Might Trigger Points Sometimes Be Useful?
If a fire alarm goes off should we listen to its’ warning sound and get out of the building?
Or should we find a large hammer and silence it because the noise is a real nuisance?
I think you know the answer to that hypothetical question, and so the short answer to the question raised in the title would – I suggest – be ‘absolutely without doubt’
The pain from a trigger point might at times be a nuisance worth putting up with – if the other effects of the trigger point are beneficial.
How could this be the case?
Consider the some of the effects of myofascial trigger points – over and above their pain producing nature.
- They increase tone locally, in the tissues in which they exist.
- They increase tone in the tissues that they target via referral, or radiation.
Well…ask yourself when increased tone might be just what particular tissues need?
One example might be when the joints with which they are associated are unstable. Clinical experience suggests that, in such circumstances, myofascial trigger points may, form part of a functional system for sustaining tension, where this is required – for instance in posturally compromised tissues, as “repositioners”
- Take as an example the mandible, when its’ position is destabilised due to forward head posture.
- Or consider the sustained tension across an unstable sacroiliac joint caused by strategically placed trigger points in the hamstrings (Vleeming et al 1997).
Simons et al (1999) have shown that, in the absence of adequate levels of adenosine triphosphate (ATP), and in the presence of calcium, the actin and myosin elements of muscles are designed to lock in a shortened position.
Trigger points therefore function effectively in the absence of ATP (thereby displaying an economy of resources), and as they are often strategically located in tissues that are straining to accommodate dysfunctional posture, or habits of use, they might be seen as part of the solution in some instances, rather than part of the problem.
As we all know, trigger points often clear up spontaneously when the immediate causes – such as poor posture, overuse etc are corrected (and/or when other stressors such as dietary imbalance, breathing dysfunction, dehydration, etc. are changed) – which makes that (removal of causes) the optimal trigger point deactivation method (Chaitow & DeLany 2002).
Trigger points also appear to demonstrate a built-in, silent (latent) and non-silent (active) alarm mechanism, when the structures with which they are associated are being abused. Therefore, to release trigger points without regard to correcting the underlying causes (the abuse), to which they are responding, may result in a less than ideal outcome, not least of which could be a rapid, or chronic, return of the trigger point activity.
Rather than always being seen as dysfunctional entities, trigger points might be considered as low-energy-consuming, contractile devices, established by the absence of available ATP, to maintain a structural or localised tensional element, for immediate or long-term adaptation/compensation purposes, until no longer required.
Additionally they may be seen as alarm signals when tissues are being overloaded and abused.
In this way of thinking, it is the individual’s posture, patterns of daily use, or lifestyle, that are dysfunctional, not the tissues housing the trigger point, which may be doing exactly what they were designed to do.
When this is true – and when we can recognise that it is – it is the context from which trigger points emerge that requires attention, not the trigger points. Even when trigger points are potentially useful as stabilizers, but are nevertheless causing pain, if more appropriate stabilization can be achieved, via (say) improved core stability, then deactivation – manually or by other means – would be seen to be appropriate.
But of course there are times – arguably in the majority of cases – when trigger points remain active well past their possible usefulness as stabilizing agents, or when they exist as historical remnants of previous overuse or trauma.
In such instances they are nuisances, and are probably disturbing normal function, and so require appropriate deactivation.
Just what ‘appropriate deactivation’ method you use is up to you. I have a preference for manual methods – although some of my colleagues use dry needling and others inject with procaine.
The neuromuscular (NMT) approaches I advocate are widely used and incorporate a mix of ischemic compression (intermittently applied) followed by positional release, followed by stretching of local tissues after an isometric contraction, followed by stretching of the whole muscle.
I have written (often with expert collaborators) widely on this subject and you can evaluate some of the books on my website (www.leonchaitow.com) – including Modern Neuromuscular Techniques, Clinical Applications of Neuromuscular Techniques (Volumes 1 and 2) – with Judith DeLany.
As in other postings – if sufficient interest is forthcoming I will expand on this in a later post….. in the meantime just as all the glisters is not gold, so all trigger points that hurt are not ‘baddies’!
- Chaitow L, DeLany J 2002 Clinical applications of neuromuscular technique. Vol. 2. Lower Body.Churchill Livingstone, Edinburgh
- Simons D, Travell J, Simons L 1999 Myofascial pain and dysfunction: the trigger point manual. Vol. 1: Upper half of body 2nd edn. Williams & Wilkins, Baltimore
- Vleeming A, Mooney V, Dorman T, Snijders C, Stoeckart R, eds. 1997 Movement, stability and low back pain. Churchill Livingstone, Edinburgh