Next weekend, I’m teaching a workshop on the LYT Daily on Myofascial Trigger Points and I’m so excited about it! Most people don’t have a solid understanding of what a trigger point is, why they occur, and how to deal with them. Muscle pain after an injury is commonplace and often resolves in a couple of weeks with or without medical treatment. In fact, muscle pain disorders have long been studied. Guillaume de Baillous (1538-1616) of France was one of the first to write in detail about them. In 1816, British physician Thomas Balfour first associated “thickenings” and “nodular tumors” in skeletal muscle with local and regional pain.
Myofascial pain is a clinical problem where muscle pain persists long after resolution of the injury and may even refer to other parts of the body. The term “myofascial” developed from the belief that both muscle and its surrounding fascia are likely contributors to the symptoms of myofascial pain. The hallmark sign of myofascial pain is the myofascial trigger point (MTrP).
MTrPs are hard, palpable knots in a taut band of muscle that can be both spontaneously painful (active TrP) or painful only with compression (latent TrP). Both types can be associated with muscle dysfunction, weakness, and limited joint range of motion. Besides the use of palpation to find these active or latent nodules, there are currently no accepted criteria for identifying or quantitatively describing MTrPs. In fact, the role of the trigger point in the symptoms of myofascial pain is not fully understood. It remains unknown whether the MTrP is an associated finding alongside the pain, if it actually causes the pain, or whether or not its disappearance is essential for effective treatment of the pain.
What we do understand about MTrPs comes largely from two US physicians, Janet Travell and David Simons, who studied myofascial pain and trigger points for decades. Simons developed the theory that trigger point development requires muscle overload/overuse, resulting in abnormal motor endplate activity, which shortens the muscle unit causing the knot. Mechanical muscle overuse is the result of muscle contractions that exceed muscle capacity. Even with sustained low-level contractions, capillary blood flow to the muscle is obstructed, ultimately resulting in high concentrations of intracellular calcium ions. This high concentration is associated with sustained sarcomere contraction and muscle damage and has been suggested to play a causative role in the development of MTrPs. Sustained low-level contractions are common in the workplace with jobs requiring prolonged positions, such as computer work, musicians, hairdressers, etc. Another theory developed by Ulf Hägg called the Cinderella hypothesis suggests that MTrPs are a result of damage to the smaller type I “Cinderella” muscle fibers, which are recruited first and de-recruited last during prolonged postures, thereby being overloaded in comparison to larger motor fibers that do not work as hard and spend less time being activated in these more static positions.
So why does this matter? Knowing the potential causes of MTrPs is not only important to prevent their development and recurrence, but also to eliminate existing ones. There are more invasive treatments such as trigger point injections and dry needling which are highly effective and believed to disrupt the dysfunctional motor endplates located near the MTrP. However, these require the involvement of a skilled physical therapist or physician and can be much more costly to the patient. Less intense and more available techniques are ones that stretch the muscle, lengthening the sarcomeres and decreasing the abnormal motor endplate activity. These include trigger point releases and transverse friction massage, both of which have also been shown to be effective and will be covered in the Trigger Point Workshop next weekend. So be sure to join me on Sunday, November 24th from 11am – 12:30pm ET! Click the link to register!
Until then, I’ll see you on the mat!
Xoxo,
Kristin
