Myofascial Pain Syndrome (MPS) is the name given to pain caused by trigger points and fascial (connective tissue) adhesions in the body, usually in muscle tissue. Trigger points are areas of muscle fibres which are permanently contracted – initially for a very good reason – and then left contracted as if the brain had switched them ‘on’ and then forgotten to turn them ‘off’. These areas are hyper-irritable, which means that they react very easily to pressure or compression, or to stretching.
Trigger points are painful when touched or aggravated through compression or movement. They cause the brain to resist movement in their own immediate area, building up fascial adhesions, and they progressively shorten and eventually immobilise the entire muscle. More important even than that, they can send excruciating pain and discomfort to other areas in the body, often quite distant from the site of origins.
To the touch, trigger points feel like small hard lumps of tissue, ranging in size from small grains of sand to large grapes, and everything inbetween.
It is important to note that trigger points do not indicate that there is anything wrong with the body. In fact, they arise out of a need for the body to protect itself by continuously contracting certain fibres because of poor posture, repetitive strain, injuries, sudden strain or perceived falls, etc. If the activity continues which caused the trigger points in the first place, then they will return. At the Trauma Recovery Clinic, as well as treating MPS, we advise clients about how to prevent themselves from inviting trigger points back again.
Over time, bodywork practitioners, beginning with Drs. Janet Travell and David Simons, have developed fairly reliable maps which tell us which trigger points send pain or other sensations to which other areas of the body. For instance, trigger points in certain deep muscles at the back of the neck will send pain to the head, just behind the eye, resulting in migraine-like symptoms. Other trigger points in the scalenes, muscles at the side of the neck, send pain, numbness, tingling and burning sensations to the arm, wrist, hands and fingers, familiar to RSI or carpal tunnel syndrome sufferers
Using these maps, and supplementing them with our own substantial clinical experience at the at the Trauma Recovery Clinic we can easily find the relevant trigger points from the description or pain or discomfort the client gives us.
Treatment at the Trauma Recovery Clinic involves de-activating the trigger points by gentle finger pressure, using highly developed palpation skills to distinguish where the trigger point is releasing, and holding that area of the trigger point as it softens so that further areas of the trigger point can soften and release too. This is not a mechanical release, but rather a dialogue with the brain to get it to recognize that there are muscle fibres which are contracted, and to persuade it to ‘un’-contract them, through putting pressure on them in a certain direction or angle, as we feel the release.
It is essential to use palpation skills (i.e. fingers!) to release trigger points as they return if not fully released, and do not fully release unless all fibres have released. Dry needling, for example, provides little or no feedback for the practitioner through the needle and we therefore do not use that approach. There is also no need for excessive force or pressure in trigger point therapy. Indeed, that can be counterproductive and often causes trigger points to return in reaction to the assault on the area.
It is not uncommon for the original pain to be reproduced when trigger points are released, as this involves putting pressure on them which activates them. This is a good sign, although temporarily uncomfortable, as it shows that we are on the right track and treating the relevant active and dormant trigger points.
Trigger points come in four varieties: active, latent, secondary and satellite. We treat all relevant active trigger points, the ones causing the pain and discomfort, continue to latent (dormant) trigger points, ones which could cause pain in that area if aggravated enough, and sweep for secondary (ones which deveop to protect the area around the active trigger point) and satellite trigger points (ones which are temporarily switched off)
Trigger points can cause fascial adhesions, areas around them where the connective tissue becomes adhesed (literally stuck to itself or other structures). This occurs in order to keep the trigger point from being aggravated, or because it is being aggravated and is causing pain. Adhesions caused by injury or posture or strain can also cause trigger points themselves.
When treating trigger points it is essential to release the fascial adhesions as well, otherwise the trigger points will just re-form. We release both fascial adhesions and trigger points at the same time when we are working through an area.
After trigger points have been released it is important to stretch the area, which we do at the at the Trauma Recovery Clinic. Please remember that over-stretching aggravates trigger points which have not been released, and will make them worse. Home stretching is only helpful if it is done exceedingly gently, stretching to the point where you can just feel the stretch and then holding that stretch for 3 to 5 minutes for the fascial adhesions to release. At the Trauma Recovery Clinic we show you simple but very effective stretches which will speed your recovery.
As a rule of thumb, it usually takes between four and six treatments at the Trauma Recovery Clinic for each area of trigger points to be cleared. As we explained before, it is not a question of mechanical release, but of persuading the brain not to contract the fibres again once they have been released. It may take a while for the autonomic nervous system and brain to realise that there is no need any more for trigger points in a certain area if there is no chronic or overwhelming strain.
Myofascial Pain Syndrome, although fairly easy to treat, can still be complex. Trigger points in one area may cause trigger points in others (secondary trigger points) which then become active in their own right, with accompanying fascial adhesions. Myofascial Pain Syndrome may therefore become more widespread as the condition builds. This is not an illness, though, but a dysfunction, in which the body does the right thing enthusiastically, because of constant demands of strain and posture.
For more information about myofascial release and trigger point therapy, please go to ‘Our Approach’
F S, London
“I had 9 months of physios, doctors, scans, and surgeons looking at me but my recovery from a lower back injury started the day I walked into Anne’s clinic.
After those 9 months I’d reached breaking point, struggling to walk or stay on my feet for any significant period. I wondered if I’d ever be able to go back to my dream job as a Fire Fighter.
Now 4 months later I’m back on full duty, having recovered so far 85% of my capability with further improvements being made every week.
After meeting with Anne Cheshire I approached my injury at the myofascial and psychological level.
These two treatments hand in hand have allowed me to recapture my life again, and I will always be grateful”.