Trigger points

Trigger points, or muscle knots, are firm, palpable thickenings in a muscle. At the site of a trigger point, a hypersensitive spot with radiating pain may develop.

Trigger points develop in small parts of a muscle. They are very localized spasms of a few muscle fibers. Just like calf cramp, where an entire muscle goes into spasm, this can also occur very locally.

A trigger point can be spontaneously painful; the trigger point is then active. When pain occurs only with pressure on the knot itself, we speak of a latent trigger point.

Trigger points are common in the so-called myofascial pain syndrome. This syndrome describes pain located in the muscles (myo) and in the connecting structures (fascia). These are therefore myofascial trigger points.

Myofascial pain is a clinical diagnosis. This means that the diagnosis is made based on complaints and symptoms. It is not a diagnosis that can be confirmed by laboratory testing.

Symptoms of trigger points

Trigger points can cause a painful and/or stiff feeling in the muscle itself or radiate to another location in the body. Sometimes there is a movement limitation and loss of strength.

Because trigger points also affect the connecting structures around muscles, the painful area can be quite large. There can even be referred pain. This means that the cause of the pain is in a different place than where the pain is actually felt.

How trigger points arise

Much is still unclear about the cause and development of trigger points. Currently, it is thought that trigger points arise as a result of a lack of blood flow and oxygen in muscles.

Normally, muscles lengthen and shorten with movement. At rest, the muscle fibers are completely relaxed. When a muscle does not receive sufficient blood flow, oxygen, and nutrients, muscle fibers can go into spasm. The fibers then remain continuously contracted and no longer relax properly. The local spasm of muscle fibers is called a trigger point.

Possible causes of trigger points are:
- Maintaining the same posture for a long time.
- Stress.
- Overuse.
- Acute trauma (accident or fall).

Trigger points are a consequence, not the cause. This means that trigger points can be treated, but when the underlying cause is not addressed, the symptoms will likely return.

Trigger points are also always fixed points in the body. Each trigger point has its own referral area. This is the area where the symptoms are felt. For example, trigger points in the lower back can cause radiation into the hip and buttock region.

Treatment of trigger points

Trigger points can be treated in different ways:

• Pressure point massage.
• Dry needling.
• Manual therapy.
• Mobilization.
• Exercise therapy.
• Posture and movement advice.

Pressure point massage, dry needling, manual therapy, or mobilization are ways to treat the trigger point directly. Exercise therapy and posture and movement advice are intended to maintain the effects of the above treatments. With exercise therapy, you stimulate blood flow and strengthen the muscle, making trigger points less likely to become active.

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