What Are Trigger Points?

If you've had a massage at least once, you're probably familiar with trigger points in some way. Whether you knew they were there, or got caught by surprise when your therapist found one, much of your musculoskeletal pain can be concentrated in these overly irritable spots. But what exactly are trigger points, and why are they so painful? 

Image Source: Healthinomics

What Are Trigger Points?

Trigger points are areas of increased muscle tension. We notice them when they appear as "knots" of tight, painful tissue in the myofascia, and they often develop in the centre of the muscle. Sometimes, a muscle may have a chain of trigger points, or multiple knots in different areas. Other times, trigger points may feel like tight bands. I commonly see a cluster of knots in the hamstrings, which are worse in people who stand for long periods. Both clients with stiffer connective tissue and those with hypermobility develop trigger points, and it doesn't matter how much muscle you have, either. 

But What Causes Trigger Points? 

Overuse, a lack of exercise, injury, stress, aging, poor posture, joint problems, chronic musculoskeletal diseases, and vitamin deficiencies can all contribute to the aggravation of trigger points. We don't know for sure how they turn on, but the integrated trigger point hypothesis is the most accepted theory today. Here, overactive muscle tissue becomes permanently contracted, resulting in less oxygen and nutrient supply, with more inflammation and metabolic demand. Testing shows that this mostly originates from the connections between nerve cells and muscles. Some research also suggests a role for central sensitisation, where long-term or intense pain causes the nervous system to become over-sensitive. 

How Do I Know If I Have Trigger Points? 

Everyone has trigger points, but they won't always bother you. If they are severe enough, trigger points can cause pain and stiffness throughout the muscle and possibly referred pain in different areas. They can impair movement and posture, and may worsen issues such as TMJ dysfunction and headaches. Other times, you may only notice knots and overall tension during treatment. If this is you, then you have latent trigger points, which may still affect the strength of movement or disrupt normal muscle activation patterns. 

How Do You Release A Trigger Point? 

Massage therapy is the best way to release an aggravated trigger point, with the best prevention being regular stretching and avoiding incorrect movement patterns or prolonged immobility. The pressure placed on trigger points during massage creates a kind of rebound effect that is meant to restore at least some function and circulation to the area. I usually apply pressure to them with my elbow (to avoid straining my hypermobile thumbs), and I may do this once or twice for around 10-20 seconds each time. I always use Swedish massage techniques to relax the musculoskeletal and nervous systems before any trigger point release or myofascial release, to avoid causing more tension. 

Trigger points don't completely disappear, as they can still reactivate when they're exposed to whatever first caused them. Your muscles need to carry some tension, but an excessive amount is what causes symptoms such as pain and poor mobility. 

Overall, while trigger points are normal, allowing them to get out of hand can contribute to pain, poor physical function, and even certain health conditions. Regular stretching and massage therapy are the best ways to manage them, and you may see the benefits build up over time. 

Bendy? Just Keep Swimming This Winter

The Gold Coast doesn't get that cold during winter, with our top temperatures only occasionally dipping below 20C. Still, it's relatively cold compared to what you get used to, and most people don't swim from some time in autumn to some time in spring, or summer. But if you have joint hypermobility like I do, it may be best to swim all year round, depending on your symptom profile and severity. 

The hypermobility spectrum, even up to more serious forms of Ehlers-Danlos Syndrome, is one of the most under-researched conditions in the world. While some people have mild cases - I and another bendy person can work as massage therapists, for example -  others need a wheelchair much of the time. There is a wide range of potential symptoms and genes that cause the condition, so many advocates spend all their time fighting for recognition and validation because it's so common to be dismissed as a psychosomatic case. 

As a genetic disorder, a cure will require gene therapy to insert a correct copy of the defective gene. But while we wait, some people have found that specific types of exercise are more beneficial in taming symptoms than others. 

Can Cold Water Swimming Relieve Some Hypermobility-Related Symptoms?

The under-researched nature of hypermobility means that we sometimes have to piece together information from personal experiences and research that implies a possible benefit. It's not the best way (my naturopathy degree had high standards of what research to cite), but if what you're trying is already known to be safe, it may be the best you can get. 

Cold water swimming is safe within limits. It's generally recommended that you keep to water between 10C and 16C, which is the usual temperature range seen in open-water winter swimming. Stay in the water for no more than 30 minutes, and only start actively swimming once the cold-shock period of 2-3 minutes has worn off. In my experience of controlled 12.5C water, your breathing will start to even out again and you will be able to feel your hands and feet more. If you have trouble with dislocating joints, it's best to see a physiotherapist to refine your stroke technique first. 

One of at least several people with Ehlers-Danlos Syndrome to publicly describe how cold water swimming has benefitted their condition is Charlotte Leonard, an advertising professional from the UK. After years of pain from injuries and pregnancy, no conventional treatment was safe and effective. Swimming worked, however, to the point that she no longer needs painkillers (individual results can vary, so this is not medical advice). Others still experience significant pain, but swimming reduces its severity. Even moments of freedom, described as a calming of an overactive nervous system, are all worth it for people with more severe cases. 

How Does Cold Water Swimming Work?

Cold water swimming may have multiple benefits for hypermobility conditions. When it comes to pain, the shock of cold water may dull pain through the adrenaline rush and by altering blood flow to the brain. It could also remove the fear of movement and desensitise the nervous system, numbing a pain response that has "learnt" to be overactive over a number of years. In a case study that used postoperative neuropathic pain as an example, cold water swimming at around 11C was more effective than standard physiotherapy. Their pain level dropped to near-indetectable levels, and they enjoyed persistent relief afterwards. 

Swimming in cold water also hardens the body in several ways. It can increase your body's production of its own antioxidants, and help to recharge them. The antioxidants we produce ourselves are reusable and more potent than those found in food, as I learnt in my naturopathy degree. Perhaps even more importantly in winter, cold water swimming may boost your immune cell counts so you can fight infection more effectively. Some research even shows a 40% lower risk of respiratory infection among regular winter swimmers! And whether you're too stressed or too flat to do much of anything, cold water swimming may help here, too. It seems to regulate stress hormone levels, which are often too high in anxiety or too low in cases of fatigue. 

Of course, the best way to relieve issues such as fatigue or pain are individual, so it's best to consult health and fitness professionals in-person. 

Remedial Massage for Lower Back Pain

It may be no surprise to you at all that lower back pain is the number one cause of disability in the world. Anyone can develop chronic lower back pain, but it’s more common in people over 30 or 40, smokers, people with sedentary lifestyles, overweight or obese individuals, and people who lift incorrectly.

Countless memes on social media paint a picture of pain being a normal part of life once you're past 30, and sometimes past 20 depending on the original poster. Fortunately, remedial massage and correct movement can be powerful tools in helping you maintain a youthful level of mobility.

What Does Remedial Massage Involve?

      Remedial massage therapy focuses on specific musculoskeletal issues and aims to address them by relieving muscle tension and restoring correct movement patterns. It's more in-depth than relaxation-style or Swedish massage.
It uses five main technique types:

·        Myofascial release, which restores length to the fascia by hooking and dragging movements. The fascia are connective tissue sheaths surrounding your muscles, and will impair their function if they are too tense.
Neuromuscular technique, using a deep, diving motion along the length of a muscle
Muscle energy technique, where you have to counteract a passive stretch for several seconds at a time
Trigger point release, where “knots” are released by sustained pressure
Mobilisation, which is gentle, dynamic stretching 

These can nip pain in the bud, or reduce the severity of chronic lower back pain over time. Prevention is best, because lower back pain so often develops from "learning" incorrect movement out of habit or as compensation for pain or injury, even if it’s minor. This causes tension in some muscle groups and weakness in their opposing muscles that provide the opposite movements. As a result, unhealthy movement patterns become second nature, nerve endings are irritated, and circulation may even be impaired. Damage to joints, ligaments, and tendons can become long-term, severe consequences that cause even more pain and poor function.

Myofascial Release vs. Lower Back Pain

In a new study, 30 people with chronic lower back pain received either treatment with myofascial release techniques or a TENS machine for two weeks. TENS machines are thought to “distract” (the gate control theory) or help regulate nerve function and are seen as a forward-thinking alternative to medications because they have no side effects.

The myofascial release techniques worked on the erector spinae, a set of muscles that run all the way down your spine. Each therapist would first release the muscles’ fascia with their knuckles, then with their fingertips while participants bent forward to each side.

Massage with myofascial release techniques was more effective in all measurements. Average pain levels fell from 5.47/10 to 3.33/10, while they only dropped from 5.43 to 4.44 in the TENS treatment group. Lumbar flexion angle and pelvic inclination degree also improved more, and only the massage group saw any benefit when it came to pelvic inclination. These two measurements look at the natural curve in your lower back, which developed as early humans began to walk on two legs. It’s meant to even out weight distribution and provide energy efficiency to the body. When this natural curve is ironed out or exaggerated over time, pain and joint degeneration can develop.

Preventive Care with Remedial Massage

Remedial massage therapy is proactive. Whether you’re a professional athlete, an amateur athlete, a retail worker, an office worker, or a surgeon, your body needs maintenance. This can mean that regular massage treatments, anywhere from once every few weeks to months, are important for overall musculoskeletal health. 

Sometimes, the occasional massage is all you need if you maintain self-care habits. Your therapist may show you some exercises that you can use to “warm up” or “cool down” from work or incorporate into your usual stretching routine. Or, you may benefit from types of physical activity such as swimming or Pilates that have subtle health-promoting effects. In lower back pain, it’s particularly important to strengthen your legs and core to protect your joints and lift objects correctly. 

If pain and restricted mobility are starting to get in your way, don't despair. Massage therapy is an important part of self-care, and can help you relieve minor issues while maintaining your musculoskeletal health.  

Welcome to My Blog!

 Hi! 

I'm Alexandra, a remedial massage therapist and naturopath on the Gold Coast, Australia. 

Here I will share various updates on remedial therapies, sports medicine and holistic anti-aging. 

As a semi-professional belly dancer, I first started studying natural therapies to protect my future as a dancer and to help other dancers, athletes, everyone really, to do the same. Because of this, I am prevention-focused and always willing to think outside the box. 

What have I been doing so far? I have spent the last five years focusing on content creation for other natural and integrative health businesses, mostly over Fiverr and one large media company. Now it's time to add clinical practice in, but I will still continue writing :)