When speaking about pre and post workout routines I often bring up trigger point release and with such comes many questions. I have promised many over the past few months that I would write an article on the subject and have before now failed to do so. In an attempt to stay true to my word, the following is an introduction to trigger points and why they matter to everyone from the professional athlete down to the obese couch potato. Please keep in mind this is an introduction to a vast and somewhat complex topic which I advise everyone read about much more in depth once they understand the basics presented here.
What is a Trigger Point (Myofascial Trigger Point)?
Etiological Definition: A cluster of electrically active loci each of which is associated with a contraction knot and a dysfunctional motor endplate in skeletal muscle (1).
Clinical Definition: A hyperirritable spot in skeletal muscle that is associated with hypersensitive palpable nodule in a taught band. The spot is painful on compression and can give rise to characteristic referred pain, referred tenderness, motor dysfunction, and autonomic phenomena.
Types of myofascial trigger points include: active, associated attachment, central, key, latent, primary, and satellite. (Note especially the distinction between central and attachment myofascial trigger points) Any myofascial trigger point is to be distinguished from a cutaneous ligamentous, periosteal, or any other nonmuscular trigger point (1).
Now let’s put that into something that is actually understandable. A trigger point (TrP) is an area in skeletal muscle fibers which will not stop contracting (microscopic units in muscle fibers called sarcomeres are actually responsible for these contractions) these contracting spots can cause both pain in the spot of the trigger point and pain in other areas, as well as other symptoms.
Central trigger points are located near the center of muscle fibers where as attachment trigger points are located where the muscle and tendon connect to each other or the muscle attaches to bone (2).
Active trigger points cause pain or other symptoms when compressed digitally and may also cause referral pain where as latent trigger points are usually tender when compressed and can cause the same symptoms as an active trigger point but do not cause referred pain.(3). A latent TrP has the potential become an active TrP via further irritation.
Muscle fibers within a trigger point. Letter A is a muscle fiber in a normal resting state, neither stretched nor contracted. Letter B is a knot in a muscle fiber consisting of a mass of sarcomeres in the state of maximum continuous contraction that characterizes a trigger point. Letter C is the part of the muscle fiber that extends from the contraction knot to the muscle’s attachment (4).
Non-myofascial trigger points also exist but for now let’s keep it simple. All references to trigger points in this article are synonymous with myofascial trigger point.
What Causes Trigger Points?
The purposed underlying causes of trigger points have undergone many changes in recent history. Some looking at trigger point research have interpreted the results from EMG studies to a possibility of not just presynaptic dysfunction as Travell and Simons had thought, but to the possibility of synaptic or postsynaptic dysfunction as well which can all be either genetic or acquired (5).
The important part of the above for the typical non-researcher is that trigger points may for some be caused by a genetic defect or may in fact be caused by an issue you can control. The most common cause for my readers will of course be overuse and high stress on the muscle. The harder you push yourself in the gym the better results you will get, but it also means a higher chance of trigger points developing. If you happen to be genetically pre-disposed to the issue the treatment techniques below should still apply.
Treating the Problem
The first step to treating pain caused by trigger points is to locate the trigger point causing the pain. To make this task much less complicated I do recommend picking up the books mentioned in the “Further Reading” section below as the diagrams give a clear idea of where to palpate when looking for active TrPs, especially those causing referred pain but the following internet resources are also good ones;
When working with others we have the convenience of using our digits (fingers) to apply pressure as needed. Unfortunately when applying trigger point massages to our selves this is not an option for most areas. In this situation a few different implements can be used to aid in the release of hard to reach trigger points.
Foam Roller
The first implement is probably the most well known in the fitness community: the foam roller. The foam roller is simple; it is after-all just a cylindrical piece of foam. Foam rollers can be purchased in different lengths and various densities to suit the user’s preferences. I prefer higher density rollers which are 3 feet or so in length but each person is different here, some may even choose different lengths and densities for different muscle groups.
The lower body and back of most athletes seems to benefit the most from use of the foam roller as it consists of large muscle groups which can be successfully massaged with a larger range of motion than the upper extremities. The approach isn’t one that takes a great deal of thought though many overthink the technique. Keep it simple, with the foam roller on the floor, lie down and use your body weight to apply pressure as you maneuver forward and back on the roller. Remember you are attempting to target areas which have the most probability of containing trigger points so use a motion which travels the entire length of each muscle and/or covers problem areas with each position you choose. Below is a video for anyone whom is unsure of how to approach this.
Lacrosse Ball
The Lacrosse ball is less known in the community as a massage tool but still fairly well known to those whom have approached the topic of trigger points previously. I like to use this ball for most of my upper body massage, especially targeting trigger points in the lats and the muscles of the rotor cuff (Infraspinatus/Teres Minor/Subscapularis etc.) although it can be used for lower body as well. The following videos explain techniques for this very well including using 2 Lacrosse balls for great back massage (ignore the Crossfit journal part, its good information).
Golf Ball
The final implement in my arsenal is the golf ball. This evil little tool is a versatile one. It can be used anywhere much the same as the previously mentioned implements however it is extremely well suited for TrP’s which require increased pressure for release and helps massage smaller muscle groups and tendons well such as those in the feet. To use the golf ball effectively on the foot simply place the ball in the middle of the foot, apply pressure and roll the ball around until you find trigger points. As with other tools, when a trigger point is found simply apply consistent pressure to the area to release the trigger point. It is recommended that this approach be done first while sitting down and as you get comfortable with the technique it can be done standing.
Another tip with the golf ball is to massage along the Tibia especially if you have problems with shin splints, doing both of these techniques when battling shin splints will generally do wonders for recovery.
Though other tools do exist for the treatment of trigger points, the basics are both inexpensive and work well. Products such as the Thera Cane may also work but when compared to the combined price of all 3 options explored in this article such items just aren’t worth the cost.
Further Reading
This entire topic goes much deeper than this article could ever accomplish. To really take advantage of the collective knowledge on this topic available I highly recommend picking up both Myofascial pain and dysfunction: the trigger point manual. 2nd ed. (both volumes) and The Trigger Point Therapy Workbook 2nd ed by Clair Davies.
References
- Simons DG, Travell JG, Simons LS. Travell & Simons’ Myofascial pain and dysfunction: the trigger point manual. 2nd ed. Vol. 1 Baltimore, MD: Williams & Wilkins, 1999:5
- Simons DG, Travell JG, Simons LS. Travell & Simons’ Myofascial pain and dysfunction: the trigger point manual. 2nd ed. Vol. 1 Baltimore, MD: Williams & Wilkins, 1999:1-2
- Beck MF Theory & Practice of Therapeutic Massage. 5th ed. Clifton Park, NY: Milady, 2010:551
- Davies C The Trigger Point Therapy Workbook: Your Self-Treatment Guide for Pain Relief Oakland, CA: New Harbinger Publications, 2001:20
- McPartland JM. Travell trigger points–molecular and osteopathic perspectives. J Am Osteopath Assoc. Jun 2004;104(6):244-9.
