched and can irritate and tire the muscle they are in but mostly you aren’t aware of them. When a latent point switches to the active state, then a characteristic pain pattern is noticed and the effects on the muscle are more extreme. Going back to our example of the trigger point at the top of the shoulder blade, the pain you felt was probably that of a latent trigger point. Had it been active, then you would not have needed to touch it to produce pain - the side of your neck and whole upper shoulder would have been sore and you may even have had difficulty turning your head to that side.
So why do trigger points get set up in the first place and why do they switch from latent to active? Well, like I said above, trigger points seem to develop in response to stress. This could be severe stress like physical trauma or it could something more mild like the tiring effects of repetitive activity. Emotions like anger or grief could cause them and it is thought that chemical imbalances in your body play an important role as well.
Whatever the reason, the end result is likely to be pain, protective guarding and restricted movement. In effect, your body seems to be stopping you from making certain movements or adopting particular positions. If you ignore these trigger point signals, and most of us do, then your body will try and adapt, usually by recruiting other muscles to perform the restricted action or posture. If this goes on long enough these muscles may themselves develop trigger points and the problem will become more widespread and probably more severe.
Next time we’ll look at how you treat trigger points
Check it out for yourself: reach over your left shoulder with your right hand and touch the top of your shoulder blade just at the corner where it goes from straight across your back to down towards your feet. If you’re in the right place, then it’ll probably hurt to rub this spot and you may even find that this pain seems to extend up the side of your neck. This is a trigger point that most of us have, and the sensitivity you are feeling illustrates two important properties of these points, namely that they are painful to touch and that this pain appears to radiate to a more distant part of your body.
Typically, trigger points, if they’re present at all, will be active or latent. Latent points still hurt when touched and can irritate and tire the muscle they are in but mostly you aren’t aware of them. When a latent point switches to the active state, then a characteristic pain pattern is noticed and the effects on the muscle are more extreme. Going back to our example of the trigger point at the top of the shoulder blade, the pain you felt was probably that of a latent trigger point. Had it been active, then you would not have needed to touch it to produce pain - the side of your neck and whole upper shoulder would have been sore and you may even have had difficulty turning your head to that side.
So why do trigger points get set up in the first place and why do they switch from latent to active? Well, like I said above, trigger points seem to develop in response to stress. This could be severe stress like physical trauma or it could something more mild like the tiring effects of repetitive activity. Emotions like anger or grief could cause them and it is thought that chemical imbalances in your body play an important role as well.
Whatever the reason, the end result is likely to be pain, protective guarding and restricted movement. In effect, your body seems to be stopping you from making certain movements or adopting particular positions. If you ignore these trigger point signals, and most of us do, then your body will try and adapt, usually by recruiting other muscles to perform the restricted action or posture. If this goes on long enough these muscles may themselves develop trigger points and the problem will become more widespread and probably more severe.
Next time we’ll look at how you treat trigger points
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