How Trigger Points Work

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A critical evaluation of the trigger point phenomenon

Quintner, J.L., Bove, G.M. and Cohen, M.L., 2015. A critical evaluation of the trigger point phenomenon. Rheumatology, 54(3), pp.392-399.

In today’s letter

• Overview of the how trigger points (may) work

• A fun infographic for you to save and use in the future

• Rapid Results =

The study points out that while treatments like dry needling and manual therapy can be helpful for trigger points, the evidence behind them isn’t very strong, mainly because of small sample sizes and varying research methods.

It also stresses the importance of considering bigger factors, like stress and poor posture, that can lead to trigger points, and suggests taking a more well-rounded approach to treatment.

• 3 Reads to check out to further you knowledge about trigger points

• Meme of the week: Being an educator is fun! 😄 

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Aim of the study

In the most simples of explanation the aim of the study is to look into the underlying mechanisms of trigger points

Trigger points - The overview

A trigger point refers to a tight, tender spot in a muscle or fascia that, when pressed, can cause pain, sometimes radiating to other areas of the body.

These "knotty" spots are typically linked to myofascial pain syndrome, a condition where pain spreads from one muscle group to others, often far from the origin.

While trigger points are often thought of as localised muscle issues, they may involve more complex factors beneath the surface, such as:

1. Muscle dysfunction

2. Nerve sensitivity

3. Biochemical changes,

Potentially affecting even areas that don't seem painful.

From a biochemical perspective, trigger points are associated with higher levels of inflammatory markers.

The chemical changes can impact not only the muscles where the “trigger points” are located but also nearby areas that may not seem affected.

This means that the discomfort may be part of a broader systemic issue, not just a localised muscle problem. Chronic stress, poor sleep, and systemic conditions like diabetes and rheumatoid arthritis might also contribute to the development of trigger points.

If they are linked to wider systemic imbalances, then just treating the muscle it self will only mask the discomfort for the time being.

Treating trigger points isn't straightforward.

Techniques like dry needling & manual pressure are commonly used, but research on their effectiveness is still mixed. (But it doesn’t mean that they shouldn’t be used)

Additionally, trigger points are often just one part of a larger picture.

Poor posture, “improper” movement patterns, and psychological stress can also contribute to pain.

Instead of focusing solely on the “muscle knot”, it's important to assess the whole person—looking at posture, movement, and overall health.

Incorporating education & specific exercises can help the effectiveness of treatment.

What causes the trigger points?

Now, the hypothesis is not fully proven, but this is the proposed mechanism:

1. Certain areas of muscle experience abnormal, sustained contractions.

2. This occurs because the neuromuscular junction, where the nerve meets the muscle, releases too much acetylcholine (a neurotransmitter that causes the muscle fibers to contract).

3. These contractions cut off blood flow to the muscle, leading to ischemia, which means the muscle isn’t getting the oxygen and nutrients it needs to function properly.

4. Without enough oxygen, the muscle starts to build up waste products, causing pain and a feeling of tightness, which is where the taut band comes from.

5. On top of that, inflammatory markers like substance P and certain cytokines are released, making the area even more sensitive and amplifying the pain signals

Clinical Tip

When using passive treatments (like manual therapy or dry needling) to address trigger points, always follow up with activity modification and stability exercises.

Passive treatments can provide immediate pain relief and help release muscle tension, but to ensure long-term improvement, it's essential to integrate exercises that focus on stabilising the joint.

Top 3 Resources to Check Out

And learn more about trigger points

1. Myofacial trigger points - Presentation (PDF) - LINK

2. Working on pain around the shoulder blades (Blog) - LINK

3. Trigger point explenation

Meme of The Week

When You’re Ready to Learn More

We have great resources for you to devourer

1. Killer Articles —> Literally everything you need to know about a specific injury

2. Tendinopathy 4 phase rehab frame work - My book that walks you through a step by step process of treating tendons

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