Massage - Trigger Point

Whether trigger points even exist is still a matter of some controversy.  Proponents on both sides will argue and reach no definite conclusion.  To explore working them, will require a slight detour into some simple muscle physiology.

Muscles work when a set of protein molecules composing them "overlap" by being electro-chemically stimulated.  These long chains slide past one another and the accumulated effect is a muscle contraction.  

Essential to this process are two things: nerve stimulation and minerals, particularly calcium (Ca).

The theory of trigger points involves the specific accumulation of Ca (calcium) at certain points and the way nerve and muscle tissue react as a result. While still under investigation, the theory isn't just wild speculation.  One chief researcher was the official physician to President John F. Kennedy, known to have severe back pain.  Trigger point therapy was regarded, at least by him and the doctor, as effective in his case.

Finding a trigger point, which is a very small area where the muscles are located in this particular condition, is a matter of careful examination. Many believe that taut bands of muscles are an indicator and a hard nodule (a central locus or area) can be felt.

One difficulty is that trigger points can often "refer" pain.

To "refer pain" means to stimulate one area where damage may actually be present but have it felt elsewhere.  Naturally that makes finding the actual trouble spot tricky.  One way is to run a finger perpendicular to the muscle direction, then look for a twitch response.  Pressing the muscle at the point that causes it to contract is thought to be a way of locating the trigger point.

Others have reported feeling an increase in heat in the area near the trigger point.  If there's higher chemical activity in an area of pain, this might possibly be a valid opinion. Pain is commonly accompanied by inflammation, which can certainly produce a small amount of heat.

Though the theory behind trigger points has its skeptics (which is a healthy thing), and isn't taught in medical schools, studies suggest there's more to it than just wishful thinking.

Once properly trained, the massage therapist can regularly locate trigger points in independent trials.  That suggests there is a factual basis that each is identifying. Even so, the medical community at large has yet to adopt any serious belief that trigger point therapy is of value in any traditional medical treatment program.

However, the neurophysiology of muscular pain is still a hot area of research.

There are serious studies that tend to locate trigger points at the juncture of small, overstimulated muscle spindles. Think of a group of vines twisting around one another. Then imagine that at some point that this "rope" has a small knot other than at the ends. That's a simple visual metaphor for a trigger point.

One way to approach them as a massage therapist is to use the common technique of tapotement. This is a gentle to moderate tapping motion that is frequently part of Swedish massage, or sports massage. Using the fingers or a small instrument the area is tapped, moving above and below the suspected problem. Sometimes elbows are employed for slightly greater force.

Keep in mind, it's important for the massage therapist to seek client feedback since excessive pressure during massage, and particularly during trigger point therapy, can cause bruising.