Have you ever experienced shoulder pain that no amount of rubbing seemed to help? Or
a deep dull pain in the wrist and forearm? How about reoccurring tension headaches? If you
suffer from any of these ailments chances are that a „Myofascial Triggerpoint‟ is the cause of
the problem. In a previous article we learned how to use a tennis ball to work on
triggerpoints that refer pain to the low back, pelvis and legs. Quite often Bodyworkers and
Massage Therapists will advertise that they offer „Triggerpoint Therapy‟. Many even have
special education as a „Triggerpoint Therapist‟. But what is a Myofascial Triggerpoint and
how can a Massage Therapist help?
Drs. Travell and Simons in their book „Myofascial Pain and Dysfunction The Trigger Point
Manual‟ defined a triggerpoint as “A hyper irritable spot, usually within a taut band of
skeletal muscle or in the muscles fascia, that is painful on compression and that can give
rise to characteristic referred pain, tenderness, and autonomic phenomena.” Referred pain
and autonomic phenomena can include headaches, sweating, goose bumps, sensations of
pressure, tooth and jaw pain, ringing in the ear, dizziness, as well as muscular weakness
A triggerpoint in the upper back might cause pain in the neck, or one in the shoulder
might cause headaches. Triggerpoints in the temple area can cause tooth pain and some in
the back of the head and upper neck will cause ringing of the ear or even visual effects.
What‟s more is that these points can create a cascade of problems. For instance a point in
the shoulder can cause pain in the upper arm, which then contributes to a new point in the
forearm, which sends pain to the wrist. Like the domino effect, each point contributing in
turn to a carpal tunnel syndrome issue.
Triggerpoints are caused by muscular tension and pain/spasm response. This can be by
gradual onset from a chronic holding/movement pattern or it can be the result of a
traumatic event like a car accident whiplash. A triggerpoint can become „latent‟, meaning it
doesn‟t cause any pain until triggered, or it can cause a constant referral. Old injuries often
will often create latent triggerpoints that are then later triggered during activity. Thus one
ends up with a „bum knee‟ or a „trick shoulder‟ that only hurts when one „overdoes it‟.
Another example would be chronic tension headaches that began months after a whiplash
injury and never seem to get any better.
Drs. Travel & Simons recommended „Stretch and Spray‟ (numbing the area with a
refrigerant spray and stretching the tissue so that the triggerpoint is torn apart), injection or
dry needling (so as to break the point up from the inside), and ischemic compression
(gradually stronger pressure which elicits the referral response and blanches the tissue
Your Massage therapist can treat these points by applying the compression method.
Ischemic compression is followed by stretching and flushing the tissue. Sustained deep
compression forces all of the chemical agents out of the area and mechanically breaks up
the point. When the compression is removed, blood rushes to the area clearing away the
chemical components causing pain and contraction response. Stretching and flushing the
band of muscle fibers serves to further clear the tissue of chemical agents and helps to
restore normal movement function to the tissues. Other neuromuscular „tricks‟ might also
be used in order to facilitate normal function.
Several treatments may be necessary to restore pain free movement. For a longer lasting
effect, treatments should include identifying and changing the movement patterns which
created the triggerpoint in the first place.
If you suffer from headaches, TMJ syndrome, repetitive stress syndrome, sciatica,
whiplash, or any type of chronic muscular pain, there are probably triggerpoints involved
that your Massage Therapist can help you with.