Massage therapy treatment for trigger points
As I discussed in my previous post, Trigger points part 2, trigger points are most often caused by Overload of tissue. Since there are so many different ways to over load you tissues, or systems, it is no wonder that trigger points are so commonly the cause of myofascial pain. Treating trigger points, and their underlying cause, is one of the primary focus of registered massage therapy treatments. With excellent palpation and manual treatment skills, registered massage therapists ( RMT’s) are well equipped with what is needed to find, and treat these pesky problem spots. In order to understand how massage therapy works to eliminate trigger points and their pain, it is first important to understand the different types of trigger points.
Different types of trigger points
- Active trigger point: This refers to a trigger point that is actively referring pain. For example a trigger point in the upper trapezius ( upper shoulder muscle) can refer pain into the head, causing a headache in the temple area.
- Latent trigger point: These trigger points are present in the muscle, but are not actively referring pain elsewhere. They can still limit range of motion, and can become active at any time. They are also still tender when you push on it.
- central trigger points: These are commonly found in the center of a muscle belly ( mid way between the two attachments) They are found in a taut band of muscles, and can be either Actively referring pain, or latent. These trigger points can make a muscle weaker, because part of the muscle ( taut band) is stuck in a contraction. Leaving only the remaining fibers to perform the action you want the muscle to perform. The can also limit range of motion and cause tightness in the muscle for this same reason.
- Attachment trigger points: These are found where muscle fibers blend into the tendon. They can lead to an increase in tension of the tendon. This can lead to irritation of the tendon, tendonitis, and even irritation of the periosteum where the tendon attaches to the bone. OUCH!
- Satellite trigger points: These trigger points develop in the pain referral zone of a active trigger point. It develops in response to the pain felt by the original trigger point. If you don’t find and treat the original active trigger point, the satellite ones will tend to return, no matter how many times you get them treated.
How registered massage therapy can help treat those nasty trigger points
The reason I briefly explained the different types of trigger points, is because the way we treat them can differ slightly. Although treatment method is slightly different, massage therapy can effectively treat all types of trigger points.
Remember in Trigger Points part 1, we discussed how trigger points are formed? Usually they are developed in response to ischemia ( lack of blood flow to the tissue). This affects the ability of the muscle fibers to release contraction. We also discussed in Trigger points part 2, that ischemia is usually caused by tissue being overloaded, or stressed. Registered Massage Therapists trigger points treatments work to address both the ischemia, the muscle fibers stuck in a shortened and contracted position, as well as the underlying cause, or tissue overload.
RMT’s are extremely trained in the art of palpation ( feeling around your tissues to see if something isn’t right). With these amazing palpation skills, finding taut bands and trigger points is actually pretty easy. We also sometimes use a cheat sheet to help us locate the possible area of the trigger point. Our cheat sheet looks like this:
The colors represent where the client feels pain, and the x represents where the trigger point may be.
Finding the trigger point is actually the easy part of the treatment. The RMT must also determine what caused the trigger point to develop in the first place. This part is super important, because if you don’t address the cause, the trigger point will usually come back. In most cases tissue overload is caused by poor postural habits, repetitive overuse, injury or mental stress. All which can be treated with massage therapy, but that’s a story for another day.
Once the underlying cause is determined, your RMT will begin to treat it, with a variety of massage therapy techniques. This may take a few treatments, there is no miracle cure for most things. It takes time, treatments, exercises and effort on your part to eliminate the root cause of trigger points.
Specific registered massage therapy trigger point treatment.
There are several different ways to treat a trigger point. In this article, I will discuss the most commonly used method by registered massage therapists.
General massage therapy techniques help improve overall circulation, this help bring oxygen and nutrients to the tissues, which helps improve their health and decrease resting muscle tone. General massage also help ease the nervous system, and reduce mental stress. Which again is great for decreasing overall muscle tone. without even addressing the trigger point itself, massage therapy has already had a positive effect on the pain producing contraction.
Your RMT will locate the trigger point by palpating for the taut band. Once the taut band is found, the massage therapists will work his/her way along the band to find the most tender spot. These are commonly found in the middle of the muscle belly ( central trigger points) or closer to the muscles attachments (attachment trigger points). If both are present, it is important to treat the central Trigger point first, so that it relieves tension in the muscle, and on the attachment trigger points.
Once the most tender spot is found, your RMT will apply pressure to it. This pressure may increase the discomfort slightly, but it is important that you let your therapists know if it causes to much pain. Your RMT will maintain this pressure for a bit, and will most likely ask you if the pain is decreasing. Most people think that the pressure is actually the main method of treatment, but in actuality it’s when your RMT releases the pressure that actually makes the most difference. When pressure is applied to the tender area it pushes all the blood away from that area, causing more ischemia. At this point, you might be thinking ” Hey, i thought ischemia is bad”? Usually it is, but in this case, a temporary increase in ischemia is necessary. Once the blood is pushed away from the trigger point, the RMT releases the pressure, and a wave of healthy oxygenated blood rushes to the area, bringing all the necessary nutrients, required to release the muscle contraction, to the trigger point. This helps release the contraction, and treats the trigger point on a chemical level. So you see, the treatment part is actually the release of pressure, not the pressure itself. This method may be repeated several times, until the painful spot is much less tender.
Your RMT will then start massaging through the taut band. We call this technique stripping the muscle. We strip along the muscle fibers, releasing where they may be stuck together (adhesions). This addresses the taut band and help re-lengthen the muscles fibers that have been stuck in partial contraction. This technique also helps increase circulation even more! The muscle is then stretched, to bring it back to it’s original length, and then in most cases, heat is applied to the area, again to increase circulation.
In some cases, the trigger point only needs one treatment, but most of the time it needs a few to completely let go. This is Ok because your RMT must also address the underlying cause of the trigger point, and this can take a few treatments, depending on the cause.
I hope this 3 part article helps you understand these pain producing points a bit more. As well as how registered massage therapy is a very effective method of treatment for trigger points.
If you have any more questions do not hesitate to contact us, at Myocare registered massage Therapy. All our Toronto RMT’s are highly qualified in the assessment and treatment of trigger points, and would be more than happy to help you.