Trigger Warning: Trigger Point Identification and Release

A trigger point, or TrP, is commonly defined as "a hyperirritable spot in a taut band of skeletal muscle that is painful on compression, stretch, overload, or contraction of the tissue which usually responds with referred pain that is perceived distant from the spot" (Donnelly et al. 2019, pg 2). In layman's terms, a tight knot of muscle which hurts A LOT when you touch it. Trigger points are some of the most common musculoskeletal diagnoses: a most people will experience a trigger point at some point in their lives (Donnelly et al. 2019, pg 2).

Etiology

"People who frequently experience stress and anxiety may be more likely to develop trigger points in their muscles" (Myofascial pain syndrome - Symptoms and causes, 2020). An acute injury to a muscle may cause trigger points to develop at a later time, but one should also be aware that "[r]epetitive motions and poor posture also may increase your risk" of developing trigger points (Myofascial pain syndrome - Symptoms and causes, 2020).

Signs & Symptoms

The most common behavioral indicator of a trigger point is the "jump sign": when a trigger point is palpated, the patient will jump, cringe, spasm, cry out, and/or involuntarily jerk the limb or body part away from the clinician.  Trigger points are usually divided into two varieties: active TrPs (which are painful to palpation) and latent TrPs (which are palpable but not painful).  Surprisingly, even ligaments can develop trigger points (Trigger Points, 2020) despite being formed of non-contractile tissue. 

Diagnosis

Diagnosis of an active trigger point is usually not difficult (the patient is sometimes said to almost 'levitate' off the treatment table when their trigger points are touched, even very gently), but if the pain is referred (which is often the case for distal TrPs), it can be difficult to locate the source. Latent TrPs do not usually cause such spectacular displays, but their tactile characteristics are very distinctive: they feel like a hard knot or bead of tissue under the skin. 

Treatment

Common treatment methods for TrPs include dry needling, acupuncture, laser therapy, and prolotherapy (Trigger Points, 2020).  Physical therapists often treat TrPs with combination of gentle stretching, postural training, massage/soft tissue manipulation, moist heat, and/or ultrasound (Myofascial pain syndrome - Symptoms and causes, 2020).



References

Donnelly, J., Fernández-de-las-Peñas, C., Finnegan, M. and Freeman, J., 2019. Travell, Simons & Simons' Myofascial Pain And Dysfunction: The Trigger Point Manual. 3rd ed. Wolters Kluwer.

Mayo Clinic. 2020. Myofascial Pain Syndrome - Symptoms And Causes. [online] Available at: <https://www.mayoclinic.org/diseases-conditions/myofascial-pain-syndrome/symptoms-causes/syc-20375444> [Accessed 3 December 2020].

Physiopedia. 2020. Trigger Points. [online] Available at: <https://www.physio-pedia.com/Trigger_Points> [Accessed 3 December 2020].

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