Heal Your Own Myofascial Trigger Points
Muscles are responsible for human movement, but often become unhealthy due to overuse, fatigue and repetitive injury. Muscles are under the direction of the central nervous system, both for voluntary (purposeful) and involuntary control. Muscle function depends on sensory feedback it receives from the periphery, or a remote area of the body. When muscles are tight or dysfunctional, motor control, or muscle action, is altered. If an area of the body sustains an injury or trauma, the nervous system protects the area by guarding and contracting fascia and muscles, resulting in myofascial trigger points. Trigger points are defined as hyperirritable, involuntary muscle spasms that cause pain and dysfunction. Trigger points will not go away without intervention and often worsen over time as repetitive, overuse patterns occur.
Myofascial trigger points are the most common cause of musculoskeletal pain, especially within the pelvic girdle, as seen in my clinical practice. Trigger points cause the muscle to remain tight, weakening it and putting stress on nearby joints. If a trigger point is palpated, it refers pain to a remote location, meaning the actual source of pain could be a different area or muscle other than the location in which the pain is actually felt. Trigger points restrict motion of the muscles and decrease circulation, depriving the muscle of nutrients and oxygen, resulting in a collection of metabolic waste that remains stagnant. These metabolic wastes excite nerve endings and lead to spasm and inflammation. Pain is caused by both mechanical pressure and chemical stimulation and this cycle repeats itself unless intervention occurs. Stretching a trigger point only tightens the spasm more, much like pulling two ends of a rope taut (see above diagram).
Contracting a muscle with a trigger point is not effective since the muscle has limited range of motion and is in a guarded position. This will only perpetuate the pain-spasm cycle. Applying pressure to a trigger point (trigger point release) interrupts the chemical/pressure cycle which helps to increase circulation and remove metabolic waste products. The muscle fibers are lengthened, which reduces the pressure component of the pain cycle. In addition, adding pressure to the trigger point overrides the pain signal to the brain, which in turn allows the muscle to relax. Moderate to heavy pressure is preferred to be effective, and the muscle should respond within a minute or two, or it isn't a true trigger point.
Physician Janet Travell is the pioneer of these referred pain patterns, which was further studied by physician David Simmons. Janet Travell was also the first practitioner to use dry needling therapy, which involves inserting a sterile needle of differing lengths into muscle tissue to elicit a reflexive twitch to reset the nervous system. Dry needling therapy is one of the techniques used at Healthy Core to retrain the nervous system to influence muscle tension and pain. Self treatment of trigger points is a long-term solution as muscles have "memory" and tend to repeat the same behavior if not addressed. To quote David Simmons, M.D., "there is no substitute for learning to control your own musculoskeletal pain. Treating myofascial trigger points yourself addresses the source of that kind of common pain and is not just a way of temporarily relieving it." At Healthy Core, we believe in empowerment and education so that individuals can help themselves. If the same muscle patterns are repeated (we are creatures of habit) and the correct muscles do not work properly, muscle tightness can return and eventually lead to myofascial trigger points that cause persistent pain and dysfunction.
Here are some examples of areas to address with self trigger point release. A small tennis ball (dog ball) can be used or a Pinky ball (contains latex). There are also other products that help with trigger point release, such as Theracane, Therawand and Armaid. Once you locate the trigger point, hold firm pressure until the pain subsides and then move onto another nearby spot. The pain should improve after the release with some residual soreness from the increased bloodflow to the area.
UPPER BACK/ NECK RELEASE
Place a small tennis ball or Pinky ball in a long sock and put it over your shoulder. Lean into the ball with your upper back and shoulders until you find a painful or sore muscle. Hold pressure on the spot until the pain dissipates and then roll the ball to locate another spot.
PIRIFORMIS/ BUTTOCK RELEASE
Place a tennis ball or Pinky ball on the wall. Lean into the ball until you find a painful or sore muscle. Hold pressure on the spot until the pain dissipates and then roll the ball to locate another spot. Common trigger points include the piriformis attachment on the spine (sacrum) and outer hip.
PLANTAR FASCIA RELEASE
Place a tennis ball or Pinky ball on the floor. Press firmly into the ball with the bottom of your foot and roll the ball forward and back for 2-3 minutes or until the soreness subsides.
FOAM ROLLER HAMSTRING RELEASE
Begin by crossing one leg over the top of the leg you are treating. Roll from the knee to the sit bone, keeping the core tight and pressing the hands into the floor to strengthen the upper back and shoulders. Repeat 12-15 times or until pain and soreness subsides.
FOAM ROLLER IT BAND RELEASE (ADVANCED)
Lie on your side with the foam roller under the outer thigh. Roll from the knee to the hip. Repeat 12-15 times or until pain and soreness subsides. This is often very painful and might require modification for basic release until tolerated (see below).
FOAM ROLLER IT BAND RELEASE (BASIC)
Lie on your side with the top leg supporting your weight and the foam roller under the outer thigh. Roll from the knee to the hip. Repeat 12-15 times or until pain and soreness subsides.
FOAM ROLLER GLUTE RELEASE
Cross the top leg to balance with the other hip and buttocks on the foam roller. Roll from the outer hip to the spine. Repeat 12-15 times or until pain and soreness subsides.
FOAM ROLLER QUAD RELEASE
Lie on your stomach with the foam foller under your thighs. Roll from the knee to the front of the hips by army crawling. Tighten the core to maximize the workout. Repeat 12-15 times or until pain and soreness subsides. Finish by stretching the hip flexors (see previous blog).
In addition to self-treatment of trigger points, it is recommended to get to the cause of the symptoms, such as gut inflammation or a disruption in the core muscular support system within the pelvis. We recommend seeking help from a skilled practitioner in healing trigger points. At Healthy Core, we get to the bottom of the pain puzzle by evaluating and treating core muscular dysfunction, adhesions in the abdominal and pelvic region that restrict muscle and organ mobility and pelvic girdle malalignment, in addition to dry needling therapy. For more information about Integrative Dry Needling therapy at our clinic, click here. We offer a cure for the problem, along with self-management tools that individuals can use throughout their lifetime.
Foam rollers can be purchased at our clinic. We recommend a dense foam roller measuring 6" diameter x 36" long that can be used additionally for core muscle retraining and strengthening (look for our upcoming blog on using the foam foller for core strengthening). Please contact us if you would like to order a foam roller or would like to schedule a dry needling session. We want you to be able to help yourself beyond an "episode of care."
Disclaimer: The exercises shown above are not meant to replace the advice of a health care professional you are under the care of nor should they cause or increase pain. Please contact your physical therapist for advice on performing these exercises.