Jeanne Mortimer awoke one morning a couple of months ago with a sore shoulder and “a weak upper arm that was very difficult to raise over my head.”
Mortimer, 60, a marine biologist associated with the University of Florida, is doing fieldwork in the Seychelles Islands off of Africa’s east coast. As a result, she is thousands of miles away from her practitioner, Sharon Sauer, CMTPT, LMT, co-director of therapy at the MYO Pain Relief Center in Chicago.
Sauer had treated Mortimer with trigger point therapy, a form of bodywork designed to eliminate tender spots in muscles. So Mortimer emailed Sauer and arranged for a video consultation via Skype.
“I followed Sharon’s suggestions, and worked on my muscles for a few minutes every few hours,” says Mortimer. After a couple of days, “I was feeling pretty much back to my normal self. And this was pretty remarkable since I’d been close to tears because of the pain prior to speaking with Sharon.”
Practitioners in the field believe that more people could benefit from trigger point work. “About 75% of pain is caused by trigger points. Yet in spite of decades of research, it is one of the most under-diagnosed conditions in medicine,” says Valerie DeLaune, LAc, of Alaskan Natural Care in Anchorage.
Tender points occur when muscle fibers contract into small, tense spots within taut bands of tissue. “You can’t feel the tender points themselves as much as the taut bands,” explains Sauer, author (with Mary Biancalana) of Trigger Point Therapy for Low Back Pain (New Harbinger). “You look for these taut bands and then for the tender points, and see if that may explain the pain the person is experiencing.”
Muscles filled with tender points are less flexible and injury-prone. This inflexibility can also put pressure on nearby joints and pull the body out of alignment. “I once treated someone whose muscles and fascia [the connective tissue that surrounds muscles] seemed to be shrink-wrapped onto their bones,” Sauer says.
Pain caused by tender points often radiates in what are called referral patterns.
“More than 70% of the time, trigger points are not located where the patient feels symptoms. For example, if someone has pain in the temple it could be coming from muscles in the back of the neck, the front of the neck or the top of the shoulder, besides muscles in the temple area,” says DeLaune, author of several books on trigger point therapy including Trigger Point Therapy for Repetitive Strain Injury (New Harbinger). Trigger points tightening near a nerve can cause symptoms that include referred tingling or numbness.
Injuries and spinal misalignments are two factors that can lead to trigger point development, as can bad body mechanics. “How you sit, stand, walk, run, move and generally treat your muscles has a great influence on whether or not you form or perpetuate trigger points,” DeLaune says.
Poor nutrition plays a role in trigger point problems. “Low vitamin D is a big cause of pain and dysfunction. We also look for low levels of B vitamins, magnesium and potassium,” Sauer says. A lack of vitamin C can lead to trigger points, which can be aggravated by not drinking enough water.
Untying the Knots
Therapists use either sustained pressure or stroking movements to release trigger points. DeLaune notes that other techniques include dry needling, as in acupuncture, or wet needling, as in the application of a numbing agent via injection.
Relaxing the trigger points is only the first step; the idea is to keep them from coming back.
DeLaune says, “You must be a detective. For example, maybe the client’s office chair doesn’t have a lumbar support or they need a headset for their phone. There could be a systemic disorder, such as hypoglycemia, allergies, hypothyroidism or chronic infections. There could be problems caused by stress.” Treating hormonal imbalances or emotional problems such as depression or anxiety can also help provide long-term relief.
Self-care is crucial to keeping trigger points at bay.
“I feel that the patients who go home and do self-treatment techniques, including trigger point therapy, get better at least five times faster than people who just let me work on them,” says DeLaune. The idea is to make the necessary adjustments slowly, over time. DeLaune gives the people she sees only one or two ideas each session or “it can be overwhelming. If you give them a list of 10 ideas, they can’t make that many changes. Once they get relief from a technique they are a lot more likely to do it.”
Self-care often requires the use of aids such as tennis balls, foam rollers and other devices to apply pressure where needed, particularly to the back and other inaccessible areas. DeLaune says too much effort can be as harmful as too little, though.
“When lying on balls, use only the weight of your body to give you pressure. Don’t actively press onto the ball,” she advises. Don’t rush through treatments, which can actually aggravate trigger points. “If your time is limited, just treat one area thoroughly,” says DeLaune.
A number of studies have shown trigger point therapy to reduce pain and increase range of motion. Sauer, who trained in this work after it eased her migraines, says, “I’ve been helping people with all kinds of pain problems that no one else has been able to help them with. It’s better to deal with the referred pain patterns then to give people painkillers—the drugs don’t work after a while.”
Mortimer says, “For the past five years I’ve stopped taking pain pills because I rely on trigger point therapy for most pains that I might get. It changed my life.”
To find a trigger point therapist, see the National Association of Myofascial Trigger Point Therapists; for a practitioner of the Prudden method, see Bonnie Prudden Myotherapy.