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Hi Ho Hi Ho, It’s off to Trigger Point I Go

I was recently invited along with a handful of other people to attend the instructor training at Trigger Point Performance Therapy in Austin Texas.

Once certified I will be teaching Myofascial Release and Flexibility Workshops.

What’s the Point?

Trigger points are hyperirritable nodules that can be palpated in muscle fibers. These are areas of local tenderness that can also refer pain to broader areas remote from the actual trigger point.

Compression of a trigger point may elicit local tenderness, referred pain, or local twitch response.

There are two main classifications of Trigger points: active or latent. (They can also be classified as key or satellite; primary or secondary).

An active trigger point is one that actively refers pain either locally or to another location. A latent trigger point is one  does not refer pain actively, unless there is pressure or strain applied to the point.

Latent trigger points can influence muscle activation patterns, which can result in poorer muscle coordination and balance. Latent points can also result in stiffness, that is  somewhat akin to the feeling of arthritis.

Potential causes of trigger points

Trigger points may be caused by a number of factors, including:  muscle overload (i.e. trauma), activation by other trigger points, internal diseases, psychological stress and radiculopathy (nerve irritation). They can be perpetuated by a number of factors (see prior blogs).

Trigger points lead to muscle shortening, which in turn can pull on tendons and ligaments associated with the muscle. This can eventually lead to tendonitis, burtsits, joint pain, spine pain, arthritis and nerve irritation.

When muscle fibers contract and remain shortened, biochemical energy (ATP) is depleted.  Depletion of ATP can result in local accumulation of acid and metabolic waste. The tightened muscle fibers constrict capillaries and prevent them from carrying off the toxins to the liver and kidneys for elimination. The buildup of these toxins in a muscle  can cause additional irritation and muscle tension.

Because of the disrupted metabolism in these areas, proper hydration and respiration is essential during treatment.

Trigger Points=Pain and decreased Athletic Performance

When trigger points are present,  there is often pain and weakness in the associated structures. There are specific pain patterns which have been  mapped, thereby helping to identify which muscles may be involved.

Many trigger points have pain patterns that overlap, and some create reciprocal cyclic relationships that need to be treated extensively in order to remove them, e.g. a trigger point in the pectoralis muscle inhibits (“turns off”) the rhomboid muscle, causing it to be over worked and to develop trigger points.

Both areas need to be addressed, but to further complicate the issue,  the pectoralis usually needs to be lengthened (stretched) while the rhomboids often requires strengthening (despite the feeling that it may need to be stretched).

Treatment

Trigger points can be treated with:

  1. Deep pressure vibration (AKA ischemic compression)
  2. Ultrasound
  3. Electric stimulation
  4.  Injection
  5. Dry-needling (my preference)
  6.  Manual therapies
  7. Tools that can be used to apply pressure (My preference being those from trigger point performance)
        

 

A successful treatment protocol includes:

  1. Identifying all the involved trigger points
  2. Deactivating the trigger points
  3. Elongating the structures affected to restore their optimum length
  4. Strengthening muscles (if appropriate)  to prevent re-occurrence

 If you are interested in taking a trigger point class for pain and/or performance enhancement please email me for upcoming dates.

About the Author

Dr. Geoff LecovinNaturopathic Physician/Chiropractor/Acupuncturist/Certified Strength and Conditioning Specialist/Corrective Exercise Specialist/Performance Enhancement Specialist/Certified Sports Nutritionist/View all posts by Dr. Geoff Lecovin

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