A Kneaded Relief - Therapies for Tension & Pain
                                 Frequently Asked Questions about Trigger Point Therapy
Q. - What exactly is a trigger point?
A. – A trigger point is a small area of abnormally contracted muscle tissue that eventually leads to overall muscle tightness, dysfunction and pain.   It is always found at a spot where a motor neuron (a nerve cell which activates muscle movement) joins the muscle body.  This motor neuron signals the muscle fibers to contract in response to some “trigger” other than the muscle’s need to perform work.
Q. – Isn’t a trigger point the same as a muscle “knot” that can be “rubbed out” by massage?
A.  – These are not one and the same.  A trigger point may cause the hypertonic muscle areas that we call knots and are characteristically hard to the touch also, but since trigger points are usually no more than ¼ inch in diameter and cannot be massaged away, they are anatomically different.   Also, rubbing or stretching a muscle possessing a trigger point without releasing the trigger point first can actually make it worse.
Q. – What causes a trigger point?
A. –
* Primary Causes (or  triggers):     These consist of such irritations to the muscle as repetitive use, overuse, injury, spinal problems, bad posture, sleeping in the wrong position and biochemical causes (like hormones from stress or menses, food reactions, air pollution, vitamin/mineral deficiencies, and byproducts from metabolism or infections).  If a trigger is ongoing, it is most important to try to identify it and work to eliminate it if at all possible.
* Secondary Causes –
      1) Satellite trigger points are produced –This happens when muscles in distress begin to affect nearby muscles, drawing them into the “fray”.  In this way, trigger points spread to adjacent areas, becoming secondary and satellite points which cause additional pain.
     2)Latent (“leftover”) trigger points are reactivated – This occurs when trigger points are only partially resolved instead of going away completely. Then, given the right opportunity, they can flare up again.  This is why a recent history of muscle pain and spasms in certain areas can predispose a person to new episodes of trigger point pain in the same area. When this cycle is repeated over and over, latent trigger points become chronic. Persons who suffer from a long history of chronic trigger point pain can even develop postural distortions, tendonitis and tendon tears.  Trigger point therapy, however, can interrupt and reverse this cascade of adverse events.
Q. – What is trigger point therapy?
A. – The clinical definition of trigger point therapy is physical compression performed directly on the muscle fibers of the trigger point, thus signaling the muscle and nervous system to relax the involuntary contraction.  This can be considered a form of neuromuscular retraining something like pressing the “reset” button.
Q. – Do I have to have trigger point therapy?  Can I get rid of this muscle pain on my own?
A. – Of course a major part of therapy is up to you.  Pain is your body’s language telling you to stop doing something that is harmful or to start doing something that is helpful.  You must avoid activities and situations that trigger your muscles to respond adversely.  You can employ home remedies, exercises, and things like massage and whirlpool baths to assist you.  However, if identifying and/or avoiding the things that trigger your pain elude you and the pain remains or returns despite your best efforts, I encourage you to see a clinical trigger point therapist.
Q. – What is a clinical trigger point therapist?
A. – There are many who claim to perform trigger point therapy or do trigger point work, and they often have some knowledge of trigger points. But for the best results, it is important to look for a trigger point therapist who has been clinically certified to perform therapy according to the methods developed by longtime practitioners such as Dr. Laura Perry, D.C. and her husband Jeff Geanangel, clinical certifiers for the state of Texas.  The results of their methods are well proven over many years.
Q. – What difference does clinical certification in trigger point therapy make?
A. – A trigger point therapist clinically certified in the state of Texas must pass written and practical exams demonstrating that they understand the science and methods involved in releasing trigger points in muscles.  They are trained to locate and physically manipulate muscles in specific ways in order to produce noticeable, lasting muscle relaxation and pain relief.  If trigger point therapy is not done properly, the results are likely to be  inconsistent and temporary.  Or worse, incorrectly applied trigger point therapy can produce even more muscle pain and irritation.
Q. – I have pressed or had someone else press on these really sore places that felt like they needed “counter-pressure” and got either momentary relief or somewhat longer temporary relief.  But why didn’t I stay fixed?
A. – The most common reasons that self-applied attempts at trigger point therapy might not work are as follows:
 Reason #1 - A single trigger point never occurs alone.  This is because muscles do not act alone, but rather in groups, and trigger points will be found at several locations within each group.  It is essential to identify which group of muscles to focus on and to locate and release all of the trigger points in that group. 
 Reason #2 – Trigger points must be released in prescribed sequences.  They must be done in order, from primary, to secondary to satellite, etc.  If the primary trigger points are not released first, and the ones hurting most are actually secondary, then lasting success will be limited or nonexistent. 
 Reason #3 - Release technique is crucial.  Trigger point release is accomplished using different varieties of compression on the contracted muscle fibers of the trigger point until the muscle and nervous system receive the message to relax.  The right kind of compression must be done and in the proper direction, requiring knowledge of the various muscles and the directions in which their fibers run.  Professional training helps with all of the above.
 Reason #4 - Pain caused by trigger points is tricky.  Three times out of four, the pain from a trigger point refers to an area other than where the trigger point is located.  This means that 75% of the time, pressing or rubbing in the painful area will not address the trigger point at all.  A clinical trigger point therapist will understand this and know where to look for the trigger point that corresponds to the pain experienced by the client.
Q. – How many times will I have to visit a trigger point therapist for my muscular pain problem?
A. – This is based on your individuality, the type and severity of the pain and the length of time you have been experiencing similar episodes. The focus of a clinical trigger point therapist is to get you out of pain as quickly as possible with as few visits as possible.  One or two sessions are typical.  If  three or four appointments do not take care of the immediate problem, then you may be referred to a different healthcare provider.
Q. – I felt sure that I identified and got rid of the “trigger” for my muscle pain some time ago, but the pain will not completely go away. Why is that?
A. –  A trigger point may cause muscle pain and spasms even after the initial trigger goes away due to a malfunction in “muscle memory”.  The good news is that muscles operating according to a “bad” memory can be retrained to go back to a “good” memory by physically finding and releasing the trigger points in them.  The more chronic the problem, the more persistent abnormal muscle memory can be.  This can make you more vulnerable to repeat episodes of the same type of pain and require a longer span of visits.   But trigger point therapy usually can help you reduce the frequency and severity of episodes and increase the length of time between them.
Q. - What if I have another “flare-up”?  Does this mean trigger point therapy is not effective in the long term?
A. – In my experience, I have found it to be just the opposite.  In my own search for relief from muscle pain and the resulting disablement, I have used medical doctors and medicines, homeopathy, naturopathy, chiropractors, massage therapy and physical therapy.  I have found trigger point therapy to be more effective in the long run than all of these for my pain.  I now know many others who share my experience and opinion. This is one reason I decided to become a clinical trigger point therapist.
           Also, a clinical trigger point therapist is trained to help you understand what to do and not to do to continue improvement and avoid reactivating trigger points.  He/she is taught:
1.) To help you recognize unidentified triggers.
2.) What types of massage, exercise and specific stretches may be performed on the muscle.
3.) What kinds of home therapy, behavioral changes and/or products to recommend.
All these techniques require study and training different from, but complementary to other healthcare methods.  Perhaps trigger point therapy can even replace your need for many of them. 
Q. – Is clinical trigger point therapy covered by insurance?
A. – Sometimes insurance will pay for clinically certified trigger point therapy.  This depends on the insurance company and its recognition of the coding used by the therapist’s employer or business.  You should ask this in advance of a trigger point therapy visit. 
      So, if you are suffering from acute or chronic back, shoulder, hip, neck, arm or leg pain, headache pain, etc., consider an appointment with a certified clinical trigger point therapist first.   I believe you will be more than glad that you did.
     I hope this section answered your foremost questions about trigger point therapy.  If you have further questions or would like to schedule an appointment with me, please call me at (281)235-2352 or e-mail me at a-relief4u@comcast.net
     Thank you and I hope you experience surgery free, drug free pain relief, plus many more blessings in your life today!
Camille B. Mitchell, LMT  -   Licensed Massage Therapist
                             CCTPT – Clinically  Certified in Trigger Point Therapy
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