It's a safe bet we've all had them and probably know many others who have them as well. So, what are they...Trigger Points!!  Small but powerful, they can cause severe pain and debilitation.  Trigger Points can cause people to miss days at work, be unable to compete and, left untreated, can cause problems in the surrounding tissue and spread to other areas.  Described as small areas of tightness, spasm, a thick knot in the muscle or even scar tissue, they typically start in muscle or tissue that is tight, weak or overloaded.  They can eventually become painful or even refer pain to other areas.  Are we destined to be at their mercy?

You can typically identify a trigger point (TP) in one of three ways:

1. Pain – either the TP hurts, it refers pain somewhere else or it causes pain in a joint due to the dysfunction;

2. Motor pattern change – you notice that something just don't feel 'right' and what once seemed a normal and easy movement becomes awkward or clumsy.  Often, muscle firing patterns have changed and you are struggling through your workouts, noticing a decrease in performance; 

3. Weakness - A muscle with one or more TPs will lose its strength until the TP is treated and could lead to a noticeable decrease in performance as well. 

A Result or a Cause?

So, which came first, the chicken or the egg!  There is sufficient reason to believe that TPs are both a cause and effect.  While the debate continues, the one thing I believe we should all agree on is this…it doesn’t matter!  Once you have identified a TP, it is part of a cycle that includes pain, spasm, tightness, TP, weakness, pain, spasm… 

Some factors that have been associated with TPs include: poor training technique/biomechanics, excessive fatigue, poor warm-up, change in training surface or routine, change in equipment or a muscle imbalance (strength, flexibility or both).  Other factors might be insufficient sleep, stress, depression, poor posture, inadequate nutrition and direct trauma to a muscle (strain, tear, direct blow.)

Muscles that surround a joint act as guide wires to keep the joint lined up correctly.  If one muscle becomes tight or weak, then the balance is disrupted and the joint is no longer lined up.  Similar to the front end of your car, if it is out of alignment, it will wear down your joint just as your tires are worn. 

The key to eliminating TPs is to break into the cycle.  You can start with the generic ‘cycle’ I mentioned above or you can try to identify these or other component that may be present.  Starting with a general stretching and strengthening program for the area around the TP is usually a good place to start.  In addition, working directly on the TP through various massage techniques from general (increase blood flow and loosening) to specific (cross friction - break up tight scar tissue that has developed) can be very beneficial.  A technique I find very helpful is direct, ischemic pressure.  This works by applying direct pressure to a TP for about 30 seconds. 

There are two main theories as to why direct pressure can be effective: increasing the pain will cause a release of endorphins (natural pain killers) and stopping the blood flow and then re-starting it can flush out inflammation and bring a fresh supply of food, water and nutrients to the area.

Treatments that are commonly used in rehabilitation treatment include using a fine, cold spray followed by a gentle stretch (a Spray and Stretch technique), ultrasound (sound waves administered to the muscle by moving a handheld wand over the area using a ‘gel’), electrical stimulation (introducing a low-level electrical current to the area via electrodes), iontophoresis (using electrical current to ‘drive’ an anesthetic medication into the tissue) or hold/relax stretches (using a gentle contraction of the muscle while applying a gentle stretch during the relaxation.)

Self treatment is always a safe way to begin working with TPs as long as you start out slowly and pay attention to what you do and the affect the intervention had on pain, movement and function.  Any worsening of your symptoms means you should stop your self treatment and seek more guidance from a qualified professional.  Any information you discovered during your self-treatment should be shared with your professional and may assist them with a more accurate diagnosis or treatment plan. 

More serious injuries that have caused the TPs will need to be addressed or else the TPs will not disappear.  Recognizing all components and addressing each of them will provide you with the most benefit in restoring normal activity, trigger point-free!