Trigger Points

Myofascial trigger points are tiny knots that develop in a muscle when it is injured or overworked. The defining symptom of a trigger point is referred to as pain. Trigger points usually send their pain to some other site. Seventy-five percent of the time they are the primary cause of pain and are at least a part of nearly every pain problem.

Trigger points can cause

  • Headaches
  • Neck and jaw pain
  • Low back pain
  • Tennis elbow
  • Contribute to carpal tunnel syndrome

The part of a muscle fiber that actually contracts is a microscopic unit called a sarcomere. Contraction occurs in a sarcomere when its two parts come together and interlock like fingers. Millions of sarcomeres have to contract in your muscles to make even the smallest movement. A trigger point exists when over-stimulated sarcomeres are chemically prevented from releasing their interlocked state.

Normally when a muscle is working, its sarcomeres act like tiny pumps, contracting and relaxing to circulate blood through the capillaries that supply their metabolic needs. When sarcomeres in a trigger point hold their contraction, blood flow essentially stops in the immediate area. The resulting oxygen starvation and accumulation of the waste products of metabolism irritates the trigger point. The trigger point responds to this emergency by sending out pain signals. Massage of the trigger point flushes the tissue and helps the trigger point's contracted sarcomeres begin to release.

Figure 6.32 Flexor digitorum Trigger points and referred Pain pattern.

This picture is a representation of several fibers within a trigger point. It is based on an electron microscope photograph of an actual trigger point.(Trigger Point Therapy Workbook)

Letter A is a muscle fiber in a normal resting state, neither stretched nor contracted.

Letter B is a knot in a muscle fiber consisting of a mass of sarcomeres in the state of maximum continuous contraction that characterizes a trigger point.

Letter C is the part of the muscle fiber that extends from the contraction knot to the muscle's attachment. Overstretched segments of muscle fiber are what cause shortness and tightness in a muscle.


Couches, chairs and car seats can strain muscles by failing to properly support the body, causing and maintaining trigger points. Strained or awkward positions in your work environment can perpetuate trigger points. The apparent comfort and familiarity of a longtime habit can make you unaware of its effects on your muscles. The way you sit, stand, and work should be examined for ways in which you may be subjecting certain muscles to continuing tension and strain.

Repetitive movement overloads the muscles, even when it requires minimal motion or effort. Strenuous repetitive movement may actually be healthier because you are more aware when the muscles become fatigued. Working at a computer keyboard is particularly stressful.The small muscles of the forearms and hands contract hundreds of times in a single session. At the same time, larger muscles of the shoulders, upper back, and neck remain immobile but under continuous contraction to hold your head and arms in position. The static posture and unrelieved subtle strain of computer work can perpetuate trigger points in any part of the upper body.

Trigger points in the flexor digitorum send sharp pain to the inner sides of the fingers, often misinterpreted as arthritis or carpal tunnel syndrome. Strain in the flexor digitorum comes from overuse of the grasping function of the hand. Grasping tools, sports equipment, scissors, and the hard use of fingers to play a musical instrument can all contribute to this strain.

Figure 4.19 Suboccipital Figure 4.20 Suboccipitals'

Suboccipital trigger points cause pain that feels like it's inside the head, extending from the back of the head to the eye and forehead. It feels like the whole side of the head hurts. The sensation is typical of what you experience with a migraine headache. The suboccipital muscles help control turning your head, bending your head forward, backward and side to side. Working at a computer monitor and similar activities fatigue these small muscles very quickly.

Trigger points do not respond to

  • Positive thinking
  • Biofeedback
  • Meditation
  • Progressive relaxation

Trigger points will respond to

  • Trigger point injections
  • Spray and stretch
  • Deep stroking massage

The deep stroking massage is a type of repeated "milking" action which moves the blood and lymph fluid out of the tissue. With this technique, the person works deeply and slowly, using very short strokes. The stroke needs to move from one side of the trigger point to the other. Unlike most massage, you move the skin with the fingers rather than the fingers over the skin. Each time you release the stroke, fresh blood immediately flows in, bringing nutrients and oxygen into the area. Over time, the tissue will become oxygenated and will go back to normal. There will be decreased pain and increased mobility in the tissue.

For more information on myofascial release, craniosacral therapy or trigger points, please call our office at (815)758-5508.