1. What is Myofascial Trigger Point Therapy? Myofascial Trigger Point Therapy is a therapeutic modality used for the relief of pain and dysfunction originating in the muscles and connective tissue; “MYO” means muscle and “FASCIAL” refers to connective tissue. A trigger point is simply a small contraction knot in muscle. This knot feels like a pea buried deep in the muscle, and can feel as big as a thumb. It maintains a hard contraction on the muscle fibers connected to it, thus causing a tight band that can also be felt in the muscle.
These trigger points in muscles and in the thin wrapping around each muscle (called fascia) are called myofascial trigger points, to distinguish them from trigger points which can occur in other soft tissues such as skin, ligaments and tendons, and also in scar tissue. Pulling the trigger of a gun makes a noise in the gun but it also sends out a bullet that causes pain at a distant target site. Pressing firmly on myofascial trigger points hurts right where you are pressing; sometimes making you jump, wince or pull away. But, more importantly, trigger points also send “referred” pain or tenderness to some other site, often quite far away. So, for example, a headache may not be caused by a problem in the head itself but may have been sent to the head from a trigger point on the side of the neck.
2. What is the difference between trigger point therapy and massage? Trigger point therapy is a pressure technique that targets specific muscles to eliminate very specific pain issues. Patients generally remain fully clothed (unless MPS therapy is needed) and oils/creams are not used. Patients who are on their lunch break appreciate this oil free session because they will generally be returning to work afterward. Sessions are typically 30 to 60 minutes.
Massage is geared towards relaxation and stress reduction. The patient would be asked to disrobe and lie under several layers of draping (the majority of the body remains covered during the session to ensure comfort and privacy. Disrobing is done behind closed doors prior to the start of the session.) Oils and creams will be used. It is important to mention and skin sensitivities, allergies or dislike of fragrances. Sessions are typically 60 to 120 minutes.
Patients who opt for a combination session will follow massage protocols, and trigger points will be addressed as needed throughout the session. 90-120 minutes is recommended for this type of session.
3. How does trigger point therapy work? Trigger point therapy breaks through the self-sustaining, vicious cycle that has kept the muscle contracted. It increases the circulation, which has been restricted in the immediate area by the contracted fibers, thus enabling oxygen and nutrients to flow to the spot. It directly stretches the trigger point’s knotted muscle fibers.
4. How long will it take for the pain to get better? With trigger points of recent onset, significant relief of symptoms often comes in just minutes, and most acute problems can be eliminated within 2 to 10 days. Chronic conditions are more complex and often less responsive to treatment. None the less, even some of these problems can be cleared in as little as 6 weeks.
5. What should I do after the therapy has relieved my pain? After therapy, apply a hot pack or dampened towel to the treated area for a few minutes. Then gradually and gently stretch the treated muscle through its full range of movement three times, with a pause to deeply breathe and consciously relax between each cycle. Drink lots of water to flush toxins from the body. This will help you not feel sore the next day. If you have a history of post treatment soreness, drink 1-2 Emergen-C vitamin packets to assist the body with recovery. If you have had a trigger point session, stretching may be prescribed. Otherwise, live life as you would normally. You may feel so relaxed that you get sleepy. Personally, I like to take a nap after I get a massage!
6. Which therapy is more beneficial, trigger point or chiropractic? Both therapies have their benefits, but the truth is that you will recover faster from painful injuries when you implement both chiropractic and trigger point therapy into your treatment plan. If you plan to see your chiropractor, you should schedule an appointment with me first. This will allow your muscles to relax and assist the chiropractor in adjusting you with greater ease. Spinal adjustments will last longer if the muscles are also being treated. When the muscles are relaxed, they will allow the spine to stay aligned. If the muscles are tense, they will force the spine out of alignment. So the answer is that trigger point therapy and chiropractic care compliment each other. I would appreciate an introduction to your chiropractor.
7. Will my pain and trigger points go away if I just rest? Yes and no. Studies have shown that with a short period of rest and the avoidance of whatever activated the trigger points, the pain symptoms may disappear over a few weeks. This makes people believe their problems have gone away. But, if you examine the muscle properly, you will find it is still tight, stiff and weak and still tender when pressed on. In other words, the trigger points are still there; they are just lying dormant (latent), and not causing referred pain at that time.
The bad news is they can be very easily reactivated to cause pain again, by acutely overloading the muscle in a new or repetitive task, working or sleeping in an awkward position, chilling the muscle, or during emotional stress, fatigue, or viral infections. How much it takes to reactivate a latent trigger point will depend on the degree of muscle conditioning, so keeping fit can help reduce the likelihood of this. But the only way to get rid of the trigger points for lasting relief is through actively hunting out and treating all the active and latent trigger points. Although this involves more effort, it’s truly worth it in order to escape “the endless replay” of trigger point pain.
8. What can I do to achieve lasting recovery? Learn respect for your muscles: they were not designed to be held for long periods in a sustained contraction or in a fixed position. Vary your tasks each day. Lift objects very carefully. Slow your working pace, and take short rests frequently, especially if feeling muscle fatigue and learn relaxation techniques, (yoga. etc.) Do a daily program of passive stretches that puts the affected muscles through a full range of movement, and repeat the stretches throughout the day. Be like a cat; it rarely tries to walk after a sleep without first stretching smoothly and slowly.
Watch your posture when sitting, reading, using the computer, car or phone. Don’t remain in a single position for a prolonged period of time. Figure out what particular postures, movements and activities stir up your trigger points. If you don’t have to do that activity, then don’t. If you do, then modify how it’s done (use the other hand, balance weight of bags and purses differently, etc.)
Correct any imbalances in your diet. Take vitamin and mineral supplements as recommended by your health care professional. Limit your caffeine intake to a maximum of 24 ounces each day.
9. How much will my session cost? Rates vary according to the length of your session. Sessions are available for 30 minutes ($40), 55 minutes ($70), 90 minutes ($100), or 120 minutes ($120). Become a member to save 15% on all massage services.
10. Will my insurance cover the cost of my session? No, not yet. Health insurance companies have resisted covering the costs of myofascial trigger point therapy by erroneously classifying it as a form of massage. However, Workers’ Compensation does recognize it as a therapeutic modality and if properly referred for treatment Workers’ Compensation will pay for your therapy. In addition, we have a working relationship with Allstate, Erie Auto Insurance, State Farm and CHAMPVA. If you have an open auto or workers comp claim, we will help you to get the necessary referrals and paperwork to have your sessions covered. Progressive and Nationwide will NOT cover our services. Body By Design accepts cash, checks, credit cards and debit cards as forms of payment (due at the time of service).
11. Are trigger points common? Myofascial trigger points are among the most common (yet poorly recognized and inadequately managed) causes of musculoskeletal pain seen in medical practice. Unfortunately, many general practitioners and orthopedic surgeons do not know about trigger points, and as trigger points do not show on X-rays or scans, the patient may be told there is nothing wrong with them or that there is nothing that can be done to help their pain.
12. Are trigger points the same as a muscle spasm or tear? No, a trigger point is not the same as a muscle spasm. A spasm involves a violent contraction of the whole muscle, whereas a trigger point is a contraction in only one small part of a muscle. A tear (or strain) involves physical damage to the muscle or tendon fibers. Such damage has not been demonstrated in studies of trigger points. (However, such injuries may predispose one to developing trigger points later on.)
13. What symptoms and conditions may occur from trigger points? Referred pain caused by trigger points is usually steady, dull and aching, and often deep. It may occur at rest, or only with movement. It varies from being a low-grade discomfort to being severe and incapacitating.
Apart from pain, trigger points may cause numbness, tingling, weakness, or lack of normal range of movement. Trigger points can also cause earaches, dizziness, sinus congestion, nausea, heartburn, and false heart pain. And they may result in depression if pain has been chronic.
Trigger points are known to cause or contribute to headaches, neck and jaw pain, low back pain, the symptoms of carpal tunnel syndrome, tennis elbow, and many kinds of joint pain mistakenly ascribed to arthritis, tendinitis, or bursitis.
14. How do you know where to find a sore spot? Referred pain occurs in predictable patterns, which have been mapped out in The Trigger Point Manual by Travel and Simons. Using their maps, trigger point therapists know which areas to search for the trigger points that characteristically send pain to the place where you are hurting. Then we feel for a tight muscle in that area, feel for tight bands within that muscle, and localize an area the band which is extremely tender: THAT spot is the trigger point. As we press or twang it, the muscle may twitch. As we keep pressure on it, it will cause your usual referred pain, thus confirming that we’ve got the spot. It is important to realize that the trigger points themselves do not hurt unless pressure is applied.
15. Could there be more than one trigger point? Yes, trigger points tend to gang together. It is common to find more than one trigger point in the tight muscle, and more than one muscle whose trigger points refer pain to the area where you are hurting. All of your trigger points need to be hunted out and treated before you’ll gain full relief of your symptoms.
16. What causes trigger points to develop? All of us develop tight bands in our muscles as we age, but some people have more than others, due to predisposing factors. Some of these tight bands go on to develop trigger points when one or more “precipitating factors” arise. For example, a trigger point may develop following an acute muscular strain such as during a car accident, a fall, a sprain or fracture, or excessive or unusual exercise, or following chronic overload of the muscles used to maintain posture because of poor sitting, working or sleeping habits, or by repetitive work tasks.
17. What causes trigger point therapy? Exercise should be regarded as a prescription, and the kind of exercise prescribed depends largely on how active your trigger points are at that time. When the trigger points are hyperactive and you have pain at rest, then gentle stretches and hot packs are your limit. Once the trigger points are inactivated and constant pain fades, then a carefully graded exercise program is needed to increase muscle endurance and strength. This involves muscle lengthening exercises. Post-exercise soreness and stiffness should not last longer than 3 days or the program needs altered. Then a regular conditioning program, such as swimming or cycling is recommended, at least twice a week.
18. Who discovered trigger point therapy? The techniques are the result of lifelong research by Janet Travell M.D. and David Simons M.D.. These pioneers discovered the casual relationship between chronic pain and its source: trigger points. Their two-volume text, Myofascial Pain and Dysfunction, The Trigger Point Manual forms the basis of this internationally renowned therapeutic protocol. Trigger points often refer pain to a location other than the site of the lesion. Referred pain from trigger points usually fails to follow “normal” neural pathways and may travel a considerable distance. Dr. Travell compiled maps of the most common trigger points and the areas to which they refer pain.
19. Is this therapy medically accepted? Myofascial Trigger Point Therapy (MTPT) is recognized by the American Academy of Pain Management as an effective treatment of myofascial pain and dysfunction.
20. How often do I need to have therapy? If you are not experiencing pain, getting a massage once or twice a month will help maintain a healthy body by improving circulation, getting rid of toxins and encouraging restful sleep. If you are in pain, I recommend that you schedule several consecutive weekly visits until we are both satisfied with your results. At that time, a maintenance schedule would be recommended.
21. Should I tip my therapist? Yes. Industry standard suggests a 15-20% gratuity on the original cost of the service. If you have a gift certificate or membership, please bring cash as gratuities are not included and cannot be charged to a credit card without a sale.