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What is Trigger Point Therapy?

Trigger points are overly irritable spots in muscles that are associated with palpable nodules in taut bands of muscle fibers. The palpable nodules are said to be small knots of contracted muscle fiber or hyperirritable areas and are a common cause of pain. Pushing on a trigger point may elicit local tenderness, referred pain, or local twitch response. Since most unexplained pain radiates from trigger points, therapy should be addressed to them. Many chiropractors and massage therapists find this model useful in practice.

 

The therapy was originated by Dr. Janet Travell, M.D., the White House physician credited with successfully treating President John Kennedy’s back pain. The main innovation of Travell's work was the introduction of the myofascial pain syndrome concept (myofascial - the combination of muscle and fascia). This is described as a focal hyper-irritability in muscle that can strongly affect central nervous system functions. Travell and her followers distinguish this from fibromyalgia, characterized by widespread pain and tenderness and a central increase in pain experience giving rise to deep tissue tenderness. Studies estimate that in 75-95 per cent of cases, myofascial pain is a primary cause of regional pain.

How do Fibromyalgia and Myofascial pain resulting from Trigger points differ?

Perhaps one of the most popular enigmatic pain conditions to affect the lives of human beings worldwide is fibromyalgia.  Fibromyalgia is a condition that, because of its symptom expression, has baffled many practitioners.  There are no current diagnostic tests available to confirm a diagnosis.  There is only a list of symptoms to look for – which lead to an educated guess.  For this reason, many people consider fibromyalgia a “wastebasket diagnosis”. 

 

Other conditions, in fibromyalgia patients, may persist such as subclinical hypothyroidism, a systemic infection, or other environmental factors that cause many of the symptoms of fibromyalgia. These are, but are not limited to, myofascial pain syndrome (MPS), chronic fatigue syndrome (CFS), and a host of other medical conditions that relate to other organs of the body.  When a systemic condition occurs it affects every cell of the body, there are many different symptoms.  It is of utmost importance that a person receives an accurate diagnosis to avoid years of needless suffering.

 

Dr. John C. Lowe, DC published a research oriented text titled The Metabolic Treatment of Fibromyalgia.  Since the text is very medically oriented, he and his wife, Dr. Gina Honymann-Lowe, published a text for the patient titled, Your Guide to Metabolic Health.  In this text, Dr. Lowe explains how the thyroid affects the human body and why, many times, patients are misdiagnosed.  This book is a must read if you feel you may have a thyroid condition or if you are on T4 therapy and it has not alleviated your symptoms.

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The X in the diagram indicates the trigger point and the colored area around it, the zone of referral (where the pain is felt). By compressing the trigger point manually, the referred pain eventually goes away. Often trigger points can refer pain to a distant point, which can make it complicated to diagnose and treat.

The American College of Rheumatology (ACR) defines fibromyalgia as, “...a clinical syndrome defined by chronic widespread muscular pain, fatigue and tenderness.  Many people with fibromyalgia also experience additional symptoms such as fatigue, headaches, irritable bowel syndrome, irritable bladder, cognitive and memory problems (often called “fibro fog”), temporomandibular joint disorder (TMJD), pelvic pain, restless leg syndrome, sensitivity to noise and temperature, and anxiety and depression.  These symptoms can vary in intensity and, like the pain of fibromyalgia, wax and wane over time.”

 

In their text, Myofascial Pain and Dysfunction: The Trigger Point Manual, Drs. Janet Travell and David Simons alert us to be sure that we have differentiated between fibromyalgia and MPS.  They state that trigger points (TrPs) are present in the majority of people who suffer with fibromyalgia and that it is easier to distinguish which is the proper diagnosis while the pain is still in its acute phase.

Clinical Features Distinguishing Myofascial Pain due to Trigger Points from Fibromyalgia:

Myofascial Pain (TrPs) 

  • 1 female: 1 male

  • Local or Regional pain

  • Focal tenderness

  • Muscle feels tense (taut bands) 

  • Restricted range of motion

  • Examine for trigger points

  • Immediate response to injection of TrPs  

  • 20% also have fibromyalgia

Fibromyalgia

  • 4-9 females: 1 male

  • Widespread, general pain

  • Widespread tenderness

  • Muscle feels soft and doughy

  • Hypermobile

  • Examine for tender points

  • Delayed/poorer response to TrP injection

  • 72% also have active TrPs

Myofascial Trigger Point Therapy may be able to provide symptomatic relief to those suffering from fibromyalgia since 72% of fibromyalgia patients have active TrPs.

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