Triggerpoint Therapy

Triggerpoints (aka Myofascial triggerpoints)  are those sore spots that are found in muscle tissue.  To the massage therapist they feel like thinkenings, lumps or taut bands of fibers.  The client may describe them as knots because that is what they feel like. They tie up the muscle fibers restricting motion and causing pain.

Looking at triggerpoints is advisable when many other types of massage have been tried but don’t seem to completely get rid of the pain or triggerpoint issue. Triggerpoint therapy is a safe and effective method for treating painful conditions in muscles.  Triggerpoints may be involved in headaches, back/neck pain, carpal tunnel syndrome, IT Band Syndrome, plantar fasciaitis and many other conditions.  They may be the result of injury or stress.

There are many things that cause triggerpoints starting with lack of sleep, lack of water, improper diet (high sugar, high salt in general), overuse (like sitting at a computer all day or climbing a mountain).

Paul Ingram of www.painscience.com calls them a “trigger point therapy is a pseudoscientific dumpster fire”, yet he supports triggerpoint therapy saying we just don’t have enough research on the topic and that the research we do have doesn’t provide enough data.

Triggerpoint therapy is usually a done in moderation during a massage session that also uses various other techniques like Swedish Massage, Deep Tissue Massage, and others.

Many different variations have been created incorporating triggerpoint therapy into the process.

Bonnie Pruden (January 29, 1914 – December 11, 2011)  coined the term and developed the practice of Myotherapy in 1976, described as, “A method of relaxing muscle spasm, improving circulation, and alleviating pain. Pressure is applied, using elbows, knuckles, or fingers, and held for several seconds to defuse ‘trigger points.’  See BonniePruden.com 

Raymond Nimmo a chiropractor, created the Receptor Tonus Technique based on what he called noxious generative point which others called triggerpoints. Nimmo’s students began teaching their own treatment protocols, based on Nimmo’s work. Among them was Paul St. John, who began teaching his own system in the late 70’s. In the mid-1980’s, Judith (Walker) DeLany became St. John’s first additional instructor of his method of neuromuscular therapy. DeLany (then Judith Walker) worked with St. John for five years (1984-89), where she assisted in the development of NMT techniques and protocols for massage therapy application.

Paul St John Neuromuscular therapies consists of five principles
1. Postural Distortion
2. Biomechanical Dysfunctions
3. Trigger Points
4. Nerve Compression/Entrapment
5. Ischemia
Paul St. John had previously studied with Marianno Racabado, P.T.; Janet Travell, M.D.; John Barnes, P.T.; Raymond Nimmo, D.C.; Dr. John Christopher; Dr. Bernard Jensen, and other orthodox and non-conventional teachers. From this research, he developed the St. John Method of Neuromuscular Therapy (NMT)

Leon Chaitow (1937-2018) was also a pioneer in the mid-1930s and early 1940’s, in the European-style neuromuscular techniques (as NMT is called in Europe). His predecessors, Stanley Lief and Boris Chaitow led the way.

“The letters NMT are used in Europe to describe ‘ neuromuscular technique’, while in the USA it is the abbreviation for ‘neuromuscular therapy’. NMT was developed in Europe in the 1930s, primarily by Stanley Lief ND DO, as a derivation of a form of Ayurvedic massage then practised with great success by Dr Dewanchand Varma in Paris and, subsequently, in London (Varma, 1936). Lief evolved a dual use of neuromuscular technique (his name for the method), one with a diagnostic and the other with atherapeutic intent”. ~Leon Chaitow. What is NMT? DOI:https://doi.org/10.1016/S1360-8592(99)80033-3

“The St. John Method was more clinically and technically robust, while Prudden’s system
was more health oriented and accessible to a wider audience. Together these two pioneers of trigger point therapy ensured its place in the tool kit of modern massage therapists.” The Emergence of Massage Therapy in Archetypes. Patricia Benjamin

Various treatment methods

Modern Neuromuscular Therapy is now a hybrid of many different therapies;

• therapeutic massage
• myofascial release (MFR)
• manual trigger point therapy (MTT)
• positional release (PRT),
• muscle energy technique (MET),
• connective tissue massage (CTM)
• lymphatic drainage (MLD),
• visceral manipulation (VM)
• neural mobilizations.

Treating Triggerpoints Yourself.

Many tools have been created to help you work on your own triggerpoints at home.  One of the most popular is the Theracane and other similar tools. They come with simple instructions but the basic premise is to apply pressure using the tool to the triggerpoints and hold it until they feel better.  Start with just enough pressure that it causes a slight bit of discomfort and hold for two minutes or less.  Too much pressure can add further pain and problems.  Try this twice a day and keep doing it if this seems to be making it feel better.  Stop if pain increases.

Cautions: When triggerpoints are treated in excess it can cause rhabdomyosis – a serious and complex medical condition involving the rapid dissolution of damaged or injured skeletal muscle. This disruption of skeletal muscle integrity leads to the direct release of intracellular muscle components, including myoglobin, creatine kinase (CK), aldolase, and lactate dehydrogenase, as well as electrolytes, into the bloodstream and extracellular space.  Signs of rhabdomyosis are dark urine, sweating, confusion and dehydration. This would be an extreme situation most likely in a classroom where triggerpoint therapy is being taught and students are instructed to treat every triggerpoint that they find in a person over the course of a few hours like what has happened in the Zentherapy Trainings in the early 1990’s.

Share your story about how using triggerpoint therapy or getting a triggerpoint therapy session has changed your life.