Trigger Points

Walt Morrey, NCBTMTB #331446-00
25 Avenue de la Plage
29950 Bénodet

What are they?
Small injuries within the body of a muscle that can cause painful sensations far from their location

Who gets them? EVERYONE!!
  • Infants have been observed with point tenderness of the rectus abdominis
  • When children were examined for them, myofascial trigger points were found to be a common source of musculoskeletal pain in childhood.
  • In hospitalized and ambulatory patients in England, trigger points were most common in people aged 31 to 50.
  • With advancing age and reduced activity, the stiffness and restricted range of motion of latent TPs become more prominent than pain.

  • How can Trigger Points persist for decades?
    The most current theory about how TPs can persist for so long is:
  • Strain or other damage occurs to a muscle, which causes acetylcholine(ACh) to be released at the synapse, often associated with excess calcium.
  • High calcium levels keeps the calcium-charged gates open and the ACh continues to be released, resulting in ischemia.
  • The ischemia causes a localized oxygen/nutrient deficiency, which leads to inadequate adenosine tri-phosphate(ATP) production.
  • Without ATP, the muscle can't remove the calcium ions that are 'keeping the gates open' for ACh release.
  • Removing the superfluous calcium requires more energy than sustaining a contracture, so the contracture remains.
  • The contracture is sustained by the local chemistry, not by action potentials from the spinal cord.
  • As the endplate keeps producing ACh flow, the actin/myosin filaments slide to a fully shortened state around the motor endplate (at the center of the fiber)
  • As the sarcomeres shorten, they begin to bunch & a contracture knot forms.
  • The remainder of the sarcomeres are then stretched, creating the taut band common in TPs.

  • Basic Rules for avoiding Trigger Points:
  • Never lift or pull with the back bent and twisted
  • Always lift with the knees, holding the back erect and forward facing.
  • Never get up from, or sit down in, a chair while leaning forward in the stooped position with the trunk rotated.
  • Avoid jerky movements -- these cause unnecessary stress.
  • Observe how you do common tasks and minimize unnecessary movements.
  • Muscle fibers need to alternately contract and relax to increase blood flow and replenish energy supplies. Avoid keeping muscles in a contracted or fully stretched position - awake OR sleeping.
  • Avoid using muscles at maximum effort, when they are most likely to be strained. Always leave some reserve. Figure a different way to do the task, if necessary.
  • Avoid cold drafts -- causes muscular contraction and invites activation of TPs.
  • Take a hot shower or bath after exercise.
  • Stretch frequently, but not to pain. Go for full range-of-motion(ROM), but in sloooow steps.
  • Be more like a cat -- stretch before moving.
  • Be sure that your TPs have been fully cleared before attempting to build strength in those muscles; otherwise your exercise will be painful and non-productive.
  • Strengthen support muscles -- hold maximal contraction for 5-10 seconds once a day is enough.

  • For lower back pain. practice the yoga Boat posture to strengthen your abdominals

  • yoga-boat
  • Practice the yoga Locust posture to strengthen your lower back - arms forward (shown) is more difficult.

  • yoga-locust

    Trigger Point Perpetuating Factors:
  • Physical imbalances like uneven leg length or short arms
  • Misfitting furniture
  • Poor posture
  • Immobility
  • Frequent repetitive movement
  • Constricting pressure on muscles -- packs, heavy purses, belts, bras, edges of chairs
  • Nutritional inadequacies, especially vitamins B1, B6, B12, Folic Acid, & C; minerals calcium, iron, potassium, & magnesium
  • Alcohol use; oral contraceptives; vegan, starchy, or crash diets; & cigarette smoking can all contribute to vitamin deficiencies
  • According to Travell & Simons, "Nearly half of the patients we see with chronic myofascial pain require resolution of vitamin inadequacies for lasting relief."
  • RDA for vitamins merely prevents disease, not optimal body function
  • Tests have shown that many water-soluble vitamins (including B1, B6, B12, Folic Acid, & C) appear to cause no problems at dosages as high as 100xRDA to 10,000xRDA