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Trigger Point Therapy was created by Janet G. Travell, MD, an innovative physician who served as personal physician to President John F. Kennedy and to President Lyndon Baines Johnson. Dr. Travell, assisted by U.S. Air Force flight surgeon David Simons, M.D., wrote the book entitled “Myofascial Pain and Dysfunction: The Trigger Point Manual.”
Trigger points are focal areas in muscle tissue that are tender spots within taut bands of muscle fibers, typically referred to as a “knot” in the muscle. Trigger points are muscle cells that are locked in a contracted state. This can restrict range of motion in the joint served by that muscle, and it can create muscle weakness and generate pain. Trigger Points develop due to poor posture or some other form of repetitive stress on the muscle, or commonly as a consequence of soft tissue injury. When a muscle remains in spasm, there is limited blood flow through the area, leading to a build-up of metabolic waste substances and a lack of oxygen and nutrients. In order to release a trigger point, the spasming muscle fibers need to be “reset” to permit the blood flow through the area, enabling proper exchange of oxygen and nutrients and removal of toxins and waste.
Trigger points commonly occur either at the “motor point” in the belly of muscles [i.e. where the main nerves innervate the muscle] or at the muscle attachments. There are two main types of trigger points. There are active trigger points and there are latent trigger points. Active trigger points constantly produce pain. Latent trigger points do not cause pain however they do possess the same stiffness, restricted range of motion, and the twitch response that the active trigger point possesses. Latent trigger points can be reactivated by strain or overuse of a muscle, resulting in an activted trigger point with pain and discomfort.
Trigger points are typically diagnosed by their characteristic twitch response, which creates a sensation of referred pain to areas called pain referral zones. Within these pain referral zones, satellite trigger points [trigger point clusters] can develop due the increased stress on these muscles. Trigger point zones were fully mapped out by Dr. Travell’s work and they follow consistent patterns. An understanding of these zones is necessary to treat the pain effectively, as treating only “local” satellite trigger points will not permanently resolve the pain.
To relieve a trigger point, the practitioner will determine its exact location through palpation of the muscle, and then apply direct continuous pressure to the trigger point for approximately 10 seconds. Although pressure upon the trigger point can be uncomfortable, the relief provided by the subsequent relaxation of the muscle is quite significant. It is common to perform this technique on a trigger point several times during a single treatment session.
Letting trigger points go untreated can cause additional problems further down the line. There are trigger point clusters that can aggravate each other and cause additional pain and discomfort. In addition, trigger points in the back can keep the muscles along the spine so tight, that they pull the spine out of alignment.