Just about everyone has what are commonly known as muscle knots that are either constrictive, painful or both.

One of the most quick, effective techniques to achieve relief from these is myofascial trigger point therapy.

Myofascial trigger point therapy has proven to be an invaluable technique in practice, one that is immediately useful and yet can take a lifetime to master. The precision of the technique is its greatest asset, allowing the therapist to key in to the most probable trigger points producing the client’s pain and deactivate that pain very quickly.

The client will often exclaim how incredible it is that more people don’t know about or utilize this technique, especially after having been seen by multiple physicians and therapists who overlooked myofascial trigger points as a cause of their pain.

A Bit of Background

In the term myofascial, myo is Latin for muscle, and fascia indicates our less-dense connective tissue. The terms myofascial and trigger point were coined by this technique’s primary researcher, Janet G. Travell, MD, in the 1950s. Travell and David Simons, MD, together researched and created the first manual for diagnosing and treating myofascial pain and dysfunction in the upper body Myofascial Pain and Dysfunction: The Trigger Point Manual, published in 1982.

This manual, and new volumes that followed, are crucial for any serious clinician treating myofascial pain, acute or chronic. They detail the nature of myofascial pain, trigger points and perpetuating factors that must be addressed, and go on to present highly detailed information on precise techniques for eliminating trigger points as the source of a client’s pain.

The techniques, which are easily learned and require no special tools, almost immediately reduce or eliminate pain, and also allow increased range of motion and strength.

Videos to Watch Now

Watch Kate Simmons demonstrate myofascial trigger point therapy for infra spinatus here.

Watch Kate Simmons demonstrate myofascial trigger point therapy for extensor digitorum here.

Intake Information

When a client is cleared for this therapy by their physician, they need to submit to the myofascial trigger point therapist basic information such as other health problems, medications and information regarding sleep, diet, ergonomics and lifestyle. All types of factors can affect and sustain chronic pain, so they must be addressed and corrected as much as possible in order to achieve longer-lasting results.

The therapist may also perform an examination for range of motion and neurological problems before treatment in order to establish a baseline to compare to after treatment. It is helpful to have the therapist or client color in a visual body chart on the SOAP notes showing the areas and quality of pain, whether it is sharp, aching, tingling or otherwise.

The therapist then may identify which muscles have active trigger points by comparing the client’s areas of pain with guides such as those presented in the manuals or in the symptom checker on myofascialtherapy.org, the website of the National Association of Myofascial Trigger Point Therapists (NAMTPT), an organization founded in 1986 dedicated to increasing public awareness of and access to myofascial pain treatment.

A Typical Session

 Applying compression to trigger points in infraspinatus.
Applying compression to trigger points in infraspinatus.

To begin therapy, the client is placed in a comfortable position suitable for the therapist’s access to the areas affected. Direct access to the skin is preferable, but not entirely necessary.

The area being addressed will benefit from being heated prior to therapy in order to dilate circulatory structures and soften fascia. If the therapist is working directly on skin, a lubricant such as oil or lotion may be applied.

The therapist may begin manual therapy by using basic Swedish massage techniques on the area, such as stripping friction and kneading, to stimulate circulation and soften fascia’s surface tension. Myofascial release methods employing full-hand compression may also be used to loosen deeper fascial structures.

 Applying compression to trigger points beneath spine of scapula for infraspinatus.
Applying compression to trigger points beneath spine of scapula for infraspinatus.

Once the area is prepared, the therapist may begin trigger point therapy by locating taught fibers within the muscles using light cross-fiber friction. The trigger point may be located anywhere within that taught band, but it is most often located with the bulk of the muscle mass. Using centripetal stripping friction up the taught band from insertion to origin, the therapist will locate the trigger point, which feels like a knot within the taught band.

Palpating for taut bands and trigger points in proximal attachment of extensor digitorum.
Palpating for taut bands and trigger points in proximal attachment of extensor digitorum.

Using direct compression from a finger, knuckle, elbow or tool, the therapist presses the trigger point only hard enough for the client to be able to relax into and continue breathing normally. Get verbal feedback from the client whether the pressure is tolerable, and also if the trigger point is referring pain anywhere else, which helps the therapist determine which muscles are active from the referral pattern.

Strumming fibers perpendicularly to locate taut bands in extensor digitorum.
Strumming fibers perpendicularly to locate taut bands in extensor digitorum.
Palpating for taut bands and trigger points in distal extensor digitorum.
Palpating for taut bands and trigger points in distal extensor digitorum.

Compression is held steady for up to a minute, but only as long as it takes for the trigger point to release. When releasing, the trigger point will feel as if it is dissolving, and the therapist will hold compression steady until it feels fully dissolved, or at least won’t release further.

If no release is achieved, the therapist may work other muscles around the area and within the myotatic unit, searching for other secondary or satellite trigger points to release. Then they may return to the original trigger point for a second or even third pass, at which time the trigger point will probably release more easily and completely.

Following manual therapy, each area addressed should have the muscles taken through a passive range-of-motion by the therapist in order to reset the resting sarcomere length.

SOAP Notes and Home Care

At the session’s conclusion, the therapist should then record all active trigger points in the SOAP notes, and instruct the client in self-care techniques for these trigger points, as well as on limbering and stretching techniques for these muscles. The therapist should carefully re-examine the client’s history for perpetuating factors that may keep activating trigger points, such as poor posture or ergonomics, poor sleep hygiene, or metabolic factors. (These factors are discussed in precise detail in chapter four of Myofascial Pain and Dysfunction: The Trigger Point Manual.)

Training and Certification

While some massage therapy schools offer introductory training in myofascial trigger-point therapy, it is essential to attend an in-depth training program, such as those listed on the NAMTPT website. This training can help the therapist prepare for passing the examination given by the Certification Board of Myofascial Trigger Point Therapists (CBMTPT), which then allows them to be listed as a certified myofascial trigger point therapist, CMTPT, in the NAMTPT directory.

Therapists can become quickly acquainted with this technique by attending the 35th annual conference on myofascial pain taking place September 12-15, 2019, in Washington, DC; find more information on it at myofascialtherapy.org.

People in Pain Need You

The demand for certified myofascial trigger point therapists is growing quickly and steadily, and therapists are being requested by more physicians as therapy resources for pain patients. If you are seriously considering investing in continuing education for your practice, learning myofascial trigger point therapy is quite possibly the best investment you will ever make.

About the Author:

Kate Simmons

Kate Simmons is board-certified in myofascial trigger point therapy and has experience since 1989 treating many chronic muscle pain relief and management conditions, such as shoulder pain and dysfunction, repetitive overuse injuries, chronic head, neck and jaw pain, and fibromyalgia. She wrote this article on behalf of the National Association of Myofascial Trigger Point Therapists, of which she is the current president.

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