Bluegrass Doctors of
Physical Therapy, PLLC

Concierge Manual Physical Therapy and Interventional Dry Needling Experts

About Trigger Points and Dry Needling Therapy

Myofascial Trigger Point Therapy, refers to the treatment of myofascial trigger points (MTrP) or simply put 'trigger points' (TrP) found in muscles and fascia. Myofascial trigger points are painful, tense areas found in muscles. Myofascial trigger points can be found anywhere on the body and are one of the most common causes for chronic musculoskeletal pain also known as myofascial pain. There are mainly two methods for treating trigger points, Manual Therapy and Dry Needling.

Definition of Myofascial Trigger Points

Clinically, myofascial trigger points are identified easily as painful areas in a muscle. These microscopic changes occur in muscle fibers causing them to contract and chronically shorten. One of the most common causes for this is usually overloading or incorrect loading of the muscle. One of the theories suggests that oxygen and nutrients supply to the trigger point is constatntly compromised, leading to a sustained contraction, unable to resolve itself.

The "Energy Crisis Theory" for Myofascial Trigger Points: Injury to the sarcoplasmatic reticulum leads to an unregulated release of calcium ions within the muscle fibers. As a consequence these constantly contract and compress small blood vessels within them, and compromise circulation and oxygen supply to the muscle fibers. The lack of oxygen and the increasing metabolic demand of the muscle cell is referred to as the energy crisis. This can lead to a local inflammation and pain as well as to further contraction of the muscle fibers and form myofascial trigger points.

In detail: Microlesions in the muscle fiber (muscle cell) organ named the sarcoplasmatic reticulum occur, triggered for example by muscular overload, such as by an injury/trauma or overuse. The sarcoplasmatic reticulum is a membrane system within the muscle fiber. One of the functions of the sarcoplasmatic reticulum is to transport and store calcium ions. Any lesion in the sarcoplasmatic reticulum system may lead to excessive release of calcium ions and thus sustained contractions of muscle fibers since calcium triggers muscle fiber contraction. Multiple contractions of this kind at a specific region in the muscle may form a taut band, easily palpable by trained practitioners. This sustained muscle contractions can then lead to poor circulation in that area due to blood vessels being compressed, preventing adequate oxygen supply to the muscle not allowing it to heal properly. If this condition becomes chronic, the muscle may further contract and become painful. This is referred to as "Energy Crisis Theory".

Pain and Myofascial Trigger Points

As mentioned above, myofascial trigger points are a major cause of chronic musculoskeletal pain, however their significant role in pain management hasn't been identified for a long time. This could be due to the fact that trigger points itself may not be painful other than to direct pressure, but refer pain elsewhere to adjacent or remote areas. The origin of the pain and the area where it manifests can be different, for example low back pain may be related to trigger points in the abdominal muscles, or headaches can be related to trigger point in neck muscles. The referred pain is a characteristic feature of myofascial trigger points and forms the basis for its name "Trigger Point" as it relates to one area triggering pain elsewhere.

Diagnostic Criteria of Myofascial Trigger Points

Four diagnostic criteria for myofascial trigger points have been proposed in the literature and through clinical practice. The closer the criteria are to four, the more acurate the diagnose of a MTrP. 

These criteria include:

• a taut band (muscle fiber bundle) in the muscle

• a pressure-sensitive area within the taut band

• referred pain from a trigger point

• a local twitch response of the trigger point or taut band in response to mechanical      

   stimulation of the trigger point

These diagnostic criteria have been shown to have a high interrater reliability in trained practitioners. 

The goals of myofascial trigger point therapy:

• improve blood circulation to the trigger zone

• streching of the taut band

• release of surrounding fascia

There are several ways to treat trigger points. Manual Trigger Point Therapy, Dry Needling and the combination of these two techniques, have been shown to be highly effective. These include specific manipulation of the muscles, fascia and connective tissues. Dry Needling includes the use of sterile disposable monofilament needles to eliminate the trigger point and improve circulation and blood flow to the affected muscle trigger point areas  to promote healing and reduce pain. The more accurate the treatment is on the affected trigger point, the better the results.