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This book is written for you. It’s divided into sections, each covering a different aspect of trigger points, and what you can do about them.
Introduction
Trigger Point Manual
What are trigger points
Written by
hy we get Trigger Points Where you get Triggers How to Recognise Triggers
Dr Jonathan Kuttner MBBCh, Dip O&G, FRNZCGP, Dip Sports Med, Dip MSM, FAFMM.
What’s in this Manual?
What’s Coming Next What trigger points are Basic cause of trigger points What symptoms trigger points have Where trigger points are found How to recognize trigger point pain
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What are Trigger Points? Trigger points are an incredibly common cause of chronic muscle pain. They are so common that most people will have painful trigger points at some stage of their life. These often last only for a short time.
Introduction What are trigger points
However they can commonly appear as recurrent episodes of pain in the same part of the body. body. Occasionally they can cause severe, unremitting pain which is as severe as other causes like cancer or nerve pain and may be destructive to any quality in life for that person.
hy we get Trigger Points The full medical description is myofascial trigger points. Where you get Triggers How to Recognise Triggers What’s Coming Next
Myo – means arising from skeletal muscle and FascialFascial- is is the the fibrou fibrous s laye layerr over over musc muscle le.. This This is a strong shiny layer of tissue that acts like ‘glue’ to hold muscles together and coordinate their actions. This layer is richly invested with nerves nerves which explain the complex patterns of pain that occur.
Most people have painful trigger points at some stage of their life There is a long history of myofascial trigger points. They were originally described by ancient Greek texts and were noted throughout the Middle Ages. However they masqueraded under many names. names. These These inclu include de – fibrosi fibrositis tis nodule, nodule, myelogen myelogenosis, osis, non-rheum non-rheumatic atic arthriti arthritis s etc. They They were were final finally ly codi codifie fied d by Dr. Jane Janett Trave ravell ll in the the 1970 1970’s ’s.. She She was was a rema remark rkab able le woma woman n who who was the personal physician to President John F Kennedy and was one of the main people who
3 Introduction
helped him recover from injuries in World War II. She created the name of ‘myofascial trigger points’ and with Dr. David Simons, mapped out the many myofascial trigger points over the body. A trigg trigger er poin pointt is defin defined ed as a “hype “hyperi rirr rrit itab able le locu locus s with within in a tigh tightt band band of skel skelet etal al musc muscle le..” But what does this mean?
What are trigger points hy we get Trigger Points Where you get Triggers How to Recognise Triggers What’s Coming Next
Let’s look a little closer at how muscles work. In the picture above there is a small knot of muscle – labeled CTrP- this is the myofascial trigger point. When you have a trigger point, your muscle is in spasm, it is irritable and tender. It pulls pulls a thin band band of taut muscl muscle e which runs runs the the length length of the muscle muscle fibre. fibre. This feels feels like a guitar string within the bulk of your muscle.
4 Introduction What are trigger points hy we get Trigger Points Where you get Triggers How to Recognise Triggers What’s Coming Next The picture above is a photomicrograph of a myofascial trigger point within skeletal muscle. In the lower half you can see parallel bands of so-called I-bands & A-bands. They are evenly spread. In the upper half there is a central elliptical elliptical area where the bands are squeezed incredibly tightly together together.. This is the myofascial trigger point. The band of fibres on either side of this are stretched further apart than normal. This is where the trigger point is.
5 Introduction What are trigger points hy we get Trigger Points Where you get Triggers How to Recognise Triggers What’s Coming Next
The diagram on the right shows that each of these small areas of spasm is called a ‘contraction knot’. Actually a number of these are present in each myofascial trigger point. When When you you run run you yourr finge fingers rs over over a musc muscle le that that has has triggers you can feel them as thickened bands, ‘knots’ or tight chords like a guitar string At firs first it may take ake a bit bit of pra practis ctise, e, but but onc once you you know what to look for, you’ll be able to locate trigger points reliably.
6 Introduction What are trigger points hy we get Trigger Points Where you get Triggers How to Recognise Triggers What’s Coming Next
Why do we get Trigger Points?
The cause of myofascial trigger points is shown in this picture. The key structure is the muscle spindle fibre. This is a nerve arranged in a spiral, looking and behaving like a spring. It is found in parallel with your muscle fibres. When it is stretched, stretched, it fires fires a message to your brain. Therefore if the muscle fibre reaches beyond a critical length, the spindle will fire. The message then goes up your nerve to the spinal cord and zooms straight back to the muscle fibre causing it to contract.
The Key Point here is that the cause of trigger points is a natural process in our body. It’s necessary for muscles to be able to contract quickly as a protection that stops damage to the muscle, and also to your joints and bones. For example if you trip over, your neck muscles will tighten immediately to prevent yourself from hitting your head on the ground. This This simp simple le refle reflex x arc arc and and the the mess messag age e from from the the musc muscle le spin spindl dle e usua usuall lly y does does not not go high higher er. This This
7 Introduction What are trigger points hy we get Trigger Points Where you get Triggers How to Recognise Triggers What’s Coming Next
means that the spindle sets sets the length of your muscle, muscle, and controls how tight or flexible flexible the muscle is. There are millions of these muscle spindles throughout the body and they are there to allow the complex movements and postures that your body performs without your conscious thought. Problems (and trigger points) happen when your muscle spindle becomes sensitised - for example after after your your have have been been injur injured. ed. Then Then it it will will not allow allow the the muscl muscle e fibre fibre to length lengthen en at all and will will cause cause a localised knot of spasm. This localised spasm is the myofascial trigger point.
8 Introduction What are trigger points hy we get Trigger Points Where you get Triggers How to Recognise Triggers What’s Coming Next
Where do you get Trigger Points? This picture shows the point where the nerve enters your muscle. This is called the motor end plate and is where Myofascial trigger points usually occur. As we have muscles all over our bodies, we can also get trigger points all over our bodies. Trigger point pain can range from a deep, dull ache to a sharp, stabbing pain. You can get triggers in your head, jaw, neck, shoulders, legs, stomach, arms, hands, pelvis, back, thigh, calf and foot.
There are other symptoms trigger points can cause that can be confused with other problems. For example triggers can cause: - Tension headaches - Tightened muscles which then compress nerves. For example the scalene muscle can compress the nerve bundle that runs down your arm, causing tingling and numbness in your arm. - Pain deep in your back/abdomen/pelvis. This can be sometimes mistaken for organ pain - Tooth pain - several muscles in your head and jaw refer pain into the teeth
9 Introduction What are trigger points
This is the motor end plate enlarged. Messages from the nerve are transferred to the muscle by neurotransmitters.
hy we get Trigger Points Where you get Triggers
This means that this part of the muscle is particularly active and therefore more vulnerable to abnormal spindle fibre fibre activity. activity.
How to Recognise Triggers What’s Coming Next
This is a special stain showing where the motor end plates enter the muscle and therefore where myofascial trigger points are found.
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How do you Recognise Trigger Points? Trigger points act like the trigger of a gun - when when the gun is fired fired,, the bullet bullet causes causes pain pain elsehere. Similarly, when a trigger point is activated, it sets off a pain pattern - sometimes causing pain far from the site of the trigger.
Introduction What are trigger points hy we get Trigger Points
Each Each pain patte pattern rn is specifi specific c to that that trigge triggerr point. There are hundreds of triggers scattered around the body. Remarkably, each trigger point pattern has been shown to be consistant over thousands of people.
Where you get Triggers How to Recognise Triggers What’s Coming Next
This is a trapezius muscle myofascial trigger point and the the red area area is the specific pain distribution pattern. As you can see, this trigger causes pain that shoots up into your neck and base of your skull. This is a very common trigger point. Once you have learned the patterns, then findi finding ng the the trig trigge gers rs beco become mes s much much easi easier er. Trapezius Muscle Trigger point and Pain Pattern
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Here is another common pain pattern from a gluteus minimus myofascial trigger point. Note how the pattern behaves like sciatica. Sciatica is usually caused by irritation of the sciatic nerve by a prolapsed disc.
Introduction
However in this case a myofascial trigger point causes the pain pattern. A MRI could show a normal disc and treatment of the trigger point would stop the pain.
What are trigger points hy we get Trigger Points
It’s important to note here that trigger points can occur in conjunction with other problems. For example, this person may have a prolapsed disc, as well as gluteus minimus trigger points.
Where you get Triggers How to Recognise Triggers
To gain proper pain relief, you would need to treat both problems.
What’s Coming Next
You can also get clusters of triggers. What usually happens here is that one or two primary triggers set off pain and tension.
Gluteus Medius Muscle
Secondary triggers then form around the painful area. When this happens, all triggers need to be found and deactivated in order to fully release the area.
12 Introduction What are trigger points hy we get Trigger Points Where you get Triggers How to Recognise Triggers What’s Coming Next
A simple way to recognise trigger point is this - by pressing on an active trigger point, you should be able to recreate the pain pattern. For For exam exampl ple, e, if if you find find the the trap trapez eziu ius s trig trigge gerr from from the the pict pictur ure e on page page 10, 10, if it’ it’s acti active ve and and you you press on it, you should feel pain up in your neck. It’s always important to conduct a full medical examination for other underlying problems. Chest pain can be caused by trigger points in the pectoralis major. It can also be caused by heart problems, so you need to rule that out first. Once you’ve switched off a trigger point, it can return. Usually switching off a trigger turns it from an active to a latent trigger point. If a trigger point is latent, then it is sitting there like an accident waiting to happen. Continuing to stretch and treat the site of a latent trigger point will help prevent it coming back. Stiffness can often be a symptom of latent trigger points, so treating them proactively can improve flexi flexibi bili lity ty.. As with with most most musc muscle le rela relate ted d prob proble lems ms,, gent gentle le,, regu regula larr exer exerci cise se,, stre stretc tchi hing ng and and good good nutrition can help prevent triggers coming back.
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What’s Next? If you got this manual as part of my free email course, here’s what you’re going to get next:
Introduction What are trigger points hy we get Trigger Points Where you get Triggers How to Recognise Triggers
Message 2 - Great free tool to easily Find Triggers anywhere anywhere in your body Message 3 - ‘Getting Rid’ of triggers - why you can’t and why it’s a good thing Message 4 - 6 Steps to help Stop Triggers Coming Back Message 4 - Are You Creating Triggers? (How to make sure you aren’t) Message 5 - 3 Core Muscle Strengthening Exercises Exercises Message 6 - The Really Advanced Stuff Message 7 - How to Switch Off Triggers - Pain Free Technique If you haven’t signed up for this free email course, here’s where you can go to sign up: The Life After Pain Trigger Point Treatment Email Course
What’s Coming Next Best Regards,
Dr Jonathan Kuttner. MBBCh, Dip O&G, FRNZCGP, Dip Sports Med, Dip MSM, FAFMM.
DISCLAIMER
Introduction What are trigger points hy we get Trigger Points Where you get Triggers How to Recognise Triggers What’s Coming Next
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