In this post we discuss if trigger points are fact or fiction, and what relevance they have to the goal of reducing muscle pain.
We’ve probably all experienced this at one time or another. The feeling that the source of all the tension in a muscle is coming from a precise location.
This can develop following a particularly difficult workout, or it might slowly build if you’re sitting in one position for a long period of time.
Either way, it’s deeply uncomfortable and feels like the muscle has a knot in it.
If you’ve been to see a rehab professional, you’ve probably been told you have something called a trigger point.
This is the medical term for what many people describe as a muscle knot.
The therapist may have applied direct pressure to the spot where they feel the majority of the tension is coming from. Or in some cases, needles will be inserted to ‘deactivate’ the trigger point.
What are trigger points?
It might be easier to start with what they’re not. Trigger points definitely aren’t muscle knots. Although that might perfectly describe the sensation, muscles can’t get themselves into knots.
Whilst there’s no agreed medical definition of what a trigger point actually is, practitioners will use your symptoms in an attempt to locate them.
They’re looking for tight bands of muscle tissue that are painful to touch and may produce a twitch in the muscle when direct pressure is applied.
Interestingly, studies show even experts can’t reliably locate trigger points unless they’re directed by their patients.
What can objective measures tell us about trigger points?
Trigger points are too small to be detected on scans such as MRIs or Ultrasound. They also lack the appearance of a structural abnormality which scans are designed to detect.
There have been studies that show higher levels of electrical activity at the proposed site of trigger points. This may point to increased muscle activity.
Analysing the biochemical nature of trigger points has also shown elevated levels of inflammatory substances. Although samples taken from other muscles of the same subjects revealed those changes to be system wide.
In short, we still don’t have an objective and definitive picture of what’s going on at these painful sites.
What is the best treatment for trigger points?
Given there’s no consensus on what trigger points actually are, you won’t be surprised to learn there’s no gold standard for treating them.
As you’ve likely experienced, the standard treatment for trigger points will be direct manual pressure on the site of pain. Dry needling is also commonly used, as well as injections of Botulinum toxin A (botox) in more recalcitrant cases.
There remains a relatively poor evidence base for all of these approaches however.
The evidence does suggest that both the very active and the sedentary are more prone to trigger points. As well as those with chronic diseases such as fibromyalgia.
This indicates that people who are most susceptible are either overusing or underusing their muscular systems.
This information can help direct us to more effective long term strategies.
A different approach to trigger points
While writing this it occurred to me that when I encounter people suffering from what many practitioners would likely diagnose as trigger points, it’s something I rarely consider.
This struck me as particularly strange as I used to routinely apply manual pressure to these painful sites to help people gain relief.
I think this gets to the root of the issue. If you have a concept of the body which has trigger points at the centre of any dysfunction you see, then trigger points are what you’ll look for and no doubt find.
Whilst there’s little doubt that pushing on these painful spots can provide relief, this is usually temporary.
Considering these issues from a different perspective may provide a more durable solution.
Targeted exercise can reduce muscle pain
Whilst it might seem counterintuitive, studies show that resistance exercise targeted at painful trapezius muscles for example, can reduce pain by up to 79%.
When we have pain from an area we first presume we need rest or treatment. This might be true in some cases, but for many people the opposite is true.
Pain from the muscular system can just as easily be a sign of chronic underuse.
Astronauts returning to Earth after extended periods in space provide a striking example of this. More than 50% experience back pain due to the underuse of their spinal muscles in the gravity-free environment.
Summary
Whilst trigger points are a fascinating subject, they’re a distraction if you’re looking for lasting change.
You can spend your time going from practitioner to practitioner, enduring needles in your muscles and hours of agonising massage.
Or you can ask yourself, why are these issues happening in the first place?
In most cases the answer will be your muscular system is either being neglected or overused. Sometimes a combination of both.
Addressing this with targeted resistance training will provide a more lasting solution.