2 Trigger Points

8/3/2019 2 Trigger Points

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Trigger Points



What is a muscle? Physiology of a muscle cell. A muscle cell is composed

of Myosin and Actin filaments between Connective tissue

As a muscle contracts the myosin pulls the actin together.The connective tissue is called fascia and joins muscle

cells into myofibrils -> fibers -> muscle tissue [Biceps]



What do muscles do? Muscles move bones

Muscles produce heat

Muscles protect from trauma



What affects muscle tone?

Environmental Stress (Daily Living!)

Physical Trauma, Repetitive motion

Chemical Toxins, Nutritional Deficits

Emotional Stress, Not adapting to change



What is a trigger point?

According to Janet Travell there are two kinds Active and Latent

An active Myofascial Trigger Point is a focus of hyperirritability in a

muscle or its fascia that causes pain and tenderness at rest or with

motion that stretches or loads the muscle. It prevents full lengthening

of the muscle, as well as causing fatigue and decreased strength.

Pressure on an active MTrP induces / reproduces some of the patient's

pain complaint and is recognized by the patient as being some or all of

his or her pain (POP is abbreviation for Pain On Pressure)

A latent Myofascial Trigger Point: does not cause pain during

normal activities. It is locally tender, but causes pain only when

palpated. It also refers pain on pressure. It can be associated with a

weakened, shortened, more easily fatigued muscle.



What do they do?

Palpates as a firm nodule in taught mm fibers

Reduces muscle strength and function

Injury cycle: Trauma -> mm spasm -> restricted

blood flow & inflammation-> reduced strength ->

compensation by other mm -> mm relaxes to

return blood flow, but keeps small area contracted

reducing function



3 Kinds of trigger points

Janet Travell(Myofacial TP)

Lawrence Jones(Strain/CS TP)

Fascial Restriction

(Dehydration of ground substance TP)

POP Better with stretch

& deep breathing

POP Worse with stretch

POP Better with stretch



How do you find Trigger Points?

Postural Analysis

History of injury

Palpation



Postural Analysis

Muscles in balance

Muscles out of balance

Normal

Tone

all even

Tight

Loose Injured

Massage concentrates on loosening

tight muscles instead of restoring

balance, This class will give you the

tools to do both!



Body Rules for Postural Analysis

The body will turn away from pain

The body is three dimensional

Top-Down, In-Out, Front-Back

Look where the body is guarding

to see which muscles are too tight

and which are too loose

The loose muscles are the root of

the problem!



Balancing Muscles

Examples of looking at the body in 3D

Prime mover AntagonistTop-Down Upper

trapezius

Latisimus

Dorsi

In-Out Hip Adductors TensorFascia Lata

Front-Back Abdominals Gluteus

Maximus



History of Injury

The trigger points will often be the result of

traumatic shearing injury (Strain/Sprain), or

repetitive microtrauma (vibration, work).These will be later addressed individually

If there is a history of compaction injury

(fell and caught self on arms, jumped fromheight) fascial flush of all muscles around

all joints of limb should be done



Changes in muscle with injury

The Nervous system

Neuromuscular Spindle Cell

Golgi Tendon Organs

Origin/Insertion attachment to theperiosteum

Fascial sheath dehydration



The Nervous system

Activates the myosin

at the ‘motor point’ or

myoneural junction Once activated, the

contraction spreads

out across muscle cells

Receives control from

the cerebellum (sets

the volume)



Compensation Chain Injury

When you injure one muscle the body

adapts by using other muscles close

to the injured one to support and take

over the work of the injured muscle

These other muscles don’t have the

same bone attachments so they are

not as efficient and become strained

and injured also

Pretty soon your body starts to run

out of muscles that don’t hurt. The

pattern is down -> up, out -> in

Foot -> Ankle -> Knee -> Hip ->Back



Fixing Compensation Chains

Find trigger point

Push to awareness of tension/pain

Maintain same pressure (do not increase)

Breath deeply (feel tension/pain decrease)

If pain radiates up compensation chain startabove then follow down and out



The Neuromuscular Spindle Cell

Facilitates contraction

of prime mover &

synergistic muscles Inhibits antagonistic

muscles

Facilitates muscles

needed for support of

movement

(fixators)



Injury of Spindle Cell Separation

Workout Soreness

Actin filaments

pulled too far

Inflammation

shortens distance

and allows

reattachment

OW



Fixing Spindle Cells (Strain/CS)

Find trigger point in muscle belly, deep

breathing won’t release much

Push on trigger point to approximate fibers

Bring O/I closer until pain eases, support

limb passively

Breath in and hold (front, inner, upper)

Breath out and hold (back, outer, lower)

Ease O/I out passively and very slowly



The Golgi Tendon Organ

Located at junction of

muscle & tendon

Inhibits prime moverand synergistic muscle

Facilitates antagonist

Measure tension in

muscle during

contraction ( Like in

arm wrestling)



Injury of the Golgi Tendon Organ

Muscle tension can increase beyond the

physiological limit of the tendon causing

microtears. When this occurs the GTO inhibits the prime

mover and facilitates the antagonist to prevent

muscle tissue from tearing free of the tendon.

It’s similar to spindle cell injury, but in this case

the bone stayed in place and the muscle pulled

away from the tendon (arm wrestling)



Fixing GTO Separation

Trigger point will be at the musculotendonous

junction. The trigger point won’t respond well to

deep breath Contact 1-2 inches proximal to the O/I and push

towards muscle belly with both contacts

Breathing is the same as spindle cell, return

muscle slowly to normal position



Injury of the Origin/Insertion

The tendon can pull away from the

periosteum anchoring it to the bone

Its like pulling apart 2 pieces of velcro, this

leaves less stability when the muscle works

The body senses the loss of stability and

reduces the amount of strength the muscle

can exert correspondingly



Fixing the Origin/Insertion injury

Locate Origin and Insertion of muscle

Feel along O/I for small tender nodules,

(areas where tendon has pulled away)

Apply firm pressure over nodules pressing

tendon back onto bone (good luck)

Deep breathing will reduce pain

Continue until nodule dissipates



Connective tissue supporting all body cells

Composed of Type II collagen fibers and

Ground substance: GAG, Proteoglycans,

Glycoproteins and intracellular fluid

What is Fascia?

GAG’s

H2OCollagen Fibers



Changes with injury to fascia

Restricted Collagen fibers due to H bonds from H2O

bridging across GAG’s during prolonged contraction (net

dehydration)

Muscle cannot return to normal length because fascia has

up to 2000 lbs tensile strength. Heavy duty shrink wrap!



Treatment Flow

Posture analysis (Think 3D!)

Trigger points -Prime mover & Synergists

Fascial Flush -Antagonists

Compensation Chains

Fascial Stretch -Return to normal length(Local/Systemic)

Documents

2 Trigger Points