Trigger point in the muscles. Massage of trigger points

Probably, many people found small painful areas of muscular densities in themselves or their relatives on the body. Most consider them to be a salt deposit, official medicine they are known as trigger points. These areas of local compaction and hypersensitivity in the muscle tissue causes pain in various parts of the body, often located at a considerable distance from them.

The theory of J. Trevel and D. Simmons

Such a concept as a trigger point was introduced by American doctors J. Trevel and D. Simons in the seventies of the last century. Thanks to their research, certain points have been described, affecting which it is possible to relieve the pain in areas of the body sufficiently remote from them. For example, the impact on a painful point that is in the neck or shoulder area, allows you to remove headache or pain in the area of the elbow joint or hand. Also, acting on the trigger zones (this is another name for these points), one can influence the condition of the musculoskeletal system and internal organs.

What is the trigger point

According to the definition of Trevel and Simons, these points are hyperexcitable areas with local muscle tension. They are located in the skeletal muscles and fascia associated with them. Trigger points appear as small, painful palpation of the compaction. They can form in all soft tissues of the body, but are usually localized in large skeletal muscles that perform static functions. So, most often you can find trigger points in the muscles of the shoulder girdle and neck (muscle lifting the scapula, trapezius, ladder, neck rotators), chewing muscles, as well as in the muscles of the pelvis and lower extremities. In addition, such points are the source of reflected pain. For example, a trigger point in the upper part of the trapezius muscle can provoke pain in the tail area, jaw and temple. Also the danger of these formations is that even if at the moment they do not cause severe pain, then eventually the muscle dysfunction will inevitably progress where they are located.

Causes

Despite the research conducted, today there is no unambiguous answer to what factors are the direct causes of the origin of trigger points. Typically, myofascial trigger points are formed in the muscles that experience overexertion or prolonged and persistent stress. Most often this is due to the position of the body in space - raised shoulders, hunched back and lowered, overly tense thorax, strong deflection in the waist. This inevitably causes a pronounced mechanical strain both in the individual muscles and in the muscle groups, which leads to their spasm and, consequently, to a violation of the circulation. Also trigger point can be formed due to spinal lesions (with blockage of the motor segment) or with pathology of the internal organ, when the surrounding muscles reflexively strain. Another reason for the appearance of such points may be acute or repetitive microtraumas of the muscle.

However, as indicated by the research data, all these factors lead to the formation of latent trigger points. In order for them to pass into the active phase, and a clinically outlined myofascial syndrome appeared, a start-up factor is necessary. Often, this role is played by hypothermia, work in an uncomfortable position, a psycho-emotional factor.

Risk group

To the group of risk of the origin of trigger points and myoskeletal pains, it is possible to include people who, by the nature of their work, are forced to maintain a static, most often uncomfortable pose, for a long time. These can include drivers of vehicles, office workers, hairdressers, surgeons, etc. Also, the risk of the formation of trigger points has a person with impaired motor functions and any disabilities of gait and posture. This is due to the chronic overstrain of various muscle groups.

Types of trigger points

There are two types. The most common latent trigger points are spasms of muscle, which are found only on palpation. A large number of latent points can be found in the elderly. The trigger point can also be active. It is characterized by acute pain, which is aggravated by stretching the spasmodic area. There are such manifestations less often. As a rule, they can be observed in middle-aged people (in women they are found 2.5 times more often than men). Under the influence of provoking factors latent points can pass into the active phase, but adequate therapy can return the active point to a latent state. Both active and latent trigger points can become a source of restriction of movements, spasm, weakness and deformation of affected muscle groups.

Phases of the disease

To date, it is common to distinguish three stages of the development of the disease.

1. Acute phase. Characterized by persistent severe pain in areas where the active trigger points are located and in the area of reflected pain.
2. Subacute phase. At this stage, the pain syndrome occurs during movement and physical exertion, but is not at rest.
3. The chronic phase. At the examination, only latent points are detected, while there is a slight discomfort and dysfunction in the area of the seals found.

Symptoms

Symptomatology with myofascial starting points can be very diverse, and not limited only to pain syndrome. Muscular dysfunction may be manifested by rigidity, muscle weakness, swelling, dizziness, gait irregularities, posture. The trigger point itself is defined as a painful compaction, a weight ranging in size from a few millimeters to a centimeter. Pressing on it provokes a sharp pain, which has the greatest intensity in the place of maximum resistance during palpation (the hardest part).

The active trigger point is not only painful, but it can also cause reflected (irradiating) pains in areas quite far from it, forming a painful pattern - a characteristic scheme of pain localization. Thanks to many years of research, map-charts were made, thanks to which it is possible to determine the true source of reflected pain.

The reflected pains caused by trigger points are most often felt as permanent, deep, lomiting and dull, but in some cases they can be very intense, burning, stabbing. Due to the fact that the spasmy muscle region can squeeze the nerve end that passes through it, the reflected pain can be accompanied by a decrease in sensitivity and numbness. The intensity of pain can also vary from minor to intense, and it can be observed both at rest and during physical exertion. It should be noted that the prevalence and intensity of pain depends on the degree of irritation of the trigger point, and not on the size of the muscle where it is located. Some trigger points can cause such phenomena as inflammation of the mucous membranes, lacrimation, visual disturbances, perception of space, vestibular disorders.

Examination and diagnosis

For effective treatment of this pathology, it is important to correctly identify the cause of pain in the patient and determine the exact location of the trigger point. For this the doctor should not only reveal the area where the pain syndrome manifests, but also compare it with the characteristic zones of reflected pain. To do this, most often use maps, which are available in almost all books devoted to this topic.

During the palpation examination, the specialist determines the overall elasticity of the muscles in comparison with the area where the presence of a trigger point is suspected. In this case, the fingers first run across the muscle fiber, noting deformation, spasmodic areas and muscle bands. When the seal is found, passing a finger along it, find the area of maximum compaction, pressing on which causes maximum pain. The fact that this will be the trigger point will indicate the following signs:

• Pressure on the point causes reflected pain, and it may not appear immediately, but within ten seconds;
• Directly with pressure on the point, you can observe a "convulsive response" - the muscle twitches at hand and often it is noticeable even visually;
• Another sign of the trigger point is the so-called patient's jump, in which, in response to the pressure, the patient tries to pull away sharply or scream;
• With increasing pressure time to the point, all zones of the pain pattern are perceived by the patient as a single whole.

Trigger points - treatment

To date, medicine uses several methods of treating trigger points, while drugs are not at all leading in them. It is proved that NSAIDs and analgesics are only able to relieve pain syndrome, and muscle relaxants have the same effect due to partial elimination of spasm.

The most effective and cardinal method for treating trigger points is blockade. Their conduct is possible only when determining the exact localization of pathology. To perform the blockade, pierce the needle with the needle of the compaction site followed by the injection of an anesthetic.

Massage and exercise therapy

Despite the fact that the blockade gives an almost instantaneous effect, the most common methods of treating this pathology are exercise therapy, manual techniques and massage of trigger points. And if the complex of therapeutic gymnastics patient after consultation with a doctor can perform on his own, then the massage should be conducted only by a qualified specialist.

If we talk about massage, then the most effective help with trigger points can be provided with the help of step-by-step compression. To do this, the masseur, after finding the point, begins a gentle pressure on her, continuing it until the patient has a slight soreness in the reflected area, which corresponds to 2 on a ten-point scale. This pressing is retained for 10-15 seconds. During this time, the pain should significantly decrease or completely disappear. After that, pressing again reinforces, and after the appearance of discomfort again hold for 15 seconds. These actions continue until the moment when the characteristic pain disappears. Usually for this there are enough 3 pressures. After this inactivation of the trigger point, a warm moist compress is applied for 5 minutes, followed by a passive stretching of the muscle.

Despite the apparent simplicity of the procedure, you should not self-medicate. Conduct all the examinations and medical manipulations must be a qualified specialist, otherwise there is a very high risk that the situation will not only not be corrected, but also significantly worsen.