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Key concepts when managing trigger points

This post is a summary of key concepts relative to all trigger points. It is a brief collection of information that supports the formulation of successful treatment plans.

Extensive research has defined the characteristics of each specific trigger point, including the area of sensation and impaired activity. This information is essential in connecting the patient’s complaint to the trigger point. It is a starting point in a treatment plan and a checkpoint in assessing how effective the treatment has been. Most of my posts on understanding trigger points are about making that connection.

Even though I have written a good bit about the treatment of the trigger point, treatment of the exact spot is not a big part of my approach. Instead, identification of the section of muscle that contains that trigger point IS a big part of my approach. Therefore, understanding how trigger points behave is essential to identify the specific section of muscle that connects to the client’s complaint.

Trigger Points are Helpful?

A trigger point is a hyperirritable spot in a taut band of muscle with specific behaviors. Here’s an illustration of a trigger point from the most respected researcher in the field.

In order to effectively treat trigger points, it is essential to understand how trigger points are helpful to our bodies. 

  • They can be activated and deactivated by the nervous system.
  • They protect and alarm you when you need to restrict your activity or get help.
  • They can be deactivated when they are no longer needed.  In many circumstances, the nervous system deactivates them without therapeutic intervention.
  • If they are deactivated and the nervous systems sees a need for them, it will reactivate them.


How common are trigger points? 

Research shows that practically speaking, we all have trigger points in about the same locations that generate similar patterns. Therefore, whether or not a trigger point causes pain and restriction is just a matter of how active that particular trigger point is.

What Does a Trigger Point do?

  • It restricts contraction. In many cases, this is that fragile feeling of weakness connected to pain such as when a knee buckles while walking on stairs.  Or, it makes you feel like another workout repetition will hurt. Or, it causes you to lose your grip on your coffee cup. Here’s an example in this post.
  • It restricts stretch. Obviously, tightness. Even more common is the that we need a minute to get going. It makes you slow or stiff for the first few steps after you’ve been still. It slows down other muscles that need it to lengthen when they work. It robs you of power by offering resistance.
  • It is associated with a referral pattern. Most people connect it with the sensation of pain. Referral can be more than pain: It can be tingling, “numbing,” itching, etc. Also, there are referral patterns that are not musculoskeletal in nature: inflamed sinuses, blurred vision, irritable bowel, ringing in the ears, fight-or-flight etc. Look at this post.

Levels of Activity

We refer to trigger points as having four levels of activity:

  • Level 0These trigger points are inactive. They don’t bother you, even when you press into the muscle or stretch or hike the Grand Tetons. We think of these muscles as not having a trigger point because it is not active. This is what you want in your body; muscles that are working well and ready to protect you if they get the right signal.
  • Level 1These trigger points are latent. They are sensitive and may elicit a referral pattern when you press on them. These are pretty common in people’s bodies and mostly go unnoticed. This is what makes a client say, “I didn’t know that I hurt there until you pressed on it.” The nervous system naturally motor plans around the movements that aggravate these trigger points, We don’t really notice them until we are do something out of our usual routine.
  • Level 2These trigger points are active. They generate notable restriction, pain, and other associated referrals when we use the muscle. As I said above, trigger points restrict contraction and stretch. These trigger points have become more active, and they let you know when you try to do either of those. These may hurt you when you do something very active like throwing a ball or less active like driving for an hour. This is the most common level of activity that I see in my practice. It is what I describe in posts like this under the heading “Client’s Description.”
  • Level 3 – These trigger points are chronic. They continue to generate a referral pattern and bother you, even when you are resting. Chronic trigger points make people miserable because they can’t sleep, sit or work without that constant backache, headache, shoulder pain or whatever the trigger point is generating.

What makes a trigger point more active?

When a muscle is working well, the trigger points are inactive. Here are the most common things that shift a trigger point to be more active.

  • Something has damaged the muscle. It has been hit, cut or torn. It generates trigger points to limit contraction and stretch while it is healing. This is why ice and rest are recommended in the first 48 hours after most injuries, not stretching.
  • The muscle is protecting a joint that is displaced – I can consistently activate and deactivate trigger points by mobilizing local joints. A big part of my practice is testing to see which muscles aren’t contracting and stretching. I gently work the associated joints to deactivate the trigger point. This is why most of my posts have a picture of the muscle and the affected joints. When joints are freed, proprioceptive feedback no longer supports activating the trigger point. Often, the muscle does not need direct work. When it is needed, it is less intense for the client and the relief is longer lasting.

Once a trigger point is latent or active, it can become more active when the muscle contracts more. This might happen in a few different ways:

  • The body is chilled – muscles involuntarily contract to generate warmth. I write about that pain in this post. This is why we have more pain when it is cold.
  • fi-headache-around-the-eyebrowThe muscle is used more than usual. This illustration is from a post about a headache around the brow. It is one of the most common trigger points that I treat. It is aggravated by pulling the head forward and to one side while reading. In this case, there’s a latent trigger point that could become more active because the person is reading in bed more than usual. This is an example of a latent trigger point becoming active. Note:This headache may also occur in someone that reads the same amount as before but had a recent event that jarred the joints around that muscle. In this case, a bump on the head or whiplash. In this example, the trigger point becomes latent by the bump and then more active with use.

Chronic trigger points occur when other factors perpetuate active trigger points. These trigger points create a facilitated reflex arc at the spinal level and may require more therapy and more direct work to deactivate.

Underlying factors that perpetuate activity

There are underlying factors that increase trigger point activity and aren’t easy for the untrained person to figure out. When these circumstances occur, trigger points don’t release or come back quickly after being released. These factors need to be identified and addressed by a trained practitioner.

  • Imbalances in key structures create postural shifts that impact joints and muscles in other areas. Imbalances around the craniosacral system, (the cranium, spine, and pelvis) are particularly influential in creating specific changes to create global balance. Some of these seem academic, like the correcting of forward head posture to help with tight neck muscles. Some of these factors are less obvious like the pattern in this post.
  • A “primary” trigger point activates “satellite” trigger points. Some satellites are a product of the irritation generated in the referral zone. This chain of activity can be difficult to identify but easy to resolve once the primary trigger point is released. Structural imbalance creates postural distortions that overload other muscles and create satellite trigger points as well.
  • Metabolic disorders like malnourishment, food allergies and raging infection can make managing pain and maintaining good muscle tone problematic.
  • Viscerosomatic reflex occurs when the nervous system senses an event in an organ that creates an event in muscle. For example, irritation in the colon often activates the logissimus trigger point near T12, creating hip pain. There are, by the way, somatovisceral reflexes as well. One of those is the trigger point that irritates sinuses like the headache in the eyebrow above.

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Tony Preston has a practice in Atlanta, Georgia, where he sees clients. He has written and taught about anatomy, trigger points, and cranial therapies since the mid-90s.

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