Elusive Foe: Understanding the Genesis of Trigger Points Can Point the Way Toward Relief


Most people don’t have a clear idea of what trigger points are, much less what causes them or how to address them. You might, however, be more familiar with the common term for this condition: muscle knots.

In fact, the vast majority of adults experience aches and pains associated with these “knots” and are all too familiar with the ways in which they can impact movement, activity, and life in general. While the average person may not necessarily need to know the ins and outs of trigger points and myofascial pain, one would expect that therapists treating such conditions would have an in-depth understanding of these phenomena.

Unfortunately, the actual formation of trigger points is not well understood by many who treat it, including massage therapists, physical therapists, chiropractors, and in some cases, even those who specialize in trigger point therapy. With ongoing education and experience, trigger points can be better understood.

However, if you’re interested in learning why trigger points are so prevalent and getting to the root of what causes them, you have a much better opportunity to serve a patient population suffering from trigger point and myofascial pain. Here are a few things you should know about the genesis of myofascial trigger points so that you can better treat them.

What are Myofascial Trigger Points?

The sensitive spots in muscles that most people call knots are not actual knots, although they can sometimes feel that way when compared to the normal smooth lines of muscle. First you need to know that the fascia is a type of dense tissues that surrounds all muscles (as well as other tissues and even bones).

When the fascia is impacted in some way (by trauma, for example), it can become tight, tense, and inflexible in spots. This is the most basic way to understand how trigger points develop. However, a deeper understanding is necessary if you want to learn how to properly treat and relieve the pain of trigger points.

Muscle Injuries

It is believed that there are two main ways in which trigger points develop, and these theories revolve around muscle injuries and the integrated hypothesis. The first is much more widely understood, perhaps because muscle injuries are relatively easy to understand.

When muscles are over-stretched, over-shortened, or simply overloaded, damage to the muscle fibers can result, in the form of tears and other trauma. When this occurs, the fascia may naturally be exposed to trauma, as well.

This, in turn, could cause a sustained muscle contraction, resulting in the formation of a trigger point of tense fascial at the site. The integrated hypothesis is more difficult to understand, but due to scientific study, it has become the leading theory concerning trigger point genesis.

The Integrated Hypothesis

This theory is related to synapses that transmit and receive data throughout the body, and specifically neuromuscular function. If synapses are exposed to certain stimuli, such as thermal, chemical, or electrical stimuli, they may not function correctly.

For example, increases or decreases in neurotransmitters could occur. This, in turn, could cause hyperexcitability of muscles, by which spontaneous muscular activity occurs.

In addition, resulting muscle tightness could restrict blood flow to the area, depriving muscles and myofascial tissue of oxygen and nutrients needed for healing, thus further impacting the problem in the area. This is thought to be the genesis of the trigger point, which will likely get worse without treatment, leading to increasing pain symptoms and perhaps limiting mobility and activity in the process.

Treatment Options

In order to reverse myofascial trigger points, targeted therapies are required. These could include various forms of myofascial release, including trigger point massage or dry needling, just for example.

What can be learned from understanding the different theories of trigger point genesis, however, is how and why certain treatments work, as well as the goals inherent to related therapeutic practices. For example, knowing that trigger points tend to restrict blood flow to the area, perpetuating pain and tightness, could prompt therapists to include the goal of increasing blood circulation to the area in order to flood the trigger point with oxygen and nutrients needed for healing.

It’s also important to understand that precise and accurate diagnosis and treatment are essential to targeting and eliminating trigger points and the pain and other issues they cause. By understanding more precisely what causes trigger points, effective and efficient treatment can occur.