TRIGGER POINTS & KNOTS [TENDER SPOTS]
The term trigger point or myofascial trigger point was first coined by the
America Physician Janet G. Travell.

Travell became the first female personal physician to an American President after helping to alleviate John F. Kennedy's back pain. She wrote many papers and books on the subject of trigger points which are still considered by many to be the most detailed and important writings on the subject to date.

Lots of research has been done on trigger points to figure out exactly what they are and why they are created but as yet we don't have definitive answers. 

The word myofascial means, muscle (myo) and fascia (fascial) and would suggest that trigger points are located within skeletal muscle although this still hasn't been proven. We often talk about our muscles feeling like they're all knotted up and this maybe where the idea that trigger points or tender spots are
located within the muscle originally sprang from.


 What is a trigger point?
Trigger points are tender spots which trigger pain and discomfort. We all
experience these pesky little tender or sore spots at sometime or other but for
a small number of people they are associated with a huge amount of persistant
pain and discomfort. We most commonly feel them in our shoulders and backs but
can actually experience trigger points or tender spots anywhere on the body.

Trigger points or tender spots are located within or below the skin and when
compressed they will usually become more tender or painful, they're also often
associated with areas of pain and discomfort adjacent to or distant from the
tender spot. These referred feelings can include a wide range of wonderfully
strange sensations from a heavy or dull aching to searing hot pain, pins and
needles or numbness to name a few.

The most popular theory on trigger points and the one put forward by Janet G.
Travell and David G. Simons in the book "Myofascial Pain and Dysfunction: The
Trigger Point Manual" is that trigger points are located within skeletal
muscle.

This theory proposes that there is a motor dysfunction within the muscle that
is characterised by a band of increased density called a taut band within the
belly of the muscle and a painful spot in the centre of the band.

Several different types of trigger point are described including Active,
Latent, Secondary and Satellite. An active point is one which is currently
triggering pain locally and in a referral area, a latent (or dormant) point is
only tender or painful when compressed and may or may not also cause discomfort
to a referral area. It is suggested that a trigger point will often cause
further trigger points in its referral area and associated muscle groups causing
a cascading effect of trigger point creation, these are known as satellite and
secondary trigger points.

It is said that trigger points can occur in multiple locations in any one
muscle, these locations can differ from person to person although rough guides
and patterns have been recorded resulting in charts of trigger point locations
and associated pain referral areas.

So what causes these trigger points in muscle? It's been put forward that
trigger points are created by muscular overload of one sort or another including
over-exertion, overuse, posture and trauma. Muscular tensions, structural issues
and nutritional deficiencies are said to predispose a muscle to these
overloads.

Although the theory that trigger points are located within muscle has been
around for over 70 years and is the primary explanation used for them it is by
no means the only theory.

Another theory that seeks to explain these tender spots we refer to as
trigger points is based on peripheral nerve pain and was first put forward in a
paper by John L. Quintner & Milton L. Cohen titled "Referred Pain of
Peripheral Nerve Origin: An Alternative to the 'Myofascial Pain' Construct".

This theory suggests that the functions of a nerve can be dramatically
altered with no apparent cause, meaning nerves throughout our body including our
skin may become inflamed and irritated without necessarily being compressed or
"trapped".

The pain ascribed to trigger points is often similar to that described in
cases of peripheral nerve trunk pain, including a deep aching with referred
areas of discomfort.

Charts and patterns used to show the locations of trigger points within
muscle and pain referral areas often match the sites and pathways of peripheral
nerve trunks and peripheral nerves has been shown to refer sensations to muscles
and other soft tissues innervated by that nerve or branch.

Treatment
Many different methods of treatment have been devised over the years to treat
tender spots and trigger points, these including: injecting the tender spot with
anything from botox to saline, a form of acupuncture called dry needling,
ischemic pressure which basically involves pressing the spot very hard for a
prolonged period and many other techniques which involve refinements of pressing
and stretching in different degrees.

 Treatment methods based on the central nervous system and neural tissue are
far gentler and less intrusive. When working with the nervous system it is
important to provide positive input to the system and this excludes anything
painful or uncomfortable which runs the risk of making the CNS feel threatened
and produce a guarding and protective response.
 
A good massage or manual therapist will give you advice on techniques you can
do yourself to help ease the tender spots or trigger points, often this will
include movement based exercises targeted at the area involved.

Trigger points and tender spots can cause a huge amount of pain and
discomfort, often restricting your movement and ability to do the activities you
want to. You don't have to put up with this pain though, with some action on
your part you can be pain free!