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  • Dr. Nancy Trimboli

Trigger Point Therapy

Updated: May 2, 2018



So, let me set the scene. You are at home on a Saturday evening, and your back is beginning to bother you. Getting out of a chair takes an effort. Your legs have an ache too. You mind starts racing…. "What did I do?  Is it a tumor?  Is it a pinched nerve?" The pain worsens, becomes more noticeable with more movements, and, now even with sitting still. "Uhgggg," you think, "what if I have to go to the emergency room?  What's wrong with me??"  As panic sets in, you now convince yourself it is probably colon cancer, or appendicitis, or a heart attack.  "You know, they say for women, heart attack pain is in unusual places…"  Panic escalates. Now the family is involved and you've made a phone call or two to some friends who alarm you even more.  You are convinced now that this is an emergency…..


We've all been there. Suspecting the worst merely because we don't have the resources to figure out and fix ourselves. That's my mission to put the power and knowledge of your health back into your hands.


Our topic today: I'm going to share with you how to use the great tools that you unknowingly carry around with you everywhere: your hands.


Trigger point therapy is the act of applying pressure to a knot in a muscle to  release it. The tricky part about trigger points is that, as the name implies, this knot can trigger pain elsewhere in the body. That "referral pain" is quite often distant to the trigger point that is creating the pain. And, to make matters worse, that trigger point pain can be debilitating.


For instance, trigger points in the muscles of the neck and upper back, specifically the scalene and trapezius muscles will cause pain and or tingling in the wrist and hands similar to carpal tunnel syndrome. The problem is not your wrist, it's your neck.


Another example is a muscle in your lower back called the Quadratus Lumborum. Trigger points in this muscle can cause referral pain similar to sciatica. It is not the sciatic nerve causing the pain, it is the referral pain from the quadratus lumborum muscle.


There are over 600 muscles in the body. Any one of them can get a trigger point. Trigger points are created as a reaction to stress. That stress can be physical, emotional, or chemical. Humans are engineered to tolerate a certain amount of stress, even thrive with a certain amount of stress. It's when we are overwhelmed by stress that bad things happen.  Trigger points are one of those things.


The term 'trigger point' and the referral pain patterns, along with the technique to alleviate the problem was discovered and pioneered by Janet Travell, MD. She was born in 1901, and published over 100 research papers in her career. She co-published a two volume set defining her life's work in the books, Myofascial Pain and Dysfunction: The Trigger Point Manual (published in 1983 and 1992.) Dr. Travell was instrumental in helping Senator John F. Kennedy with his severe back pain. In 1960 the Terre Haute Tribune reported "Kennedy Selects a Woman Doctor" when Dr. Travell was appointed as the first female to become Personal Physician to the President. The work of Janet Travell became a foundation for Nimmo Chiropractic technique which I studied while at Life Chiropractic College. Nimmo technique is one of the nine Chiropractic techniques that I've used in my practice for the last 25 years.


Trigger point therapy for our purposes is simple. There are two steps to it.


#1 Find the Trigger Point


#2 Hold 10 seconds pressure on that point.


As I said, any muscle can get a trigger point and there are over 600 muscles in the  body. So, that begs the question, "How do I know what I need?", or "How do I know what I need to do for someone else?"


The secret is to start with the most likely muscles that affect humans today. Many of us carry stress in the upper back and neck. Specifically, those muscles are the trapezius muscles that bridge the neck to the shoulder, and the upper neck muscles at the base of the skull.  Other likely muscles  are the paraspinal muscles that line the spine from your neck to your waistline.


When you are searching for a trigger point on yourself or your partner, you press slowly and deeply into the muscle tissue. Using your thumb is usually the best, as that is your strongest finger. The important part is to listen for your partner to express a soreness, or to feel for yourself for soreness at a particular point. This is the reason you press slowly and deeply. You need a moment to feel for that soreness. And, to be clear, this is a good soreness. A good pain.  If it is a bad pain, move away from that spot. You may be directly on a joint or on a nerve that runs close to the surface of the skin. (This is most likely in  the lower neck area.)  So, let's suppose that you are pressing on your friend's shoulder looking for a trigger point. Your friend says, "Ohh, that's a sore spot."  Your job is to stop at that point and press deeply for 10 seconds.  Ten seconds is the magic number as discovered by Dr. Travell. (Actually she found it was 7 seconds, but I know some of you out there may rush the counting.) When you finish with that trigger point, you move along and look for another. It's that simple.


Here's a few tips:

  1. Remember to breathe. Sounds silly to say, I know, but, when something is painful, we tend to hold our breath. Deep breaths, in and out, actually help the trigger point to release.  The muscle has been starved for oxygen because the small blood vessels, called capillaries, could not bring adequate blood supply to the muscle.  Pressure on the trigger point opens the capillaries and brings that oxygen into the muscle. Your deep breathing through the nose, deep into your belly, oxygenates your blood.

  2. A trigger point that is fairly fresh, perhaps caused from tensing up when someone cut you off in traffic yesterday, may release quickly and with one session. A trigger point that is releasing feels like it is melting under your finger. This is a great thing. One the other end of the spectrum, a trigger point that has been there since you crashed your bike when you were 10 will take many more sessions for it to release.

  3. If you are encountering the same stress that created the trigger point, (the job, the caffeine, the mother-in-law), you will always have that trigger point. It will help to work on it. Just don’t expect it to go away.

  4. When your partner whines, "Oww! That's too much pressure!", you are allowed to believe them. More is not better in this instance. You have encountered what I call a 'butterfly person.' The pressure that you'll be using is as light as a butterfly wing. That's fine.  It's what is right for them and will be effective. Other people are 'push- your- thumb- through- my- skin- and- touch- my- lung- people.'  For these people, do what you can to apply more pressure. Use your body weight, use wooden or plastic trigger point tools, or use your elbow.

  5. Only hold the trigger point pressure for 10 seconds. You will be tempted to hold it for longer, or to apply pressure on that same spot all day long, repeatedly. Resist the urge to do this. You will create inflammation at that site that will be very sore and you'll need to use ice. A better strategy is to remember to work on that same point every day until the trigger point is resolved.

  6. Don't worry if you cannot feel the trigger points on your partner. Use that person as a guide to tell you where to press and when to stop and hold 10 seconds pressure. Some people have the gift to feel trigger points on others, and some people do not. But we all have the tools, right at the ends of our arms. It's our hands!

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