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Trigger Points & Treatment by Osteopaths

Trigger points are a controversial facet of pain science with ties to conditions like fibromyalgia, and concepts like referred pain.


Basics of Trigger Points

At the most basic level, a trigger point is a "muscle knot". Muscles are made of fibres, and only some of them contract when there is a knot. The knot itself is often tender, but pressing into it might elicit a "good pain" as it begins to encourage those muscle fibres to relax. Beyond this description, unanimous definitions are hard to find. When you have a handful of these knots, and they're particularly symptomatic, you might consider it Myofascial Pain Syndrome. But even this isn't particularly descriptive, just referring to a collection of painful symptoms that involve muscle and connective tissue.

If a muscle problem is simple, and not persistently irritated by something else, we expect it to resolve on its own within a couple of months. But trigger points can stick around for much longer, with single episodes lasting as long as a few months. After an episode passes, it may return for no apparent reason. Your osteopath will work with you to see if there are any other potential causes, such as a joint problem that repeatedly overloads the muscle, causing discomfort.

Identifying a Trigger Point

Paul Ingraham of has created a checklist for identification (abridged):

  • You have sore spots, sensitive to pressure, primarily in muscles.

  • Your pain is primarily dull, aching, and nagging.

  • Your pain feels more like it’s in muscles than joints, and seems deep.

  • Affected limbs may feel a little weak, heavy, and stiff.

  • Your pain mainly occurs in a specific area with a fairly clear epicentre.

  • There is no clear mechanism of injury, but flare-ups often occur in response to extremes of position, exercise, or temperature.

  • Your pain is mostly episodic, but episodes can last for weeks or months.

  • Your pain may move around a bit, even to the other side of your body.

  • You crave hot baths or showers and massage, but they usually provide only temporary relief.

  • You usually feel better with activity and exercise.

  • Your pain is not strongly or sharply linked to movement.

Referral Patterns

Trigger points get much more interesting from an osteopath's view when they refer pain elsewhere. We've spoken beforeabout how joints and organs follow a fairly predictable pattern of pain that may be nowhere near the stimulus itself. The illustration above shows where muscles in the neck and cheek might refer their pain. These examples are particularly interesting, as they show that perceived tooth pain or headaches could be coming from a muscle.

We associate pins and needles, numbness, and shooting pain with other conditions, like nerve radiculopathy (such as sciatica).

Osteopathy for Trigger Points

Your osteopath will work to identify the root of your pain, whether it is a simple trigger point, something else, or a combination of the two. Sometimes these knots are easy to manage once they are found, and your pain may reduce quickly with treatment and exercises- but this does vary from person to person.


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