Chiropractors and many other therapists, including physiatrists and osteopaths, often focus their therapeutic attention on trigger points, the hypersensitive spots in muscle tissue that develop as a result of overuse or misuse of muscles. Trigger points are actually palpable nodules located in deep muscle fibers. Trigger point therapy is designed to relieve pain and stiffness by applying controlled pressure directly to the trigger point. During the procedure, the patient participates by identifying areas of pain and relief, and by breathing deep, controlled breaths to facilitate relaxation. Trigger points affect not only the local regions, but muscles at some distance from the site. Regions away from the trigger point that respond to manipulation of the point itself are known as areas of referred pain. Scientific maps have been created to identify which specific trigger points cause responses in which other parts of the body.
Pressure applied directly to the trigger point loosens the knot in the muscle, sometimes supplying immediate relief. More frequently, patients feel positive effects from trigger point therapy after several regularly scheduled visits. The most effective results usually come from a combination of treatments, including some or all of the following: manual adjustments, massage, heat therapy, ice packs, electrical stimulation, and ultrasound. Recovery from injury is generally shortened by trigger point therapy. Compression of a trigger point may provoke a response of local tenderness, referred pain, sometimes accompanied by muscle twitch, or motor dysfunction, but this is diagnostic and temporary.
Trigger points generally develop due to muscle overload which may result from injury, muscular atrophy due to illness, or excessive exercise. The precipitating cause of trigger point development is usually ischemia, or blood loss. The nodules that appear in the deep muscle tissue are considered to be small knots of spasmodic muscle contraction.
Trigger point therapy should not be painful, though it is likely to be somewhat more uncomfortable than a typical massage. Patients are advised to speak up if the pressure causes real pain, since it is important for the therapist to receive ongoing feedback. In most cases, the discomfort experienced is described by patients as "good pain" since it is followed immediately by relaxation of muscle tension in the problem area. Trigger point therapy is designed not for general relaxation, but to target a particular region It may be used to relieve pain or increase range of motion due to:
- Whiplash, falls, sports injury
- Carpal tunnel syndrome
Many patients are sore in the day or two following a trigger point treatment session. This is normal and expected, like the discomfort after a strenuous physical workout. Increased hydration is recommended after trigger point therapy to shorten recovery time.