A Trigger Point (TP) is a small nodule or knot in a muscle which is in constant uncontrolled contraction or spasm. It can be classified as active and be extremely tender and painful or latent (inactive) and cause tightness in the muscles but not cause pain. Both are basically the same but only different in perceived pain at rest.

What’s the difference between a cramp and a muscle spasm?
A cramp and a muscle spasm are the same thing but different in intensity. We think of a muscle cramp as something in our leg or arm but it can happen in any muscle anywhere in the body. Also, the entire muscle can cramp up or just a small clump of muscle cells can go into a spasm and form a small knot within the muscle itself. These don’t hurt like a full cramp does. They just feel a little tight or stiff. But when these knots (trigger points) are worked they flare up and can cause severe pain. Even a little activity can cause them to flare up.

So it’s just a muscle spasm. Right?
Yes—and – No. Very often these muscles with TPs have nerves passing through then or surround other body structures. If they tighten around a nerve bundle the results can mimic Sciatica or Carpal Tunnel Syndrome. If they surround the intestine they can cause blockage and mimic Spastic Colon (Irritable Bowel Syndrome) and even be a cause of TMJ pain. They will often cause the headaches and backaches we experience.

Can’t I take a muscle relaxant for cramps or trigger points?
Sometimes a muscle is tight and you feel stiff but actual trigger points haven’t developed yet. A true trigger point is an involuntary contraction of a group of muscle cells. So is a cramp in the leg. When it’s a true spasm a muscle relaxant would have to be so strong that it forces all muscles in involuntary contraction to stop contracting. This includes the heart muscle which isn’t healthy to stop. For those cases where there are true spasm specialized physical therapy must be done to the specific spasm or cramp. A wide full body approach doesn’t work.

How common are Trigger Points?
VERY common! Most people will have them at some time or another. Rest, a little massage, heat and stretching often take care of them. When tightness, stiffness and occasional pain even without excessive muscle work persist beyond a few weeks it’s best to have specific therapy done for the TPs before they set in and become chronic.

What happens when they become chronic?
Your body is always healing, adapting and changing based on its activity, stresses and irritations. A low grade irritation may not hurt but it will change the body. In muscles TPs will begin to form a type of scar tissue within it to tighten and prevent the muscle cells from becoming irritated through work, stretch or activity. This fibrous tissue triggers the pain much sooner to prevent damage to an injured area. However, the damage has healed and no longer is a problem but the body doesn’t recognize that and continues to act as if it was still over stressed o injured. This creates a cycle of TPs causing pain leading to more TPs.
How long does it take to get well?

Gradually, over many months and sometimes years the problem gets worse than a person can ignore and they seek treatment. At that time people will sometimes say it’s only been a few months but there is no accident date to pinpoint. A good exam will learn that the problem started a long time sooner and has just gotten worse in the last few months. Just like anything in the body, it takes time to heal. How long depends on widespread the problem area is, how severe it is, how a person responds to therapy and what a patient does to get well or continue irritating a condition. Generally, it takes from 4 to 10 weeks to recover from TPs to the point they are gone.

What types of therapies help?
The most effective therapy is direct manual trigger point therapy. This works on the specific knots or TPs. It’s somewhat painful but almost all patients find it acceptable and well worth the few minutes of discomfort. Other therapies like diathermy, electrical muscle stimulation, ultrasound and massage are beneficial and helpful. Adjustments or manipulation are often apart of the therapy because tight muscles tighten joints which need to be returned to flexibility. This is one of the benefits of manipulation whether it’s to the neck, back, elbows, fingers or toes.

How will I know when I’m well?
Most people feel noticeably better after the first treatment. The steps to wellness from constant pain to occasional pain to discomfort and tightness to feeling ok to final wellness. We all know when we have pain but the best way to know when you’re well is when the TPs are gone. Muscles with TPs have usually created tight fibers within them which are difficult to break up. In addition, research has found that muscles have a form of memory which maintains their condition over an extended time. As the TPs become chronic it becomes more difficult to eliminate them. That’s what takes the 4 to 10 weeks. Most people feel much better and almost no pain after 3 to 7 weeks but it’s the last few weeks that gets rid of the final TPs. Once the TPs are gone we have the patient return once or twice over the next several weeks to monitor before final release.

Will TPs come back?
No and yes. Most people can finally be rid of their long term pain. But, just as a person can have a sprained ankle one time and sprain the same ankle several years later the pain is in the same area but it’s a different injury. The important thing is to recognize it and take care of it next time before it gets bad. Several times I’ve had patients that were in an accident come in the same day while other people in the same accident didn’t. By beginning treatment before the muscle develop TPs they were pain free and released within a few weeks while the other people still suffered for months following the accident.

Can anyone do TP therapy?
Yes, with some specific training. We often teach a patient’s family or fiend how to help them at home for faster recovery. Some TPs you can even do on yourself. The initial requirement is that the patient has to become knowledgeable in where, how, how hard or soft and when to stop the therapy. Even with that most patient find it’s not quite enough without the doctors specific work. It’s usually not sufficient to stop therapy but it can increase the overall speed of recovery.