Are trigger points causing your chronic pain? If you know the answer, you could have a quick solution to pain problems

Many of us know and fear the debilitating effect of recurring, or chronic, pain on the body. It makes any everyday movement torturous, often resulting in long-term suffering. If you have chronic pain that won’t go away, you may have undiscovered trigger points. Never heard of them? That’s no surprise. After all, trigger points are the most commonly overlooked causes of pain in physiotherapy. That’s according to Marion Thurn, who’s both a physiotherapist based in Wolkersdorf near Vienna, and chair of the organisation Triggerpunkt Österreich (Trigger Point Austria).

She’s been specialised in the field of myofascial trigger point therapy for several years now. At her practice in Wolkersdorf, she works with trigger points on a daily basis: «We don’t get through a single day successfully without trigger point treatment,» she tells me during a Zoom conversation.

What are trigger points?

«Trigger points are sore spots in the soft tissue,» Marion Thurn explains. «Microscopically small knots form in the muscle which contract within the smallest unit of the muscle, causing issues there.» These small units of muscle are called sarcomeres. Located within the muscle fibres, they contract, forming points of tension which can be palpated during a therapy session. Because all of this goes on in the muscles, the official diagnosis is «myofascial» trigger points. «Myo» stands for muscle, while «fascial» refers to the fascia or connective tissue.

Points of tension in the muscle tissue trigger pain, which is where the immense difficulty in detecting trigger points arises. Namely, that the pain doesn’t appear in the same place as its source. «The classic characteristic of a trigger point is that it radiates, causing pain elsewhere,», says Thurn. Patients come to her practice complaining of headaches, while the trigger point is actually located somewhere else entirely.

Where are trigger points? And what causes them?

«Everybody has trigger points. However, some cause symptoms and others don’t,» Marion Thurn explains. Theoretically, they can be activated in any muscle throughout the body and become problematic. Where and whether it happens depends on the stresses the patient is exposed to. «The main thing that can set them off is day-to-day work,» explains the physiotherapist.

«Too much strain on one side of the body because of a habitual movement is the primary cause of trigger points.» She goes on to say that it doesn’t matter whether this is down to strain caused by an office job or competitive sport. As soon as the body moves either repetitively or not at all, people run the risk of activating trigger points.

Pain disconnected from its cause: how do you detect trigger points in your own body?

«You don’t,» the expert says. «That’s why quite a lot of patients end up receiving the wrong treatment for a long while.» In conventional medicine, symptoms are often addressed where they occur, whereas the causes remain untreated, she explains. Many patients have already gone through a lengthy ordeal by the time they come to Marion Thurn’s physiotherapy practice.

«Trigger point pain is radiating pain,» explains Thurn. It manifests as a diffuse pain across the entire arm or leg. She explains that because the pain and its cause occur in different parts of the body, misdiagnosis is common. People who come to see Frau Thurn at her practice often come in with complaints such as herniated disks, pulled muscles and pinched nerves.

Scientific scepticism: what’s the theory behind trigger point treatment?

Thurn explains that trigger points were discovered by purely empirical observations. Since then, however, many studies have provided theoretical proof of their effect. A comparative study by Dommerholt et al. (2011), for instance, captures the state of research at that time. The authors come to the following conclusion: «Current scientific evidence strongly suggests that myofascial trigger points in particular should be considered in the practice of manual therapy.»

But dissenting voices have been raised over the years too. In their study (2015), Quintner et al. cast doubt on whether the empirical observations of triggers points mentioned by Frau Thurn were scientifically sound: «When shown where a problem may exist, examiners may agree. […] those who claimed expertise in the field were unable to detect putative TrPs [triggerpoints].» In other words, simply palpating the body in order to prove the existence and treatment of trigger points isn’t scientific enough for the discourse.

A more recent paper published by Gesing et al. (2019) pointedly sums up the discourse around trigger points and their therapy. It states: «The studies chosen as examples show that selected therapeutic measures are promising. However, many aspects have not yet been studied or have been studied inadequately.»

Therapy: how are trigger points treated?

In her practice in Wolkersdorf, not a day goes by without treating trigger points. But what exactly does the physiotherapist do with patients experiencing diffuse pain? «Trigger point treatment is a muscle treatment, but it always involves fasciatherapy,» says Thurn. During treatment, the trigger points concerned are pinpointed and then massaged out in a sequence of four to six techniques. The key, she says, is to follow the order of these techniques. «Once I’ve found the point, I have to press down on it and then smooth out the entire muscle strand in a targeted way,» explains the physiotherapist. Afterwards, the upper and lower fascia are treated and the entire muscle strand is stretched.

It’s a given that the technique has to be carried out by someone who’s trained to do so. «Massage at home as part of aftercare is really important, but only if the patient has received instruction from an expert beforehand,» explains Thurn.

If trigger points are left untreated, a domino effect can occur: «With time, lots of problems arise on top of it. Untreated trigger points between the shoulder blades can cause a herniated disk, as well as chronic migraines,» explains Thurn.

Is treating trigger points at home dangerous?

You should definitely ask an expert for advice before working on your trigger points yourself. Thurn also explains that treating trigger points daily is an absolute no-no. Pain therapy puts the body under strain, which is why there should be a gap of at least two days between sessions. But can treating trigger points at home be dangerous?

«It’s certainly true that massaging or pressing trigger points incorrectly can aggravate the symptoms,» Thurn explains. She adds that the treatment is unsuited to neurological illnesses such as increased muscle tension after a stroke, or fresh haematomas and injuries. Since trigger point therapy can cause minor bleeding, Thurn advises people on blood thinners to refrain from undergoing the treatment.

«Trigger point therapy is a painful treatment,» she explains. Anyone who tries it needs to understand what it involves and capable of giving feedback to the therapist. For this reason, it’s unsuited to children or people with dementia. As long as those requirements are fulfilled, anyone can undergo the treatment. «If you’re aware the problem is being caused by a trigger point, there’s often a drastic improvement, even on the same day. If you’re unaware of that, you often end up with a very complex set of symptoms.»