The Surprisingly Effective Results Using Trigger Point Therapy and Neuro-Muscular Technique (NMT) or
"The daily clinical experience of thousands of massage therapists, physical therapists, and physicians strongly indicates that most of our common aches and pains - and many other puzzling physical complaints - are actually caused by trigger points. Pain clinic doctors have found that they are the primary cause of pain roughly 75% of the time and they play a part in virtually every pain problem." (The Trigger Point Therapy Workbook Third Edition)
Trigger points: are areas of myofascial tissue (the fibrous tissue that encloses and separates layers of muscles) where the local circulation has been impeded to the extent that they are held in contracture. They are intensely painful and are characterised by referred pain patterns. The trigger point forms characteristic referral pain patterns for an individual muscle that is held in undue stress for long periods. The subsequent pain can be managed by releasing them. The patterns of referred pain and common sites of trigger point formation have been mapped out in some journals, these points often correspond with acupuncture points and channels.
Trigger points cause headaches, neck and jaw pain, low back pain, tennis elbow, and carpal tunnel syndrome. They are the source of the pain in such joints as the shoulder, wrist, hip, knee, and ankle that is so often mistake for arthritis, tendonitis, bursitis, or ligament injury. Trigger points also cause symptoms as diverse as dizziness, earaches, sinusitis, nausea, heartburn, false heart pain, heart arrhythmia, genital pain, and numbness in the hands and feet. Furthermore fibromyalgia may have its beginnings with myofascial trigger points.
Posture, work activity and hobbies and sports may play a crucial role in maintaining trigger point activity. Faulty sitting, standing or even strange sleeping positions can be pathogenic factors in trigger point formation. Work posture is also a contributing factor in many cases, for example hours sitting in front of a computer. Activities such as standing on one leg frequently, sitting in a cross legged fashion, even being a heavy smoker may contribute to trigger point formation in the Biceps, Brachii and Deltoid.
Muscles that commonly contain trigger points: muscles of mastication, splenius, suprasinatus, infraspinatus, trapezius, levator scapulae, scalenes, wrist extensors, erector spinae group, hamstrings, calves, gluteals, pectoralis, quadratus lumborum, quadriceps and the rhomboids.
Trigger points feel: like small nodules the size of a pinhead, pea sized nodules, large lumps, several large lumps close to each other, tender spots - embedded in taut bands of semi hard muscle that feels like a cord, rope-like bands lying next to each other (like partially cooked spaghetti!), the skin over a trigger point area is often slightly warmer due to increased metabolic activity.
Sometimes when massaging a client, I notice an area of muscle tightness, tension or irregularity. The muscle tissue can feel denser than normal and the client may experience pain and discomfort - often they may refer pain to another area of the body. Referred pain is a defining symptom of myofascial trigger-point.
Additionally, through the use of palpation (examining by touch), I might be able to pinpoint an area or 'trigger point' in a muscle area. I carry this out very slowly, feeling and exploring the area more thoroughly; usually with my finger or thumb.
If a problem occurs within a soft tissue, there can be a gradual change in tone or tension of tissue in that area. This variation in tension is controlled by the nervous system, by way of protecting the area it holds the damaged tissue in a shortened position. This is an important reaction by the peripheral nervous system in 'protecting' the tissue concerned - as part of the body's healing process. If this continues, however, over a period of time this shortened tissue is accepted by the nervous system as 'normal' even after the tissue has recovered.
A muscle may be held in a tight position by occupational, emotional, habitual or postural factors. As time goes, this tension can naturally increase, making it uncomfortable to stretch or relax a particular muscle - this causes tension in the surrounding areas as the tissue pulls on surrounding tissues and joints. The individual will instinctively hold the muscle shorter to avoid discomfort until this becomes the new normal level of tension - and so it goes on.
All of this happens through the natural reflex action of the nervous system which is not consciously controlled. We can treat this problem by bringing it into awareness and consciousness of the nervous system to stimulate recovery. It is well researched and well understood that deep pressure in a tender spot will cause discomfort and/or pain. Deep pressure on the spot will make the client aware through the discomfort felt - this usually means that relief will be experienced psychologically, which may stimulate the recovery process.
It is also thought that when pressure is applied to the area, possibly due to the release of endorphins, the area is relaxed and therefore discomfort, pain and tension are reduced or eliminated. Also, because the muscle tissue is tense and compressed, blood to the area is starved therefore the tissues become ischemic causing ischemic pain. Once the pressure is released, blood carrying oxygen and nutrients rush into the area resulting in relaxation in the restricted muscle tissue.
I usually ask the client to report the level of pain or discomfort on a sliding scale of 1 to 10. Once an area has been found, pressure with my thumbs or elbow are slowly and carefully applied - too much pressure will cause severe pain and the muscle will tighten; then the technique will not work.
Once the point is found, pressure is applied within the client's pain tolerance, held for around 90 seconds, released briefly and re-applied. Often, breathing exercises help with pain and discomfort here - pressure is usually applied on the 'out breath'.
It is such a relief for the client when that chronic pain is released and they can walk or stand properly, for example, once again. Trigger point therapy is not magic but for a lot of people suffering with chronic muscle pain, it really can feel this way!