Trigger-Point Therapy

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Referral Patterns of Triggerpoints

Pain referral area

Check these area

Low Back

rectus abdominus, psoas, quadratus lumborum, piriformis


sub occipitals, scalenes, SCM, infraspinatious, subscapularis, pectoralis major and minor,
facet joints in the neck


psoas, TFL, iliacus


piriformis, quadratus lumborum, serratus posterior inferior,


Quadriceps, adductors, psoas, hamstrings, sartorius


psoas, TFL, adductors


sub-occipitals, scalenes, levator scapulae, rhomboids


Triggerpoint Definitions


Trigger point - (Myofascial):   An area of hyper-irritability within soft tissue structures, characterized by local tenderness and sometimes referred phenomena.  These referred sensations can include pain, tingling, numbness burning, or itching.

  • Not all trigger points refer pain, some are just localized.  Each person is different depending on their life history.
  • Localized areas of deep tenderness and increased tissue resistance that often produce referred pain.
  • The origin of the trigger point is thought to be changes in the chemical balance in a local area, irritating the sensory systems.

Active trigger point: Cause of  the immediate pain, prevents muscle from fully lengthening and sometimes weakens.

Latent trigger point:  Unnoticed by the client until pressure is applied, Not actively painful.  Usually feels dense and fibrous.


  1. Trigger points may be associated with Vitamin B-6  and other vitamin deficiencies.  Usually after a trauma or stressful event, the body is lacking in B-6, magnesium or Vitamin C.  Trigger points are more likely to develop.
  2. Trigger point are usually bilateral, with one side being more symptomatic than the other.  Both sides need to be treated.
  3. Trigger points may be a result of underlying visceral disease, arthritic joints, or other trigger points.
  4. The most tender trigger points are usually not the source of the problem. Other areas need to be treated like the referral area and the surrounding tissue.  Look for tight stringy band in small supporting musculature.
  5. Trigger points can cause referred pain, but not always.
  6. The referral patterns are not the same in any 2 people.
  7. Referred pain does not follow segmental, scleratomal or dermatomal patterns.
  8. May cause pain and stiffness especially after periods of inactivity such as sleeping or sitting for awhile.

Possible Causes:

  1. Acute overload, overwork, fatigue, direct trauma, chilling
  2. skeletal asymmetry such as short leg or pelvic imbalances.
  3. Other triggerpoints can cause new points to occur
  4. arthritic joints can cause triggerpoints
  5. Visceral diseases such as ulcers, renal colic, myocardial infarction, gall stones, kidney problems, irritable bowel syndrome can cause triggerpoints.
  6. B-6, magnesium, vitamin C, folic acid deficiencies which are common after injuries or trauma may cause triggerpoints
  7. hypoglycemia
  8. chronic infection from a viral or bacterial disease.
  9. food allergies or intolerances.  Wheat and dairy products should be checked first.
  10. toxicity due to exposure to organic chemicals or heavy metals



Trigger points may develop any where in the body, but are most commonly found at the sites of the greatest mechanical and postural stress.
Hints for locating:

  • look for changes in thickness of tissue, resistance to gliding strokes, lumps or strings.
  • immobility
  • edema
  • pain or tenderness
  • temperature changes-area is usually colder
  • color  most often somewhat pale and unhealthy looking
  • muscle shortening with weakness
  • occasionally increased perspiration in reference zone
  • hypertonicity
  • ischemia

Factors that can worsen trigger points:

  • fatigue, improper sleep
  • chronic infection
  • severe stress (mental, emotional, physical)
  • nerve entrapment, compression
  • excessive creatine in urine
  • postural imbalances
  • nutritional health of the tissue
  • food allergy, inhalant allergy
  • visceral (organ) disease - gall bladder problems, ulcers, kidney problems, irritable bowel syndrome
  • exercise may worsen an active triggerpoint, but helps heal a latent triggerpoints

Signs of Triggerpoints:

  • restricted movement, stiffness of muscles
  • weakness in muscles
  • passive or active stretching increases pain
  • resisted contraction causes pain
  • subcutaneous tissue feels coarsely granular, ropy, knotty,
  • client "jumps" when pressure applied to triggerpoint
  • deep tenderness and paresthesia
  • client may feel "Numb" but sensation is normal
  • dizziness
  • taut palpable band in the affected muscle
  • exercise makes the pain worse when there are active triggerpoints, but helps heal the latent triggerpoints
  • hyperirritability, increased metabolism, decreased circulation

Thing to pay attention to:

  1. What layer of tissue are you working on?
  2. How can you work more efficiently?
  3. What does the tissue feel like?  How does it change?
  4. What other areas may be associated with the trigger point?


  • Triggerpoint therapy can relieve the pain of angina, myocardial infarction and acute abdominal disease.  Refer clients to physicians when necessary.
  • Rule out such conditions as: Tendinitis, bursitis, giant cell arteritis, neuralgia, infection (both viral and bacterial), neuropathies, disc problems, disc herniations.
  • Check for thyroid malfunction, anemia, hypoglycemia and vitamin deficiencies.


Triggerpoint Treatments

Firm digital pressure causes hypoxia and reactive hyperemia that clears the triggerpoint.  Reconditioning the muscle after the pain is reduced makes latent triggerpoints less prone to reactivate.

Treatment Method I:

1.  Treat superficial trigger points first, applying 8-30 seconds or until the pain is gone as the client permits.   Notice changes in feel and pain intensity ( ask client for feedback regarding pain intensity).

2.  Are there any referral patterns?

3.  Flush the area with deep effleurage, pettrisage or friction.

4. Return to same trigger point and repeat treatment, 3-4 times removing as much of the pain as possible.

5.  If the pain intensifies, just hold for a few more seconds and go back later.

6.  You can vary the intensity of pressure gradually, moving with the point as it changes and releases.

 Advanced Technique: Treat as many trigger points as you can in the area and related area and throughout the body.
CAUTION:  Do not do this unless you know how to ground a client properly.   Watch for sweating palms or feet, feelings of nausea or dizziness.  This indicates sympathetic over stimulation. Emotional release may also be triggered with such intense work.  Pulling clients fingers and toes should be done after such intense treatments, for grounding.  Hold clients wrist with one hand and grab little finger with the thumb and forefinger, wrapping the hand around the little finger.  Gently, but firmly begin pulling the little finger and let go of their wrist and continue pulling finger until you snap off the end.  Grab the wrist again as you complete the snap to hold the hand up (do not let the hand/arm fall)  Continue with ring finger, middle finger, index finger and thumb.  Repeat as necessary.  Repeat with toes, pulling each toe and releasing.  The pull must come from your center and be pulled from the clients center (abdominal area).  Can you see the abdomen move when you pull the fingers or toes?

  •  Ice can be applied after session or recommend client to ice at home.
  • Client must follow up with high intake of water to flush the toxins and a detox bath consisting of 1 cup epsom salt, 1 cup sea salt and 1 cup baking soda.( or walk in the ocean or other body of salt water).  This will eliminate detox symptoms such as headaches and fatigue.
  • Also following up with movement re-education exercises will integrate the changes into the nervous system.  
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