What is a trigger point or “knot” in a muscle?
A trigger point (also known as a knot, myofascial trigger point or contraction nodule) is a very irritable spot in your muscle that is associated with a hypersensitive nodule within a taut band of muscle. This spot can be painful on compression and can give rise to characteristic referred pain and tenderness.
Trigger points can be latent (inactive) where they cause stiffness to movement (e.g. trigger points around the shoulder blade area may cause stiffness in the neck and shoulders), but they are not painful. Active trigger points not only cause stiffness to movement, but also cause pain.
Severity of symptoms from trigger points can vary greatly, from the agonising and incapacitating pain caused by active trigger points, to the painless restriction of movement from latent trigger points which can often be over looked.
There are around 400 muscles in the body, making up around 50% of your body weight, so this amount of tissue can have a huge impact on your movement and pain! In one study, around 50% of non-symptomatic young adults had latent trigger points in their shoulder. We know the incidence of musculskeletal pain and dysfunction in older populations is even higher!
How do trigger points become activated?
A trigger point is usually activated through some form of muscle overload, or by leaving a muscle in a shorted position for a prolonged period of time (such as poor posture or sleeping position). Consider dysfuntion due to a stroke and loss of normal movement due to osteporotic spinal changes. These can all contribute to tight muscles and painful trigger points.
Sudden activation of a trigger point can occur following a one-time trauma (such as lifting something heavy). A trigger point may also be activated gradually due to chronic overload (such as poor posture or repetitive tasks). Nervous tension associated with emotional stress can also induce trigger points, as can direct cooling of the skin (e.g. exposure to a cold draft). Onset of pain following activation of a latent trigger point due to muscle overload may be delayed as long as 12 to 20 hours. Other factors such as depression, vitamin or mineral deficiencies can also increase the likelihood of having trigger points.
How can painful trigger points be treated?
The provision of ongoing therapeutic pain management services is supported via the Aged Care Funding Instrument (ACFI) where a clinical need for onging treatment is identified. This type of chronic muscular pain and stiffness is very common! Treatment for trigger point pain needs to address the trigger point itself, as well as the factors which activated it.
If you only treat the trigger point itself, the causative factors will remain and the trigger point will be reactivated. Many people assume muscula pain will resolve on its own, but that is often not the case especially for our clients with limited mobility.
Trigger points can be released using massage techniques such as trigger point pressure release, dry needling, deep massage or contract and release methods.
Depending on the area of your pain and the underlying causes, your therapist will determine corrective options such as massage and exercises to help manage your pain. All Encara therapists are skilled at localising trigger points as well as performing various treatment methods to alleviate your symptoms of pain and stiffness. Encara deliver these services via our ACFI pain management program at residential nursing facilities across Australia. Encara also support clients living in the community with the support of a home care package (HCP).