What Are Trigger Points?
Trigger points cause pain more often than any other condition, are drastically under-diagnosed due to lack of information. Trigger points are specific, hyper-irritable and hypersensitive areas in muscle that suffer from decreased circulation, increased contraction and spasm. Lack of circulation creates a high anomaly of toxins and increased nerve sensitivity that can range from low ache to sharp pain. Now just because the trigger point causes the pain does not mean that the spot is painful itself. When the pain causing spot is painful it is called a primary trigger point. However, pain can also manifest itself in areas away from the active trigger point - such pain is called referred pain.
A significant trigger point nodule can often be noticed as a small lump in the muscle, usually no larger than a pea. Less substantial trigger points are not so noticeable by a lump, but are easy to find anyway - just search your own muscles for the spots that feel most tender; they will transmit pain pain when you press on them. You may not be able to locate a trigger point by feel, but it will always hurt when you press on it.
It is not uncommon to find a "taut band" of muscle stemming from an advanced trigger point; this taut band will feel much like a small cable. These taut bands extend from the trigger point outward and can be mistaken for a tendon, and it is these taut bands, brought on by trigger points, that keep your muscle in a state of tension. Taut bands that are found in shoulder muscles are directly attributable to lack of shoulder movement. The bad news is that left untreated, the trigger point will worsen and the taut band will become more taut, freezing up your shoulder joint more and more. To free up your shoulder mobility, it is hugely important to:
- Find the location of the trigger points that are freezing up your shoulder joint.
- Eliminate these trigger points as soon as possible, to escape the downward spiral toward worsening adhesive capsulitis.
Trigger Points and Frozen Shoulder
Within the physical therapy arena, one of the classic resources for Kinesiology (the study of movement and the way muscles cause movement to occur) reference is Brunnstrom's Clinical Kinesiology (Smith, Weiss, and Lehmkuhl 1996); much of the following information on this page will stem from this book. Though much of Kinesiology is focused on movement, it is also concerned with the myriad of factors that limit the function of muscles.
As you may or may not know, many shoulder problems will occur because one or more of the 24 muscles associated with the shoulder are not functioning properly. Trigger points within the muscle tissue affect muscle function negatively, and the most important effects of trigger points are as follows:
- Trigger Points shorten muscles and actively prevent them from lengthening
- Trigger Points often cause muscle weakness.
- Trigger Points often are painful -> This pain makes muscles stay tense -> This constant tension in the muscle will make the trigger point worse, thus completing a continually worsening cycle.
The reality about adhesive capsulitis is that it takes time for adhesions to develop and the shoulder already has to be locked into place for adhesions to form. In the opinion of some *doctors, the first step in treatment is to get rid of the trigger points that reside within the muscles associated with the problem shoulder. The sooner the trigger points are treated, the better chance there is to keep adhesions forming in the shoulder joint.
Travell, J., and D. Simons. 1983. Myofascial Pain and Dysfunction: The Trigger Point Manual. Vol. 1. Baltimore: Williams and Wilkins.
Trigger Point Treatment
The good news is that nearly all muscles attributed to shoulder immobility can be treated with the Shoulder T•Shellz Wrap®. This is exactly what you need to start the process of eliminating your trigger points. I posted a quick summary of Benefits attributed to Electromagnetic Therapy on the front page of this website, but knowing how absolutely important it is when related to trigger point treatments, I'm posting it again below:
Benefits attributed to Electromagnetic Energy (the energy used in T•Shellz Wraps:
A Summary from Chapter 9 of "Therapeutic Heat and Cold", 4th edition.
(amazon.com link) Ed. Justus F. Lehmann, M.D., Williams, and Wilkin.
Generally it is accepted that heat on soft tissue (muscles, tendons, ligaments) provides the following desirable therapeutic effects:
- Electromagnetic heat increases the extensibility of collagen tissues
Tissues heated to 45 degrees Celsius and then stretched exhibit a nonelastic residual elongation of about 0.5 to 0.9 percent that persists after the stretch is removed. This does not occur in these same tissues when stretched at normal tissue temperatures. Therefore 20 stretching sessions can produce a 10 to 18 percentage increase in length of tissues heated and stretched.
Stretching of tissue in the presence of heat would be especially valuable in working with ligaments, joint capsules, tendons, fasciae, and synovium that have become scarred, thickened, or contracted. Such stretching at 45 degrees Celsius caused much less weakening in stretched tissues for a given elongation than a similar elongation produced at normal tissue temperatures.
Experiments cited clearly showed low-force stretching could produce significant residual elongation when heat is applied together with stretching or range-of-motion exercises. This is safer than stretching tissues at normal tissue temperatures.
- Electromagnetic heat decreases joint stiffness.
There was a 20 percent decrease in rheumatoid finger joint stiffness at 45 degrees Celsius (112 degrees Fahrenheit) as compared with 33 degrees Celsius (92 degrees Fahrenheit), which correlated perfectly to both subjective and objective observation of stiffness. Speculation has it that any stiffened joint and thickened connective tissues may respond in a similar fashion.
- Electromagnetic heat relieves muscle spasms.
Muscle spasms have long been observed to be reduced through the use of heat, be they secondary to underlying skeletal, joint, or neuropathological conditions. This result is possibly produced by the combined effect of heat on both primary and secondary afferent nerves from spindle cells and from its effects on Golgi tendon organs. The results produced demonstrated their peak effect within the therapeutic temperature range obtainable with electromagnetic heat.
- Electromagnetic heat treatment leads to pain relief.
Pain may be relieved via the reduction of attendant or secondary spasms. Pain is also at times related to ischemia (lack of blood supply) due to tension or spasm that can be improved by the hyperemia that heat-induced vasodilatation produces, thus breaking the feedback loop in which the ischemia leads to further spasm and then more pain.
Heat has been shown to reduce pain sensation by direct action on both free-nerve endings in tissues and on peripheral nerves. In one dental study, repeated heat applications led finally to abolishment of the whole nerve response responsible for pain arising from dental pulp.
Localized electromagnetic therapy using lamps tuned to the 2 to 25 micron waveband is used for the treatment and relief of pain by over 40 reputable Chinese medical institutes.
- Electromagnetic heat increases blood flow.
Heating muscles produces an increased blood flow level similar to that seen during exercise. Temperature elevation also produces an increased blood flow and dilation directly in capillaries, arterioles, and venules, probably through direct action on their smooth muscles. The release of bradykinin, released as a consequence of sweat-gland activity, also produces increased blood flow and vasodilatation.
- Electromagnetic heat assists in resolution of inflammatory infiltrates, edema, and exudates.
Increased peripheral circulation provides the transport needed to help evacuate edema, which can help inflammation, decrease pain, and help speed healing.
- Electromagnetic heat affects soft tissue injury.
Electromagnetic healing is now becoming a leading edge care for soft tissue injuries to promote both relief in chronic or intractable "permanent" cases, and accelerated healing in newer injuries.
Your massage therapist can certainly help with trigger point massage, but if you are treating your shoulder at home with the Shoulder T•Shellz Wrap® multiple times per day, you have a greatly improved chance of getting rid of your trigger points (and subsequently increase the range of motion in your shoulder).
A stretching routine can undoubtedly lead to a successful outcome for many patients. However, there are time that many people in pain simply cannot tolerate stretching. When pain levels are high and your muscles are too taut, stretching may actually aggravate your injury. In cases such as this, the smart way to go is to first minimize your pain using trigger point massage and Deep Tissue Therapy home treatments until you can reach a point where you start some moderate stretching without the pain. If you find the stretching aggravates the problem, stop stretching and just continue with the massage and Deep Tissue Therapy treatments.
Combined with a stretching routine you will find the Shoulder T•Shellz Wrap® to be highly for dealing with trigger points. Successful treatment of your trigger points will increase shoulder range of motion and reduce the likelihood of a worsening frozen shoulder injury.
Examples of Possible Causes of Trigger Point Pain
Tender trigger points typically develop from lack of stretching or improper stretching but can also be caused from stress/trauma, repetitive motion or even poor posture. Other common causes are:
- sitting without firm back support (slumped posture)
- prolonged sitting in a chair without armrests, or armrests that are too high, or too low (leaning to one side)
- cradling a phone between ear and shoulder
- large breasts
- one leg shorter than the other
- typing on a keyboard that is too high
- prolonged improper sleeping position
- playing a violin
- overly tight bra straps
- carrying a purse (prolonged hiking up of the shoulder)
- head-forward posture
- walking with a cane that is too long
Reduced circulation in trigger points will eventually lead to muscle shortening and restricted movement which further accentuates the pain, thus completing a cycle of decreased mobility and further pain. This commonly becomes the underlying cause of adhesive capsulitis, chronic shoulder immobility and even chronic headache pain. The patient will typically continue to suffer from these ailments for long periods until the problem trigger points are treated directly.
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