MTP

Has this happened to you?  You have a headache, and a friend says,"Here, just press your finger there and it will help you feel better".  They explain to you that it’s a trigger point, and that they learned all about it from their Mom/massage therapist/Uncle Frank.  So what is all this Trigger Point Therapy stuff?  Is it just folk remedy mumbo-jumbo, or does Uncle Frank know what he’s talking about?

I’ll tell you right up front – Frank is not completely out to lunch.  Still, he may be confused about exactly what trigger points are.  But trigger point therapy is a real and well researched treatment, with great potential to keep the pain in your head away.

Muscles

To understand what trigger points are, you need to understand how muscles work.  A muscle’s job is to contract.  So how does it do that?

Your muscle is made up of bundles of cells called fibres (fibers), smaller around than one of your hairs.  A fibre contains myofibrils, which are made up of protein filaments.  These proteins slide past each other, which causes the "contraction" or movement of your muscle.  This complex system in the myofibril is called a sarcomere.  (we’re focusing on skeletal muscles here – other types are arranged differently)

We could get a lot more complicated, but I just want you to remember these tiny sarcomeres are contracting, and that means the muscle is contracting.

When trigger points appear

So when we’re talking about trigger points, (more properly mayofascial trigger points or MTPs) what do we mean?  Once in a while, these sarcomeres go crazy.  A bunch of them all contract together – a part of the muscle contracts, as opposed to a full muscle cramp.  The muscle actually ends up in a tug-of-war with itself, meaning that some of it is pulled together, and some is stretched tight.  The patch of clenched muscle actually gets very sick, actually cutting off its own blood supply.

Now the problem is you can’t really use the part of the muscle that’s "stuck" like this.  You can’t strengthen it, you can’t stretch it – it just stubbornly folds its hands and refuses to do anything.

Where do they come from?

People who have regular headache or migraine attacks will appreciate this one – we have an idea what gets them going, but in the end they’re very unpredictable.  Certainly an injury or poor posture can aggravate a muscle.  But there are also major trigger points that seem to appear out of nowhere.  Or, pain itself could actually trigger them – chronic headache, anyone?

Tracking down trigger points

So is that what we call a knot, or a tight band?  Well, it could be.  But the truth is, you can’t always feel trigger points, and sometimes something that feels like one isn’t.  A trigger point could actually be tiny – even microscopic – making it very tricky to find!

The most common way to identify trigger points is how they feel to the patient – they’re often sensitive and painful – but strangely it’s a "good pain" – there’s a feeling like release when the trigger point is worked on.

Trigger points and your head

There are a lot of things going on in a trigger point.  Not only is the muscle tissue unnaturally contracted, there is also a soup of metabolic waste around the area.  These acidic chemicals could have a lot to do with the pain – and may show why the problem of trigger points goes beyond the exact area.

MTPs not only cause pain where they are, they can mysteriously cause pain in other parts of the body.  Just because you have pain in the back of your head doesn’t mean the MTP is there – it could be in your lower trapezius muscle – in the middle of your back!

What kinds of signals are these chemicals sending to the rest of your body?  We don’t understand everything that’s going on, but we do know that migraine, for example, is tightly connected to the pain signals and sensitivity of your body.  Recent studies have shown that a) migraine patients very often have trigger points related to their areas of pain (Calandre et al. 2006) and b) working on trigger points can improve quality of life for those with chronic migraine, especially helping with the headache pain people often get between the major attacks (Jensen et al. 1988).

Ignoring mayofascial trigger points

Ignoring these problems is not a good idea.  In fact, if left long enough, serious MTPs may cause permanent damage.

The researchers in the study mentioned above discovered that people who had had migraine symptoms longer also had more trigger points.  That’s right, it looks like there is a cumulative effect!  The pain of a headache may bring on MTPs which can trigger more headaches…  More evidence that you should not just "hope the problem goes away" – whether it be chronic headache, migraine, or the trigger points themselves!

Coming up

This is the first post in a series on mayofascial trigger points and headache.  Later on, we’ll go more in-depth on how trigger points may be involved in the cluster headache, migraine or tension type headache scenerio, how they can be treated, and what you can do on your own to fight back.  Stay tuned!

Fakery or fact?

Fact, but regularly misunderstood or ignored.  To quote Paul Ingraham, Registered Massage Therapist and trigger point researcher/writer:

Trigger points are not a flaky diagnosis.

You can take photomicrographs of them, measure their electrical activity, take samples of their acidic and toxic tissue chemistry, and a new MRI-like technology can now show them as well.  They rest on a bedrock of thousands of scientific papers published in mainstream, peer-reviewed medical scientific journals.   Detailed charts of the patterns of pain that they cause, as seen at the right, are widely available.

The pioneers of trigger point research still are and always have been medical doctors like Janet Travell1, David Simons, Siegfried Mense, and Chan Gunn.

You can take pictures of trigger points, and take samples of their toxic tissue chemistry.

So, I repeat, the existence and importance of trigger points is not scientifically controversial.  The problem is educating health care professionals and getting the word out.

Paul Ingraham from his article Save Yourself from Trigger Points and Myofascial Pain Syndrome!

Credits/To find out more

Some of the sources I consulted for this article:  An overview of how muscles work here.  Study New Views of Myofascial Trigger Points: Etiology and Diagnosis, and definitive manual (for professionals) Travell & Simons’ Myofascial Pain and Dysfunction: The Trigger Point Manual, materials from Paul Ingraham including this article on the physiology of sarcomeres, and Trigger Point Therapy for Headaches & Migraines: Your Self-Treatment Workbook for Pain Relief by Valerie Delaune.