Understanding and Being Effective in treating a Trigger Point. – Ryan G. PT
In previous articles I have advocated for the need for every PT currently practicing to include some form of manual, hands on skills with his or her patient. In dealing with the elusive trigger point, using one’s hands is a must. Myofascial pain afflicts many of our patients and one explanation for this pain is the trigger point. Originally coined and extensively researched by Janet Travell, MD, trigger point therapy can be the special tool in a PT’s toolbox to give his/her patient that improved optimal level of function.
Trigger points (TP’s) are best described as a nodule in the muscle that results in either pain at the sight of the nodule, or referral patterns of pain. In some cases these TP’s can elicit severe migraine-like headaches or even nausea. Each muscle in the body has several or hundreds of TP’s. By simply palpating and progressively going deeper into the muscle of scrutiny, one can find the TP. The referred pain I spoke of is specific to each trigger point, and with the assistance of Tramel’s maps, can be used to find the specific muscle in question.
Now that the therapist has discovered which muscle is causing these problems, there are several techniques, new and old, that can be implemented to treat the patient. A new and exciting technique that was demonstrated to me recently is dry needling. Dry needling has come under fire by acupuncturists that say it infringes on their specialty; however, I counter with, one, the application and technique is very different from acupuncture, and, two, the methodology behind acupuncture is similar to chiropractic where by they believe in a method of medicine based on invisible energies and corrections that have yet to be proven through empirical evidence. Like PT manipulations, the dry needling done by PT’s has this empirical evidence. This research is early and limited, but promising all the same.
Ultrasound and electrical stimulation are additional treatment modalities used for TP’s. The best method I have implemented in my experience is manual pressure and/or ischemic pressure to the TP’s directly. I have had much success treating headaches, sciatica, and other musculoskeletal conditions by finding and treating the TP. Applying steady pressure, gradually increasing my pressure depending on the patient response, and then feeling the TP reduce with objective signs of success from my patient is a sequence I employ often. The post pressure increase in blood flow and oxygenation to the tissue help heal and alleviate further symptoms with the patient. After release of the TP’s I must stress that a specific exercise regimen and various other PT interventions must be implemented to keep the TP’s from returning.
Myofascial pain can be a debilitating and mysterious condition for patients. Knowing what a trigger point is, how to diagnosis it, and how to treat it, gives every PT a valuable tool in providing the best care possible to any patient.