trigger point manual

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This book is written for you. It’s divided into sections, each covering a different aspect of trigger points, and what you can do about them.

Trigger Point Manual

Introduction What are trigger points

Written by

Why we get Trigger Points Where you get Triggers How to Recognise Triggers What’s Coming Next

Dr Jonathan Kuttner MBBCh, Dip O&G, FRNZCGP, Dip Sports Med, Dip MSM, FAFMM.

What’s in this Manual?

What trigger points are Basic cause of trigger points What symptoms trigger points have Where trigger points are found How to recognize trigger point pain

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2 Introduction What are trigger points

Why we get Trigger Points Where you get Triggers How to Recognise Triggers What’s Coming Next

What are Trigger Points?

Trigger points are an incredibly common cause of chronic muscle pain. They are so common that most people will have painful trigger points at some stage of their life. These often last only for a short time.

However they can commonly appear as recurrent episodes of pain in the same part of the body.

Occasionally they can cause severe, unremitting pain which is as severe as other causes like cancer or nerve pain and may be destructive to any quality in life for that person.

The full medical description is myofascial trigger points.

Myo – means arising from skeletal muscle and Fascial- is the fibrous layer over muscle. This is a strong shiny layer of tissue that acts like ‘glue’ to hold muscles together and coordinate their actions. This layer is richly invested with nerves which explain the complex patterns of pain that occur.

Most people have painful trigger points at some stage of their life There is a long history of myofascial trigger points. They were originally described by ancient Greek texts and were noted throughout the Middle Ages. However they masqueraded under many names. These include – fibrositis nodule, myelogenosis, non-rheumatic arthritis etc.

They were finally codified by Dr. Janet Travell in the 1970’s. She was a remarkable woman who was the personal physician to President John F Kennedy and was one of the main people who

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3 Introduction

helped him recover from injuries in World War II. She created the name of ‘myofascial trigger points’ and with Dr. David Simons, mapped out the many myofascial trigger points over the body.

A trigger point is defined as a “hyperirritable locus within a tight band of skeletal muscle.”

But what does this mean?

What are trigger points

Why we get Trigger Points Where you get Triggers How to Recognise Triggers What’s Coming Next

Let’s look a little closer at how muscles work. In the picture above there is a small knot of muscle – labeled CTrP- this is the myofascial trigger point. When you have a trigger point, your muscle is in spasm, it is irritable and tender.

It pulls a thin band of taut muscle which runs the length of the muscle fibre. This feels like a guitar string within the bulk of your muscle.

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4 Introduction What are trigger points

Why we get Trigger Points Where you get Triggers How to Recognise Triggers What’s Coming Next The picture above is a photomicrograph of a myofascial trigger point within skeletal muscle. In the lower half you can see parallel bands of so-called I-bands & A-bands.

They are evenly spread. In the upper half there is a central elliptical area where the bands are squeezed incredibly tightly together. This is the myofascial trigger point. The band of ďŹ bres on either side of this are stretched further apart than normal.

This is where the trigger point is.

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5 Introduction What are trigger points

Why we get Trigger Points Where you get Triggers How to Recognise Triggers What’s Coming Next

The diagram on the right shows that each of these small areas of spasm is called a ‘contraction knot’.

Actually a number of these are present in each myofascial trigger point.

When you run your fingers over a muscle that has triggers you can feel them as thickened bands, ‘knots’ or tight chords like a guitar string At first it may take a bit of practise, but once you know what to look for, you’ll be able to locate trigger points reliably.

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6 Introduction What are trigger points

Why we get Trigger Points Where you get Triggers How to Recognise Triggers What’s Coming Next

Why do we get Trigger Points?

The cause of myofascial trigger points is shown in this picture. The key structure is the muscle spindle fibre.

This is a nerve arranged in a spiral, looking and behaving like a spring.

It is found in parallel with your muscle fibres.

When it is stretched, it fires a message to your brain.

Therefore if the muscle fibre reaches beyond a critical length, the spindle will fire.

The message then goes up your nerve to the spinal cord and zooms straight back to the muscle fibre causing it to contract.

The Key Point here is that the cause of trigger points is a natural process in our body. It’s necessary for muscles to be able to contract quickly as a protection that stops damage to the muscle, and also to your joints and bones. For example if you trip over, your neck muscles will tighten immediately to prevent yourself from hitting your head on the ground.

This simple reflex arc and the message from the muscle spindle usually does not go higher. This Life After Pain

7 Introduction What are trigger points

means that the spindle sets the length of your muscle, and controls how tight or flexible the muscle is.

There are millions of these muscle spindles throughout the body and they are there to allow the complex movements and postures that your body performs without your conscious thought.

Problems (and trigger points) happen when your muscle spindle becomes sensitised - for example after your have been injured. Then it will not allow the muscle fibre to lengthen at all and will cause a localised knot of spasm. This localised spasm is the myofascial trigger point.

Why we get Trigger Points Where you get Triggers How to Recognise Triggers What’s Coming Next

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8 Introduction What are trigger points

Why we get Trigger Points Where you get Triggers How to Recognise Triggers What’s Coming Next

Where do you get Trigger Points?

This picture shows the point where the nerve enters your muscle. This is called the motor end plate and is where Myofascial trigger points usually occur.

As we have muscles all over our bodies, we can also get trigger points all over our bodies.

Trigger point pain can range from a deep, dull ache to a sharp, stabbing pain.

You can get triggers in your head, jaw, neck, shoulders, legs, stomach, arms, hands, pelvis, back, thigh, calf and foot.

There are other symptoms trigger points can cause that can be confused with other problems.

For example triggers can cause: - Tension headaches - Tightened muscles which then compress nerves. For example the scalene muscle can compress the nerve bundle that runs down your arm, causing tingling and numbness in your arm.

- Pain deep in your back/abdomen/pelvis. This can be sometimes mistaken for organ pain - Tooth pain - several muscles in your head and jaw refer pain into the teeth Life After Pain

9 Introduction What are trigger points

Why we get Trigger Points Where you get Triggers How to Recognise Triggers What’s Coming Next

This is the motor end plate enlarged. Messages from the nerve are transferred to the muscle by neurotransmitters.

This means that this part of the muscle is particularly active and therefore more vulnerable to abnormal spindle ďŹ bre activity.

This is a special stain showing where the motor end plates enter the muscle and therefore where myofascial trigger points are found.

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How do you Recognise Trigger Points?

Trigger points act like the trigger of a gun - when the gun is fired, the bullet causes pain elsehere. Similarly, when a trigger point is activated, it sets off a pain pattern - sometimes causing pain far from the site of the trigger.

Introduction What are trigger points

Why we get Trigger Points

Each pain pattern is specific to that trigger point. There are hundreds of triggers scattered around the body. Remarkably, each trigger point pattern has been shown to be consistant over thousands of people.

Where you get Triggers How to Recognise Triggers What’s Coming Next

This is a trapezius muscle myofascial trigger point and the red area is the specific pain distribution pattern.

As you can see, this trigger causes pain that shoots up into your neck and base of your skull. This is a very common trigger point.

Once you have learned the patterns, then finding the triggers becomes much easier.

Trapezius Muscle Trigger point and Pain Pattern Life After Pain

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Here is another common pain pattern from a gluteus minimus myofascial trigger point. Note how the pattern behaves like sciatica. Sciatica is usually caused by irritation of the sciatic nerve by a prolapsed disc.

Introduction

However in this case a myofascial trigger point causes the pain pattern. A MRI could show a normal disc and treatment of the trigger point would stop the pain.

What are trigger points

Why we get Trigger Points

It’s important to note here that trigger points can occur in conjunction with other problems. For example, this person may have a prolapsed disc, as well as gluteus minimus trigger points.

Where you get Triggers How to Recognise Triggers

To gain proper pain relief, you would need to treat both problems.

What’s Coming Next

You can also get clusters of triggers. What usually happens here is that one or two primary triggers set off pain and tension.

Gluteus Medius Muscle

Secondary triggers then form around the painful area.

When this happens, all triggers need to be found and deactivated in order to fully release the area.

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12 Introduction What are trigger points

Why we get Trigger Points Where you get Triggers How to Recognise Triggers What’s Coming Next

A simple way to recognise trigger point is this - by pressing on an active trigger point, you should be able to recreate the pain pattern.

For example, if you find the trapezius trigger from the picture on page 10, if it’s active and you press on it, you should feel pain up in your neck.

It’s always important to conduct a full medical examination for other underlying problems. Chest pain can be caused by trigger points in the pectoralis major. It can also be caused by heart problems, so you need to rule that out first.

Once you’ve switched off a trigger point, it can return. Usually switching off a trigger turns it from an active to a latent trigger point.

If a trigger point is latent, then it is sitting there like an accident waiting to happen. Continuing to stretch and treat the site of a latent trigger point will help prevent it coming back.

Stiffness can often be a symptom of latent trigger points, so treating them proactively can improve flexibility. As with most muscle related problems, gentle, regular exercise, stretching and good nutrition can help prevent triggers coming back.

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13 Introduction What are trigger points

Why we get Trigger Points Where you get Triggers How to Recognise Triggers

What’s Next?

If you got this manual as part of my free email course, here’s what you’re going to get next: Message Message Message Message Message Message Message

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Great free tool to easily Find Triggers anywhere in your body ‘Getting Rid’ of triggers - why you can’t and why it’s a good thing 6 Steps to help Stop Triggers Coming Back Are You Creating Triggers? (How to make sure you aren’t) 3 Core Muscle Strengthening Exercises The Really Advanced Stuff How to Switch Off Triggers - Pain Free Technique

If you haven’t signed up for this free email course, here’s where you can go to sign up: The Life After Pain Trigger Point Treatment Email Course

What’s Coming Next Best Regards,

Dr Jonathan Kuttner.

MBBCh, Dip O&G, FRNZCGP, Dip Sports Med, Dip MSM, FAFMM.

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DISCLAIMER

Introduction What are trigger points

Why we get Trigger Points Where you get Triggers How to Recognise Triggers What’s Coming Next

The information contained in this manual is based on sources and information reasonably believed to be accurate as of the time it was recorded or created. However, this material deals with topics that are constantly changing and are subject to ongoing changes related to technology and the market place as well as legal and related compliance issues. Therefore, the completeness and current accuracy of the materials cannot be guaranteed. These materials do not constitute legal, compliance, medical, or related advice.

The end user of this information should therefore use the contents of this manual and the materials as a general guideline and not as the ultimate source of current information and when appropriate the user should consult their own accounting, construction or other advisors.

Any case studies, examples, illustrations cannot guarantee that the user will achieve similar results. In fact, your results may vary signiďŹ cantly and factors such as your health, medical condition and many other circumstances may and will cause results to vary.

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