Written by: Liz Paton, MSc

Understanding Trigger Points

Trigger points are regions of pain felt in local, or often separate, areas from the palpable site. You may recognise a trigger point as a tight “knot” beneath your skin. They develop in taut bands of muscles, ligaments or fascia. Trigger points typically occur from repetitive activities, injury, or psychological stress. They are also often accompanied by chronic musculoskeletal disorders.

Causes of Trigger Points

Several factors can cause trigger points including repetitive or strenuous activities, sleeping habits, poor health and injury. Lack of sleep, generalised fatigue, or sleep position can cause trigger points. An example of this would be if you were to wake up with a sore neck from sleeping in an awkward position. Poor health including joint problems, obesity, nutritional deficiencies and poor mental health, such as chronic stress, anxiety, depression, can also cause trigger points. Sedentary behaviour such as sitting at a computer for several hours per day, general lack of activity, and obesity are large contributors. Active people are also susceptible to trigger points through muscle overuse with activities like weightlifting. Finally, a common cause of trigger points includes trauma from injuries.  

Trigger Point Symptoms

There are a number of signs and symptoms associated with trigger points. They may cause tension headaches, tinnitus (a ringing in the ear or ears), joint pain and lower back pain. A common manifestation of a trigger point is a hypersensitive “knot” (a hard node of muscle fibres). Pressing on these nodes either cause pain on the site or cause referred pain, weakness or muscle spasms.  

Active trigger points can cause pain when at rest and cause referred pain when palpated. For example, if you were to press on an active trigger point on the dorsal hand, the pain will radiate up to the posterior elbow.    

Latent (inactive) trigger points are very tender areas of local pain. They may cause muscle weakness or decreased range of motion. An example of this would be if you press on the shoulder (deltoid) and feel significant pain directly on the palpated site.  

Treatment and Management

Trigger points can be treated with the application of heat and ice, stretch and spray technique, massage and acupuncture and injections.  

The application of ice is beneficial for reducing inflammation, particularly if a trigger point flares up directly after an aggravating activity. Applying heat is best for low-grade, achy, persistent pain caused by trigger symptoms as it helps loosen tight muscles. Stretch and spray involves applying vapour coolant spray to the troubled area after gently stretching the affected muscle.    

Acupuncture involves finding the most painful node of muscle and applying a needle to cause muscle contraction which can potentially release the node. Massage works in a similar fashion, where a therapist will press on the painful node to try to relieve the tension in the muscle.  

Trigger point injections can provide quick relief. The corticosteroid injection is given directly in the trigger point site and can provide relief for days to months, depending on the severity of the trigger point.