What is a Trigger Point?
Dr’s Travell and Simons defined a myofascial trigger point as a hyperirritable spot in a skeletal muscle. A trigger point is usually painful on compression and may give rise to characteristic referred pain, referred tenderness, motor dysfunction and autonomic phenomena. Myofascial trigger points occur in both acute and chronic pain conditions. Hendler and Kozikowski suggest that myofascial trigger points as the most commonly missed diagnosis in chronic pain patients.
Why Do Trigger Points Cause Pain?
According to Dr Gunn, ‘Shortening in muscles acting across a joint increase joint pressure, upsets alignment, and can precipitate pain in the joint, i.e. arthralgia.’ There is also a theory that permanent muscle contraction is abnormal and can create an ischaemic muscle pain due to the restriction decreasing normal muscle blood flow.
How are your Trigger Points Treated?
It is possible to deactivate triggers points by various methods such as acupressure, dry needling, muscle stretching, trigger point massage devices or injecting them with a large number of varying substances, including saline (saltwater) placebo.
Trigger Point Massage/Acupressure
Trigger Point Therapy is a form of Remedial Massage Therapy in which direct pressure is applied to specified points on tender muscle tissue to bring about a reduction in muscle tension and pain relief.
Trigger point therapy is for almost everyone. Muscles with active trigger points are always weaker than healthy muscles and unable to move through their full range of motion. Often because they are unable to perform their normal function, you recruit alternative muscles to perform the activity of the compromised muscle. These secondary muscles can go on to develop trigger points themselves if you don’t treat the original hypertonic muscle.
Dry needling may assist with decreasing local muscular pain and improving function through the restoration of your muscle’s ability to elongate and shorten. When your therapist inserts a fine filament needle into the centre of a myofascial trigger point, blood pools around the needle triggering the contracted muscle fibres to relax by providing those fibres with fresh oxygen and nutrients, as well as by flushing away any additional acidic chemicals. This reaction leads to the decompression of the local blood and nerve supply.
How Does Dry Needling Work?
The needle sites can be at the epicentre of taut, tender muscle bands, or they can be near the spine where the nerve root may have become irritated and supersensitive. Penetration of a healthy muscle is painless. But, a shortened, supersensitive muscle may ‘grasp’ the needle or trigger the muscle.
Dry needling of the ‘shortened’ muscle band causes an immediate, palpable relaxation. The patient often experiences a sense of release and increased range of motion. When used in conjunction with motor control retraining and postural and movement behaviour retraining, the trigger point release obtained from dry needling can be long-lasting. The result is a stimulation of the stretch receptor within the muscle (muscle spindle), producing a reflex relaxation or lengthening response.
Dry Needling vs Trigger Point Injections
Researchers have studied trigger point injections using placebo saline and drug therapy. They have concluded that the only consistent factor is that the pain relief is from the stimulation of the needle used for the injection itself, rather than the drug or saline solution used. While the jury is probably still out on the effect of trigger point injections, it is perhaps fair to suggest that the mechanical needle stimulation of the trigger point without the use of a drug (dry needling) does have a positive effect upon hyperstimulated trigger points. If you are interested in dry needling, most of our PhysioWorks Physiotherapists are dry needle trained.