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What is a Trigger Point

Focus of hyperirritability in a tissue that, when compressed, is locally tender and, if sufficiently hypersensitive, gives rise to referred pain and tenderness, and sometimes to referred autonomic phenomena and distortion or proprioception.

Tender area in muscle and its fascia

Can cause referred pain

Upon Palpation, feels like a taut band with a nodule

Techniques to treat : ice, Massage, Digital or Ischemic Compression, PNF, TPPR


Biopsied TrP

Large, Rounded, Darkly stained muscle fibers,

Statistically significant increase in diameter of muscle fibers.

coined "contraction knots"


Characteristics of Trigger points

Consistant referred pain pattern upon compression of TrP

Local Twitch response elicited by palpation.

Possible restricted ROM

Muscle weakness with no appreciable Atrophy

Possible autonimic phenomena including vasomotor and pilomotor responses.


Two Types of Trigger Points

Active - always tender, produce referred pain. associated muscle may be weak and present with decreased motion/flexibility. when palpated, present with a localized twitch response.

Latent - Painful only when palpated.


Potential TrP Causes

Acute Conditions - Fractures, Sprains, Dislocations, Muscle impact injuries

Stress from excessive or unusual exercise

Articular dysfunction

Overload on the muscle from prolonged stationary posture or prolonged muscle immobilization in a shortened position

Nerve compressions.



Viscious Cycle

Muscle contraction ----> local blood vessels to be compressed which decreases oxygen supply

Decreased Oxygen + Metabolic demands = depletion on ATP

Depletion of ATP = increase in ACh and a decrease in Ca+ reuptake

= Continued muscle contraction.


Trigger Point Pressure Release

gentle digital pressure; aim to reduce ischemic effect to the injures tissue.

One finger palpating the TrP whilel the muscle is passively lengthened to the point of tissue resistance.

At tissue resistance, pressure on the TrP is slowly increased.


Digital compression

should be applied to one point for a prolonged period (10-45 secs) and pressure released with the resolution of pain,

effleruge/petrissage top warm tissues

Digital compression

Effleurage / petrissage