What is the science behind Trigger Point deep muscle massage? Does it work? How many sessions does it take before you feel relief?

The answer to this question will include current, state-of-the-art research, as well as my and my colleagues’ clinical experience over several decades. I will address each of the three questions in sequence.

 

1) What is the science behind trigger point deep muscle massage?

There are several theories for the etiology/pathophysiology of trigger points and myofascial pain syndrome. Research continues on each, as none have yet been decisively proven.[1][2] Massage therapy (MT) has been studied extensively, and has been shown to produce objective effects most notably in those bodily systems which interact locally with the myofascial (muscle and connective tissue) systems.[3] These include the local circulatory systems, local and central nervous systems, and the lymphatic system within the immediate vicinity of the area worked on. It should be noted that the fascial structures, which encapsulate the contractile structures and tissues, exert mechanical forces upon the other associated structures, thus affecting their physiological function. MT (specifically ischemic compression and friction massage) has been shown to be effective in releasing myofascial trigger points.[5] MT also has minimal side effects, no drug interactions, is low cost, and often includes positive patient-practitioner relations (which lead to a positive and productive mentality during therapeutic treatment and rehabilitation).

 

2)  It does work. But how?

MT that successfully releases trigger points includes ischemic compression and friction massage. Ischemic compression involves holding pressure steadily on a trigger point until it softens/releases. Friction massage involves sliding the finger/hand/etc. along a (usually) venous direction of a muscle. This creates a vacuum/suction effect upon the circulation which quickly introduces freshened circulatory fluids to the area, and moves inflammatory chemicals present back into general circulation.[6] The freshened circulatory fluids include blood and lymph, which carry pain-relieving endorphins, as well as energy constituents for metabolic recovery for both the myofascial tissue and the neuromuscular junctions. Inflammatory chemicals removed include substance P, prostaglandins, bradykinin, etc.[7]

Dry Needling & Manual Trigger Point Therapy Courses and Training )

(image: Dry Needling & Manual Trigger Point Therapy Courses and Training)

If you’d like to see some of this for yourself, try this: locate the blue (venous) lines on the underside of your wrist. Press, then rub, slowly along the blue line toward the elbow. The blue line will go clear for a moment, then the blue, or venous, blood will return in a second or two. You have just performed friction massage to the veins which will drain blood and lymph from the tissues it serves. These tissues may contain nociceptive (pain inducing) and/or inflammatory biochemicals. If you flush the tissue of venous blood/lymph, creating a “quick-refresh” of arterial blood, the tissue will be flushed of painful biochemicals, while receiving pain-relieving biochemicals. This is the function of ischemic compression and friction massage for painful areas, including tissue with active trigger points.

3) How many sessions does it take before you feel relief?

If you have been properly diagnosed with MPS, and your practitioner is well-trained and experienced, you should feel immediate relief. Ischemic compression and/or friction massage releases a trigger point (and the attendant pain and tension) within a minute or two. If trigger points are extremely active, it may take several passes over an area to treat it completely.

There is a clinical understanding in our profession: the complex part of therapy is not releasing the patient’s pain (if you know what you are doing), but rather keeping them out of pain.

If your therapist is good, you will feel better, at least significantly, for a while. The task for you then is to:

  1. learn to do effective self-care to release the trigger points,
  2. stretch/strengthen the tissue, and
  3. track when the pain recurs, so that your practitioner can superimpose the timeline of recurrence with functional tasks, to possibly trace those tasks that need to be modified or eliminated (which will remove the trigger point’s perpetuating factor).

When these have been accomplished, you should be solidly on the road to recovery. Progress often follows a “two steps forward, one step back” pattern, as perpetuating factors are gradually eliminated and the tissue rehabilitates successfully. How long that will take depends on many factors: your age, general health, metabolic factors, stress levels, fitness, ergonomic factors, daily functional tasks, diet, sleep, emotional state, etc. Your doctor and therapist should help you to minimize the impact of triggers, and also to bolster those areas of overall healthy living that need help. If symptoms don’t improve noticeably within several weeks, you should seek other opinions and help.

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[1] “Etiology of Myofascial Trigger Points,” article on the National Center for Biotechnology Information, U.S. National Library of Medicine website.

 

[2] “Uncovering the biochemical milieu of myofascial trigger points using in vivo microdialysis: an application of muscle pain concepts to myofascial pain syndrome,” article on the Science Direct website.

 

[3] “Physiological and clinical changes after therapeutic massage of the neck and shoulders,” Article on the Science Direct website.

 

[4] “The Effects of Pressure Release, Phonophoresis of Hydrocortisone, and Ultrasound on Upper Trapezius Latent Myofascial Trigger Point,” article on the Science Direct website.

 

[5] “The muscular force transmission system: Role of the intramuscular connective tissue,” article on the Science Direct website.

 

[6] Myofascial Pain and Dysfunction: the Trigger Point Manual, pg. 86.

 

[7] “Changes in Blood Flow and Cellular Metabolism at a Myofascial Trigger Point With Trigger Point Release (Ischemic Compression): A Proof-of-Principle Pilot Study,” article on the Science Direct website.

 

What kind of doctor should I see if I have myofascial pain syndrome?

What kind of doctor should I see if I have myofascial pain syndrome?

This answer is based on my 25 years of teaming up with Bay Area physicians to help patients with myofascial pain syndrome.

To see the most effective and well-educated physician for myofascial pain syndrome, you should see a physiatrist, especially one specializing in pain management. Some other options include:

  • Physicians who specialize in occupational injury, as they seem to have greater training and understanding of myofascial pain syndrome, and
  • An increasing number of neurologists and orthopedists who specialize in pain management.

The first step to finding the right medical professional will be to do your own research on your condition, and thereby make sure that you actually have symptoms that fit the profile of MPS. While an official diagnosis will need to be done by a physician, your self-education will (or should) be welcomed by the physician, as it will save them time.

Next, you will want to do a cursory search on Google and Yelp to determine which physicians state a specialty in MPS. There may be many, as physicians seem to be racing to learn proper protocol for MPS treatment right now. The primary physiatrist I knew at Stanford Pain Management Clinic spends about 65% of his time traveling to educate physiatrists in MPS. Once you’ve decided a doctor might be right for you, you can always call their office, and ask the staff if they treat myofascial pain syndrome. You can even ask how they do it; or you can ask the physician at the appointment.

If they reply, “We inject cortisone into the sore/tender area,” they are probably not well-trained, as this doesn’t address the taut band and trigger point.

As part of a team with the well-trained physician, my job is to get rid of as much of the active/latent trigger points as possible. If there’s something I can’t address (too deep, too active, etc.), they inject it, because IT WORKS. However, they also realize that you can’t do more than 4 or 5 at a go, because they are painful.

The internet and the phone are your friends. Don’t be afraid to use them in order to find the best doctor to help you. Good luck!

 

What should I do to relieve a nerve pain above my fingers?

Finger pain

My answer here is based on the following question: (paraphrased) “I work on a computer keyboard quite a lot. When doing so for a long time, I get pain in the circled area (above). If I take a rest of around 2 days, the pain goes away. However, I have to work at the keyboard, and taking breaks of that length is not an option. Are there any exercises, medicines or foods that can help me with this?”


First of all, you MUST get a physical exam from a physician to receive the best advice. Another thing to address is whether or not you might be holding your hand in slight extension/elevation above your keyboard when you type, like this:

Conventional keyboard trays can increase injury risks

This position puts undue strain on the Extensor Carpi Radialis Brevis muscle (which extends the hand at the wrist), and can produce a pain pattern as follows:

The extensor carpi radialis brevis muscle

You might examine your keyboard and hand positions during typing and bring them both back to neutral (straight).

Another thing you might try involves the following steps:

  1. Heat the forearm (particularly the muscles, around where the “x” is above),

  2. Compress the muscle knot (trigger point) around the x until it feels dissolved,

  3. Then massage and lightly stretch the muscle, like this:

Massaging the arm

(image: Page on Easyvigor)

Be sure not to stretch so hard that it produces pain; this could further irritate the muscle and tendon.