I use trigger point therapy a lot while treating patients in my office; it’s one of the many tools used to get a person well. Trigger point therapy is very effective for a variety of problems, often structural, but even sometimes visceral (organ-related). Since I discuss trigger points in articles throughout the Sock Doc site and especially in my videos, I thought it would be helpful to go deeper (no pun intended) into trigger points: why you get them and will want to correct them, and how to go about doing just that safely and effectively.
What Is a Trigger Point?
Trigger points are termed as hyperirritable points in the muscle and fascial matrix, which can alter nervous system function. They are often created by nervous system stress, which I’ll talk about more in a bit. Tiny parts of the muscle called sarcomeres are unable to release from their interlocked state, creating poor blood flow, inflammation, and pain in the area. Trigger points can be anywhere in the body, and can result from a local injury or one distant from the perceived injury location. They are described as hard nodules, tight bands of fiber, or “knots” in the muscle or fascia. In reality, many trigger points refer to pain in a distant area. Common examples include a trigger point in the calf muscle that causes ankle or foot pain, or a trigger point in the upper trapezius that causes jaw or headache-type pain.
The concept behind trigger points is nothing new. In 1942, medical physician Dr. Janet Travell coined the term based on what she described as myofascial pain syndromes. This basically means pain derived from muscle, fascia, or both. Fascia is the thick type of connective tissue that surrounds pretty much everything in your body, from muscles to blood vessels to organs. Fascia is like a spider-web matrix of tissue, making it plausible that everything is in some way connected to everything inside you. That means that muscles in your foot are connected to muscles in your neck, and even to your liver, obviously not directly, but it’s definitely amazing (at least to me).
In the 1960s, chiropractic physician Dr. George Goodheart used a similar type of trigger point therapy to correct muscle imbalances. He called his therapy “origin-insertion technique,” and observed that when manually treating a “knot” in the muscle or fascia, not only was the patient’s pain decreased or eliminated, but muscle strength, posture, and range of motion also improved. This type of work, which is used by many doctors (including myself) who practice applied kinesiology techniques and various forms of manual muscle testing, also allows them to figure out precisely where the trigger points are, as changes in muscle function can be detected immediately upon palpation (slight pressure) of the trigger point. This also allows these practitioners to understand abnormal patterns (such as gait imbalances) that have developed from the trigger points and the order in which they are best corrected. As discussed in other articles, stretching will not change a muscle that is neurologically facilitated (in spasm); exercise of any type will not benefit a muscle that is neurologically inhibited (weak) more than temporarily. Many hold onto the belief that either type of therapy provides healing benefits. Trigger point therapy, however, can correct these muscle imbalances and restore function, often very quickly.
How Do You Treat a Trigger Point?
Ideally when you treat a trigger point, you press on it just hard enough but not too hard—you sorta have to get a feel for it. This can sometimes be difficult to do on yourself. You can hold a trigger point, rub it in a circular motion (either direction), or work the trigger point in a back-and-forth motion. One method may provide a better result than another on a case-by-case basis. Apply pressure or rub out the trigger point for at least 10–15 seconds. If the pain improves as you treat the point, continue until there is no further relief. Sometimes you can feel the trigger point “wash away” beneath your fingers and disappear.
Some practitioners use modalities and tools, such as wooden or metal spoon-shaped devices and other handheld appliances, mechanical vibration, laser therapy, electrostimulation, dry needling, or injections to treat a trigger point. Although some of these can be beneficial, I prefer using my hands as much as possible. It allows me to feel the area I’m working on, and often the dissipation or release of the trigger point can be felt. Using a hands-on approach also reduces the chances of pressing too hard and creating further damage or bruising, as well as not pressing hard enough or long enough, which results in inadequate results. If your hands are not strong enough or you’re unable to reach a suspected trigger point, then tools such as a foam roller, tennis or golf ball, Thera Cane, or The Stick may be beneficial.
Why Treat a Trigger Point?
One main benefit of treating a trigger point is that it helps correct neurological muscle imbalances. Other therapies such as acupuncture, chiropractic and cranial-sacral adjustments, nutritional and lifestyle interventions, and biofeedback programs can also correct muscle imbalances, which is vital for injury prevention and treatment. As mentioned previously, stretching and exercise therapies cannot correct muscle imbalances; they can only alter function for a very short period (often less than one minute). Once the neurological muscle imbalances are corrected, then rehabilitation via exercise is definitely recommended. But (static) stretching? Definitely not. By addressing the trigger points as described, muscle fibers and connective tissue (including scar tissue) can realign and begin to heal, and the injured area may remove waste through improved blood flow. It is also suspected that treating trigger points can help with inflammation, perhaps much like compressing an injury can be beneficial.
I also believe that when using trigger point therapy on an old or chronic injury, it’s also making your body aware that there is an injury still present that needs to be dealt with; it’s as if your body has compensated and forgotten that there is still an injury affecting you, though there is no acute pain. I see many patients with patterns of injuries that are not healing because their bodies essentially don’t recognize that there is a problem anymore. It’s difficult to explain, but when you’re injured, certain aspects of your nervous system respond a certain way. When they don’t respond correctly, you don’t heal properly, or at all. For example, you may have injured your shoulder in the past but no longer experience pain (that you are aware of, anyway). Now, months or years later, you have a pain in your hip due to a gait imbalance caused by that old shoulder injury. This is actually very common, and the hip problem will not be resolved until you deal with the shoulder issue, perhaps via a trigger point in a muscle in that region.
Why Do You Have Trigger Points? (Are You Addressing the Problem?)
If you suddenly become injured—say you are running and you fall into a hole and twist your ankle—you’re going to have trigger points in several areas surrounding the injury. It’s a local issue in a problem like this. If not properly treated (which often is the case), then continuing to walk on the injured ankle will cause gait imbalances, and you may soon develop trigger points (from muscle imbalances) in your knee and/or elsewhere. So it’s important to address the trigger points very early in an injury. If you’re self-treating and not a professional (therapist or doctor), and you are unsure of what you’re doing, you should be very careful. Obviously, you don’t want to cause more harm than good, such as inflaming an already inflamed area. You also don’t want to not address a more serious problem such as a fracture, tendon tear, or blood clot. So, be smart about it.
Often, trigger points develop from problems in another area, making them much harder to find. One example would be if you’re wearing footwear that isn’t right for you. You may develop trigger points in your calf muscles or lower back until you resolve the footwear problem. So if this is the case, you’ll be treating the trigger points all day long and see little, if any, lasting results.
I often like to remind patients that the cause of their problem is often distant from where it is felt. This means a problem in the thigh could be causing their foot pain, or a problem in the foot might be causing knee, low back, or even neck pain. This has a lot to do with the fascial connections throughout the body, as well as our kinetic chain (how we move): the foot affecting the knee, the knee affecting the hip, the hip affecting the spine. But the statement also means that muscles are affected by much more than just the muscles themselves. They’re highly influenced by visceral organs, nutrition, hormones, stress, emotions, the environment—pretty much everything and anything. Let’s take an example that is easy to understand. Say you eat something and you get very bloated—your belly distends. The abdomen distention is going to put pressure on your lower back, and this may cause you to have some low back or hip pain. Now you have a muscle imbalance between the front and back of your body as a result of your diet. Trigger points are going to be present in the lower back in various places, and probably deep in the abdomen in the psoas muscles, and treating these will most likely provide relief. But the problem is really deep within the gut, and it will continue to affect the trigger points until, well, you pass what you shouldn’t have eaten and the belly distention goes down.
Remember, muscle imbalances can come from everything and anything, and most often as a result of too much stress (including exercise training) and a poor diet. So consuming too much refined sugar or inflammatory-type fats will result in muscle imbalances and, therefore, trigger points (and in essence, an injury). Training too hard (anaerobic) or inadequate recovery (or poor sleep) will also cause various muscle imbalances, common in the knee, lower leg, ankle, and foot, and result in injuries and trigger points due to the relationship of these areas with the adrenal glands, where you make adrenaline, cortisol, mineral-balancing and sex hormones. So yes, the trigger points need to be addressed, but it is as important, if not more, to address why they’re there. These are concepts that traditional medicine does not recognize or understand.
I think this is a vital point because so many people, including “fit athletes,” eat poorly, are under substantial stress, and train improperly. So what happens? Well, they get injured. Then they, their doctor, or their therapist look only at where the injury is felt. Although this is necessary to some degree, depending on the injury, you have to address the WHY more than the WHERE. Also, the longer the injury is present, or has gone unresolved (such as the injury you perhaps had for months that just slowly went away on its own), the greater chance you’ll have a lot of trigger points present that you are unaware of. That old ankle injury can easily create shoulder problems, and most docs won’t even consider linking the two together.
Remember—trigger points can correct muscle imbalances, and that’s how you can effectively treat an injury or prevent one from occurring. One area might respond to a trigger point, whereas another area might not. If an area doesn’t respond, it’s either because you’re on the wrong trigger point or you aren’t treating it correctly (too much or too little pressure or time). Or, most often, that trigger point needs its source addressed: diet, lifestyle, training, a footwear change, or maybe a different therapy, such as acupuncture, chiropractic, or another effective type of bodywork. It’s okay to treat a trigger point a few times a day if you’re improving each time, but don’t think more is necessarily better. If you’re sore the next day, don’t continue—give it a rest.
One final point, which I discuss often in the videos, is that you usually don’t want to treat the exact area where the pain is felt, but the area around it, usually further proximal (up) or distal (down) on the muscle from where the pain is occurring. This is especially true for tendon pain—such as ITB problems and Achilles tendon pain—look deep in the muscle and not on those already tender muscle insertions. Think outside the box!
