To be or “knot” to be… that is the trigger point!

One of the most common complaints we get from patients is that they feel as though they have a “knot” in a muscle.

Perhaps you’ve experienced something similar?

It could’ve been after waking up and sleeping in an awkward position, or even after a long work day sitting in front of the computer.

While this is extremely common, it does beg the question…

What are these “knots” within your muscles?

These “knots” are commonly referred to as “Myofascial Trigger Points” or Trigger Points for short.

In short, a trigger point is a taut band of fascia within a muscle that forms a palpable nodule or “knot”. 

When pressure is applied to a trigger point one might feel pain that is either local to that individual body region or pain that seems to travel along a specific pattern. 

Occasionally, trigger points can be so tender to the touch that it can elicit what is called a “jump sign” and cause a person to physically jump or involuntarily squirm away from the pain when any pressure is applied to the area.

In other cases, someone might not necessarily be aware that they have a trigger point until someone does apply pressure and then it seems to “light up”.

This is because there are various types of trigger points, but to keep it simple we’ll focus on two main types…

• Active trigger points are nodules that produce pain, with or without provocation via pressure or movement, that can be local to that area or radiate in specific patterns.

• Latent trigger points are nodules that are not associated with pain though they may be somewhat tender when pressure is applied. 

If you have an active trigger point you’ll likely feel some pain and discomfort with specific movements and when you press on the trigger point it will intensify the symptoms that you’re feeling.

On the other hand, latent trigger points tend to show up in places that are commonly associated with prolonged postures. 

For example, if someone stands for hours throughout the day they may have latent trigger points throughout their feet and calves. They may not have any pain in those areas, but if you poke around a bit you’ll likely be able to find a “spot” that’s more tender than the surrounding area.

In fact, trigger points can be found in muscles, tendons and ligaments all over the body! 

Example of trigger points in the upper and lower trapezius muscles (indicated by the x’s) along with their pain radiation patterns (shown in red). The example on the left is classically known as the “coat hanger” pattern due to its shape.

What causes a trigger point to form?

There are quite a few theories and hypotheses regarding why trigger points form.

However, the most widely accepted explanation called the Integrated Trigger Point Hypothesis is as follows…

Muscles are innervated by nerves that supply the “signal” for those muscles to contract.

The point at which a nerve connects with a muscle is referred to as a “motor end plate”.

Upon closer observation, it was found that trigger points will often form at these motor end plates where the nerves enter the muscles.

Trigger points are thought to form when there is an overactive signal being sent to these motor end plates, which causes extremely frequent or even permanent contraction of these muscle spindles.

This hyperactivity leads to less blood flow to the muscle fibers, which results in a lack of oxygen and nutrient delivery to these tissues.

This also causes shortening of the fibers, thus creating the taut “nodule” within the muscle.

A graphic representation of trigger points within skeletal muscle.

While there are various causes, the most common ways to develop trigger points include:

• Injury/trauma

• Poor posture (postural muscles over-working due to prolonged postures)

• Muscle overuse and/or repetitive stress conditions

• Lack of physical activity

• Chronic stress (anxiety, depression, etc.)

The logical follow up question is… 

Can trigger points be treated?

Yes!

Because there are so many things that can contribute to the development of an active trigger point it makes sense to have an approach to treatment that can provide relief from each potential cause.

For example, we treat trigger points by utilizing a range of approaches including myofascial release technique, instrument assisted soft tissue mobilization, cupping, and corrective exercises. 

Because trigger points are found in myofascial tissue (meaning muscle and fascia), manual therapy techniques can be extremely useful in not only reducing pain but also improving overall range of motion and function.

Other manual therapy techniques that can be beneficial in treatment of trigger points include acupuncture and dry needling.

In terms of movement-based therapies, corrective exercises can help to address the postural aspects of trigger points.

For example, it’s extremely common for individuals to develop trigger points in their neck and upper trapezius muscles. This is typically associated with prolonged “forward head posture” that causes the muscles on the posterior, or back side, of the neck to be overactive throughout the day.

If we identify this type of prolonged posture to be a cause or aggravating factor we can address it by providing corrective exercises that help those overactive muscles relax while engaging the lesser used muscles (the deep neck flexor muscles) to help correct that posture and remove the cause of pain.

By combining manual therapy techniques and corrective exercises we can effectively provide relief from pain while creating better movement habits that can help to resolve those painful trigger points!

Are you experiencing any pain stemming from trigger points? If you have questions, or if you’re interested in seeking care, please feel free to reach out and schedule an appointment with one of our Momenta Doctors!

Follow our booking link here to schedule your appointment online now!