General self-myofascial release has become familiar to the general public in recent years but targeted trigger point release is much less well-known. Although myofascial trigger points can certainly be self-treated with simple massage techniques and some targeted stretching when needed, in many cases a trained professional may be a better option. This is especially true in the case of chronic recurring pain conditions as opposed to occasional acute pain problems. Trigger points can have an underlying cause, and reading a trigger point self-help book, although highly recommended, is a long way from preparing us to identify and treat these underlying causes. However, when choosing to perform trigger point self-therapy there are some simple and universal precautions.
Trigger Point Self-Therapy Cautions
1. Going straight to trigger point treatment and thus relieving the pain symptoms may cause us to ignore underlying causes or in fact, to never recognize them until they become something you can’t massage away! Stress and overload leading to acute injury or repetitive strain injury can be caused by habitually repeated movements or even by chronically sustained body positions. As the body adjusts to these problems compensations occur which force the body’s segments out of their proper positions.
Although the most recognized trigger point reference, Myofascial Pain and Dysfunction: The Trigger Point Manual by Janet Travail and David Simons of course recognizes and explains some of these underlying pathologies that may lead to TrP’s this reference may be too technical and daunting. It was never meant as a self-help reference. However, those TrP references that are self-help oriented, such as The Trigger Point Therapy Workbook by Clair Davies could be criticized for under-stressing the importance of recognizing underlying causes of trigger points other than trigger points themselves. In fairness, though a self-help reference that tries to cover too many scenarios and reveals too many technical details ceases to be a viable self-help reference. Although these books do touch on the importance of posture and overuse syndromes in TrP’s the reader should be aware that it is up to him or her to investigate this facet of pain syndromes further in order to be as educated as is reasonably possible.
2. Don’t apply too much pressure or stretch too vigorously all at once. Start off with just as much as you can stand and gradually increase the pressure and go deeper into the tissues. Too much pressure by someone improperly trained can produce micro-trauma of the tissues. In fact, while ischemic compression was at first used by Travell and Simons in the later 1999 edition of their book they recommended gentle pressure using the “barrier-release” concept in which the fingers follow the “lines” of the tissue rather than pressing down directly over the area of most pain. Compressive techniques are still used by massage therapists, however.
3. Don’t go overboard! Do not try to identify and treat every trigger point you have all at once. Deal with your worst pain area first and then move on to the others gradually. The body must repair and adapt to what you are doing. Don’t overwhelm it. You may just end up in more pain than you started with.
Fixing your posture and over-use problems should go hand in hand with any myofascial treatment. Keep in mind that there are conditions that help bring trigger points on. Fixing the trigger points without addressing the underlying conditions will be a temporary fix, at best.
Trigger point (Trps) should be viewed as a “bodily alarm”. Leon Chaitow relates “switching off” a TrP without discovering why it is active to “silencing a fire alarm with a sledgehammer”. Sure the alarm stops but the fire is still raging. There is nothing wrong with easing your pain symptoms through some judiciously applied self-massage or other treatment but don’t let your ability to relieve the pain blind you to the importance of putting out the “fire underneath” the pain.
How do I know it’s a Trigger Point?
Sometimes pain in an area can be to specific injury to the soft tissues in that area or some other type of local activity in the area. Not all pain is referred pain! Sometimes people get so caught up in finding and fixing their trigger points they forget this simple fact. So remember that one of the main definitions of a trigger point is that they do refer pain to other areas.
When you feel pain in an area and press on that area, if the pain does not increase then it is more likely to be referred pain from a trigger point. From there you will need to use a trigger point resource to help you identify where the trigger point may be located. But if you press on the painful area and the pain gets worse, then it is not referred pain and is less likely to be a trigger point and more likely to be a local injury or problem with the tissues. However, this is but a general rule because it is possible to encounter a secondary or “satellite” trigger point in the referred pain area of a trigger point, because they can tend to occur in these areas.
Another clue may be the relationship between the amount of pressure applied and the pain induced. With trigger points, the pain induced tends to be proportional to the amount of pressure. If you press on a trigger point just a little you get just a little pain. Whereas when the pain is of local origin just a tiny amount of pressure may produce pain that seems all out of proportion. Some trigger points in themselves can be very very tender to the touch…even a slight touch. But in general, you can expect an association with the amount of pressure applied. If the pain is just as bad when you lightly touch the spot as when you press on it hard…it is more likely to be of local origin.
Trigger points in one muscle can send pain to a surprisingly wide area or to areas you wouldn’t expect. It’s possible for trigger points in the rectus abdominis to send pain to the back, for example. The scalene trigger point patterns in the image below show that pain from the scaleni TrPs affects most of the arm, shoulder, and medial scapular border of the same side. It is possible for other satellites trigger points to from in these areas in chains. But unless the primary scalene trigger points are treated then treatment of the satellites will never help for long if at all.
Remember also that trigger points can affect the autonomic nervous system as well. Pain is not always the only symptom. Trigger points in the neck or head muscles may cause the teeth to become hypersensitive to hot or cold. They may affect tear or saliva production. They may make you break out in a sweat. Or cause gastric symptoms.
The key point to finding a trigger point, however, is that a TrP is extremely tender. You shouldn’t have to press down with all your might to induce pain. Muscular tenderness is possible with other conditions but rarely is the pain as easy to induce. If you are in doubt, check with your medical doctor and consult with a qualified professional. 1Chaitow, Leon. Maintaining Body Balance, Flexibility, and Stability: a Practical Guide to the Prevention and Treatment of Musculoskeletal Pain and Dysfunction. Edinburgh: Churchill Livingstone, 2004. Print.,2Davies, Clair. The Trigger Point Therapy Workbook: Your Self-treatment Guide for Pain Relief. Oakland, CA: New Harbinger Publications, 2004. Print.
When Can I Begin Trigger Point Self Therapy?
1. Once any and all of your underlying problems (posture, over-use) have been identified and are being tended to (perhaps by a qualified physical therapist in conjunction with some appropriate strength training) and rehabilitation.
2. You know the self-massage guidelines and you own a good trigger point self-treatment book.
“…without the professional input of trained health care providers ‘self-help’ can often produce inadequate results.“ – 3Leon Chaitow Chaitow, Leon. Maintaining Body Balance, Flexibility, and Stability: a Practical Guide to the Prevention and Treatment of Musculoskeletal Pain and Dysfunction. Edinburgh: Churchill Livingstone, 2004. Print.
It is possible to treat trigger points successfully by yourself! But in an era that puts so much emphasis on alternative health care, of which self-care is a huge facet, many people might feel like a failure if their pain doesn’t go away because they locate their trigger points and begin a massage regime. You are not a failure if this happens. All pain cannot be solved by self massage so do not hesitate to seek professional care. Your pain syndrome may just be too complex to solve by yourself. However, your efforts may well coincide and complement the efforts of a professional therapist. And the more you understand the more your care will improve.4 Davies, Clair. The Trigger Point Therapy Workbook: Your Self-treatment Guide for Pain Relief. Oakland, CA: New Harbinger Publications, 2004. Print.
Sources [ + ]
|1.||↲||Chaitow, Leon. Maintaining Body Balance, Flexibility, and Stability: a Practical Guide to the Prevention and Treatment of Musculoskeletal Pain and Dysfunction. Edinburgh: Churchill Livingstone, 2004. Print.|
|2.||↲||Davies, Clair. The Trigger Point Therapy Workbook: Your Self-treatment Guide for Pain Relief. Oakland, CA: New Harbinger Publications, 2004. Print.|
|3.||↲||Leon Chaitow Chaitow, Leon. Maintaining Body Balance, Flexibility, and Stability: a Practical Guide to the Prevention and Treatment of Musculoskeletal Pain and Dysfunction. Edinburgh: Churchill Livingstone, 2004. Print.|
|4.||↲||Davies, Clair. The Trigger Point Therapy Workbook: Your Self-treatment Guide for Pain Relief. Oakland, CA: New Harbinger Publications, 2004. Print.|