PRIDE Physiotherapy – Trigger Points

Neil - Doctor of PhysiotherapyEvidence, Manual Therapy0 Comments

southport physiotherapy physio pain rehab

Trigger points. Here goes…
‘Trigger point’ is a *noun*. It is not a *verb*. We don’t DO trigger points, we TREAT trigger points.
If you strain a muscle by over-stretching or over-loading it, you may end up with a minor muscle tear. The term ‘pathological’ is non-specific and used to describe something being, for want of a better word, ‘wrong’. A muscle tear is considered pathological.
If your therapist told you that they were going to “muscle tear your calf” you’d correctly think they’re crazy and likely want to turn and run. That suggestion would be nonsense. It is quite common however to hear therapists and clinicians suggest that they’re going to “trigger your calf” or “trigger point your calf” (or any other muscle). Equally nonsensical.
If a therapist or clinician suggested that they were going to muscle tear your calf to treat the pain in your calf, would you trust them to treat it?
Let that be a warning to you.
So, what do we actually know and understand about trigger points?
Not much that’s helpful really.
– What are they?
We’re not really sure, but there are lots of theories. Either way, the science of trigger points is half-baked at best. They’re sensitive areas in muscle, commonly called “knots”, believed to have characteristic patterns of pain. There is a well-established definition, but that doesn’t matter at this point and the current ‘integrated hypothesis’ is more far more complicated than most people understand (1) ‘Myofascial Pain Syndrome’ is a frequently used label.
– Do they exist?
Something does. Something in muscle has been observed with fancy imaging equipment. They’re also believed to exist in other tissue too, like fascia and tendon. So whatever a trigger point is, there is some reasonable consensus at least that muscles and pain are related.
– What causes them?
There are several theories. Underuse, overuse and abuse are three common descriptors.
– Can we feel them?
The evidence says no, but lots of manual therapists claim they can. Pareidolia – the illusion in which we perceive what we want or expect. If your therapist believes in trigger points they will likely find them simply because that’s what we’re looking for.
– How do I know if I have a trigger point?
Trigger points are believed to have particular features. When you push on them for example, they’re supposed to have a characteristic pattern of pain (those funny coloured charts you may have seen on a therapist’s wall) and they’re supposed to create a ‘twitch’ response too.
– Can they be treated?
Maybe. We can’t really claim to effectively treat them if we don’t really understand what they are, what causes them, or how to objectively measure an outcome. It does appear that a range of treatment techniques can have a significant impact upon the symptoms associated with them though. The various treatments can and do improve symptoms but their mechanism is likely related to something else.

Manual therapy, dry needling, heat, foam rolling – there’s a long list.
You’ll find a lot of people and resources claiming to be experts in trigger points and their treatment. Every trigger point therapist has a seemingly endless list of treatment success stories and will talk with unwavering conviction. Several of us here at PRIDE have been in tutoring roles over the past decade (and continue to teach) and trigger point therapy in its’ various forms has been an integral part of that. Teaching something as part of a national curriculum however, doesn’t make it valid.
Muscular pain is very common and trigger points have been linked to a wide range of conditions from head to toe. Are we suggesting that trigger points shouldn’t be treated? Not at all, we do it all the time. We like to think we’re pretty effective at helping people with muscular pain too. What we don’t do though is create an unhelpful picture in our patient’s mind of what’s happening.
If you’re interested in learning more about trigger points, Paul Ingraham does a much better job of explaining it than we ever could here: https://www.painscience.com/tutorials/trigger-points.php
Here is the integrated hypothesis:
(1) Gerwin RD, Dommerholt J, Shah JP. An expansion of Simons’ integrated hypothesis of trigger point formation. Curr Pain Headache Rep. 2004 Dec;8(6):468–75.
(2) https://www.painscience.com/…/expansion-of-simons-integrate…
And here is the latest rebuttal:
(3) Quintner JL, Bove GM, Cohen ML. A critical evaluation of the trigger point phenomenon. Rheumatology (Oxford). 2015 Mar;54(3):392–9
(4) https://www.painscience.com/…/critical-evaluation-of-the-tr…
Body in Mind’s contribution to the subject:
(5) http://www.bodyinmind.org/trigger-point-evaluation/
In the words of Public Enemy: Don’t believe the hype wink emoticon
If you’ve got muscular pain, we can help you with that.

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