I have finally returned after 10 months of maternity leave! It feels odd being back and I’m sure many of you can relate to the feeling of really wanting to leave your child at nursery, and yet really not wanting to leave them at nursery! But here we are, slowly getting back into the swing of things.
For my blog I have decided to start a short series of therapeutic techniques that I regularly use. I hope you find them useful and that they give you a greater understanding of physiotherapy techniques.
So for today I have chosen to talk about Trigger point Release Therapy – I think I have shared a similar post on Facebook before, but I wanted to share my own musings. I think we have all experienced knots in our muscles at some point, but what are these, and how can we treat them?
Trigger point release is by far the treatment that I use the most, in both human and equine patients. Within human therapy there is a wide amount of controversy as to whether or not trigger points exist.
In one corner we have those that say they don’t exist as all, in the other corner we have full, thick text books mapping out the most common areas of trigger points and there referral zones (more about that later). The reason for this controversy is purely because we can’t see them and because whenever tested, even the most experienced therapists are unable to reliably locate a trigger point and agree where that trigger point is. . . .Personally I think this is because as soon as you palpate (touch) a trigger point you are already starting to treat it, have 10 therapists trying to find the same trigger point on the same person, of course it’s going to ease and become more difficult to find! So I’m of the opinion that, yes they do exist, and yes they do affect the effectiveness of a muscle, but no we can’t reliably study them. . .its just another grey area of therapy – one of the reasons I love Physio – unlike Biology (I got an E At A-level) - It is not an exact science!.
This brings us to my favourite subject . . .Biology – Yay! Unfortunately despite my misdoings at A-Level I did actually have to learn some. And in order to really understand what a trigger point is, you need to understand how a muscle works . . .So here goes. . ..
First some muscle anatomy – I feel this picture speaks for itself (Tortora + Derrickson 2006). We will be talking mostly about the myofilaments, where the muscle contraction starts within the sarcomere.
With help from Tortora + Derrickson (2006) Principles of anatomy and physiology 11th edition USA: Wiley + Sons, I give you the arrangement of the filaments. A muscle contraction occurs when the myosin head ‘walks’ along the filament from both ends towards the M line. The thin filaments slide inwards meeting in the centre of the sarcomere, shortening it. This in turn shortens the muscle fibre, which then shortens the entire muscle. . .Make sense??
In order for the muscle to relax the myosin heads must release. It is believed that
this is where trigger points develop. Instead of relaxing and letting go a few of the myosin head stay attached, thereby creating a small area of contacted muscle within a relaxed muscle. This results in the muscle becoming less effective (kind of like when you tie a knot in an elastic band, the knot remains and each side of it has to work harder to produce the same effect) Giving rise to localised pain and hyperirritable spots, often with referred pain as well!
So how do we treat this nasty little areas of contacted muscle? We use trigger point release of course! Also known as ischemic pressure. The idea is that if you press and hold for around 20 secs or more you may feel a localised muscle twitch and create an area of ischemia (reduce blood flow) on release of the pressure a surge of blood is released to the area, creating the right environment for the myosin head to release and relax. Simples.
However it doesn’t always work. . .particularly with the larger (equine) patient. In these circumstances, if the horse can tolerate it, I will use a technique called reflex inhibition, a muscle energy technique used to promote relaxation of the tissue.
Often mistaken for ‘putting it back into place’ this technique involves a short sharp knock to the area pain. The theory is that if you can elicit a reflex or contraction of the muscle, maximal relaxation follows. Thereby releasing areas of contraction within the muscle.
Most commonly I will use a combination of both the above as well as myofascial release and soft tissue massage before then using further techniques such as manual therapy, electrotherapy and exercise therapy. All of which will be discussed in subsequent blogs.
I hope that has shined some light on trigger points for you. Feel free to leave questions below. As always with my blogs they are mostly just brain farts – if you would like any actual references please let me know, I’m sure I can dig something out from somewhere.
Thanks for reading.