Trigger points are areas where the muscle fibers do not slide to lengthen or shorten properly. Due to the complexity of these trigger points mechanically and neurologically, they can contribute to a variety of intense symptoms. They can cause severe pain along with referral of numbness or tingling into other nearby regions. Many factors can contribute to the creation of trigger points from postural imbalances, repeated motions, leg length differences and injuries.
When the muscle fibers get stuck, there is a change in blood flow and energy required by the surrounding tissue to produce muscle force and activation. Overtime there is a cascade of other biochemical changes which ultimately lead to changes in the signals being sent from the area thru the nervous system to the brain. There end up being an increase in amount and sensitivity of the alert or danger signals sent to the brain from the trigger point region. This leads to an increase in the sensitivity of the alert signals being sent to the brain from the trigger point region. Pain can be present at rest but generally will be worse with movement. Overtime it takes less pressure or change to illicit even greater pain.
In terms of movement, there can be increased pain when multiple trigger points are present in a muscle due to the increase sensitivity of the nervous system. But from a structure, mechanical point of view, trigger points contribute to weakness because taut/stuck fibers cannot fire.
Everyone makes 1000s of trigger points every day. If everything in that area is healthy and balanced, you break down those trigger points at a rate that keeps them from being on your radar. But when there are imbalances the trigger points will start to accumulate and get more complex and larger.
What factors can influence our ability to process out trigger points from our daily routine?
· Flattening of the arches in your feet
· Dysfunctional breathing
· Stress
· Poor nutrition
· Poor posture
· Asymmetries thru your posture and alignment
· Lack of adequate movement and prolonged sitting
· Dehydration
· Poor sleep quality and duration
· Toxic overload from infections, allergies, toxins in products
· History of injury or trauma
After reading this list, you can see that you can make some general lifestyle changes right away that will help your body have improved blood flow, improved healing at the cellular level and therefore improved ability to flush out trigger points. Eat more vegetables and less donuts. Drink more water. Go to bed earlier. You know all the good things we have been instructed to do our whole lives. Well they do matter. Of course, none of this helps overnight.
But there are also times when you may need some additional help from a physical therapist.
We will start with assessing which muscles have trigger points and which are causing the most issues. Then we will assess any satellite trigger points in the surrounding areas that may be contributing to those primary problem areas. We can do manual therapy specifically to relax the tissues and the trigger points themselves.
From there it is very important to take a look at the bigger picture. Those painful, stuck areas did not just show up one day just for fun. There was a reason – and probably a long term combination of the list above. So progress with treating trigger points can be very gradual. We need to identify the main root factors that set the stage for these trigger points to get stuck. We may discuss sleep hygiene, nutrition for pain management and decreasing inflammation, stress management with relaxation techniques. But physical therapists will definitely focus on addressing muscle imbalances, alignment imbalances along with assess your foot alignment. Sometimes certain exercises and stretches are appropriate. Sometimes you need external support such as arch support or a small heel wedge. We can educate you on very specific exercises that are the correct intensity and specific for your muscle and alignment imbalances.
If you are interested in learning more about this, we do offer treatment at the Physical Therapy Specialty Center. It is covered as part of your basic PT services under insurance plans. It is not a separate service.