fascial = the thin three-dimensional sheath of connective tissue meshed within muscles as well as surrounding muscles, bones and organs
When injured or stressed, muscles commonly form a trigger point or a palpable ‘knot’ area in a muscle that upon squeezing or compressing emits pain and tightness. The region of muscle where the trigger point is formed is in spasm (contracted), thereby shortening muscle fibers which in turn produce taut muscle fiber bands (the knot) and hypersensitivity.
This describes a myofascial trigger point and how it’s problematic can be summed up in 3 steps:
The “knot” in the muscle restricts the blood supply and consequently reduces the amount of oxygen and healthy nutrients to the area of muscle.
This leads to the accumulation of metabolic waste products and toxins which sensitize the knot area creating a ‘trigger point’ on the muscle tissue or ‘myofascial’.
Now hypersensitive, the knot area or myofascial trigger point sends out pain signals throughout the body further increasing local and/or referred symptoms. The myofascial trigger point has the ability to send out or transfer what is called referred pain. Referred pain describes how a myofascial trigger point in one muscle can transfer pain to other areas of the body.
At the end of the day the physiology of the palpable small knot area or myofascial trigger point evolves into a vicious cycle of repeating pain, creating weakness, and limiting range of motion – all onto the muscle and requiring disruption (treatment) to eliminate the symptoms all stemming from the knot or trigger point. Myofascial Trigger Point Therapy is the hands-on manual approach that can effectively intervene and disrupt this cycle.
What is Myofascial Trigger Point Therapy?
Myofascial trigger points or muscle knots, are tight regions in muscles typically caused by overuse, inflammation, trauma, nerve issues, of the muscle and can emit pain over the affected region as well as transfer pain to other parts of the body, called referral pain.
Myofascial trigger point therapy has many application methods and modalities designed to reduce the pain caused by the muscle knots by applying targeted pressure, manipulation, stretching and then release on the region of muscle experiencing pain. It should be noted that the targeted region may be different from the region where the patient actually reports the pain.
As a specialist in body systems, my expertise is in identifying trigger points and tracking their referral patterns or patterns of pain that consistently repeat when pressure is applied to a specific trigger point in a muscle. Below are diagrams of referred pain patterns of different specific ailments. Tracking referral patterns is how I identify muscle groups requiring treatment to alleviate pain. So in sum, Myofascial Trigger Point Therapy is a technique that treats tense, damaged, knotted, or immobile muscles and resolves musculoskeletal pain and other ailments.
How Does Myofascial Trigger Point Therapy Work?
Once I have gathered all relevant information and the trigger points have been identified, I can structure a treatment plan that includes the appropriate and best suited techniques to loosen the knots, including sports massage, craniosacral therapy, deep tissue massage, myofascial release, vibrational tuning forks, chiropractic care or others therapies. The precise treatment or coupling of treatments is customized and tailored to the individual, their pain points, pain patterns, and other unique underlying circumstances.
Nonetheless generally speaking treatment comes down to applying targeted effective touch therapies with the chosen hands-on therapy to direct blood and lymph flow to the affected areas, which in turn increases the oxygen and healthy nutrient levels in the muscles to relieve the pain and return the full range of motion.
More precisely, only gentle techniques are used to apply pressure onto the trigger point in the muscle. I typically initially target the knots or trigger points reproducing your symptoms as a form of specific diagnosis. Then the therapeutic modality is applied to the area on the trigger point until I detect a change in the tissue underneath the trigger point. At this juncture patients generally notice a change in the pain sensation in the region which is a sign that the treatment is working.
For example if someone is experiencing headaches, either tension or migraine, I’ll assess the range of motion and check the tightness of their upper head area, neck, upper back, and shoulders and then hone in on the trapezius muscle region (shown in the image above) for any knots or trigger points. Why? Well research has shown that active myofascial trigger points in the muscles of the shoulder, neck, and face are a common origin of headaches.
In fact this case study shows how an upper trapezius (shoulder muscle) spasm build-up of scar tissue can result in a knot or trigger point of tension in the shoulder that can transfer or ‘refer pain’ to the neck, on through to the lateral head and settling at the front of the head. That referral pain pattern of a trapezius trigger point is illustrated below.
What originates as a knot in the shoulder muscle can transform into a trigger point able to transfer pain from the shoulder to ultimately manifest as either a tension and or migraine headache.
In this example with the trigger point and pain referral pattern identified, treatment can start with massaging to help ease the trapezius (shoulder) muscle pain and loosen the knot, by applying sports massage, craniosacral therapy, deep tissue massage, myofascial release, chiropractic care or others techniques.
Myofascial Trigger Point Therapy Coupled with Craniosacral Therapy
I often achieve faster and greater results in eliminating myofascial trigger point pain and any referred pain by coupling myofascial trigger point therapy with craniosacral therapy. In the previous example involving the shoulder and headaches, note the trapezius muscle raises, lowers, and rotates the shoulder blades, as well as helps with neck extension and side bending.
Because of the trapezius muscle’s attachments to the spine, neck and thorax, the shoulder blades, and the collar bone, tension in the trapezius often leads to neck pain or tightness, and contributes to pain in the shoulders or head.
The neck contains many structures, such nerves, the vertebrae, the larynx (voice box), blood and lymph vessels, the trachea, the thyroid, the upper portion of the esophagus, and more. These structures are separated from each other, and enveloped, by the connective tissue (fascia), which permits a certain amount of glide of these structures relative to each other when moving the neck, swallowing, or taking a deep breath.
When there is trauma to the tissue like a knot or trigger point in muscle, the fascia will sort of “shrink wrap” around these structures as a protective measure to prevent further injury. Inflammation, infection, or dehydration on the other hand, change the consistent viscosity of the connective tissue, making it more sticky and less flexible or resilient. This distorts the fascia which then creates a sort of stranglehold on the neck’s structures reducing the amount of smooth glide between the various muscles and other structures. This has an overall “gluing” effect on the muscles, restricting their range of motion, depriving them of their independent movement culminating in neck pain. In the below diagram you can see the trapezius muscle spans from the back to the shoulders through the neck and to the back of the skull and myofascial trigger points can manifest anywhere along this span of muscle.
In order for these neck structures to return to their full health, function, and independent movement, the tension and restriction in the fascia needs to be released – best accomplished with craniosacral therapy. Hence in this example craniosacral therapy acts as a ‘force multiplier’ in ensuring the successful outcome of trigger point therapy. The takeaway here is Myofascial Trigger Point Therapy in combination with Craniosacral Therapy delivers a comprehensive “one-two punch” resulting in a quick, powerful, and lasting effect in eliminating all pain.
It should be noted there can be trigger points in muscles that refer to pain but deviate from normal trigger point referral patterns. There isresearchtheorizing why this is but it’s insufficient to be conclusive in understanding the mechanisms behind trigger point referral patterns.
What are the Benefits of Myofascial Trigger Point Therapy?
Myofascial trigger point therapy quickly eliminates pain, increases range of motion, improves blood circulation, and retrains muscles to operate efficiently to reduce chances of reinjury going forward. The benefits to your health and wellbeing include:
Improves tissue recovery & reduces soreness
Improves neuromuscular efficiency
Increases blood flow
Maintains normal functional muscular length
Improves joint range of motion
Reduce overall effects of stress on the body
Boost your immune system by encouraging movement of your lymph
Restores ideal-length-tension relationships for movement exercises
It’s important to be mindful that myofascial trigger points create congestion or metabolic traffic jams preventing oxygen and helpful nutrients from reaching their destination. Myofascial trigger point therapy releases the traffic jam, opens up the “highway” of oxygen and nutrients enabling muscle cells to receive all the nutrition that they need to thrive and perform all their daily tasks. Myofascial trigger point therapy can effectively treat a wide range of ailments and conditions such as the following:
Neck, shoulder and knee pain
Lower back pain
Sports and dance-related injuries
Carpal tunnel syndrome
Jaw Pain / (TMJ) disorders
Stress and fatigue
Rotator cuff (shoulder) pain
Carpal tunnel syndrome
Hand and arm pain
Repetitive Strain Injuries
“Sciatic” pain (buttock and leg pain)
Leg and knee pain
Plantar fasciitis (foot) pain
Disc pain (bulge/rupture/herniation) and radiculopathy
and MUCH more
In closing, myofascial trigger points are a major cause of chronic musculoskeletal pain and since they could be a sign of a bigger problem – require immediate attention. Fortunately myofascial trigger points can be treated in several ways but if not addressed in a timely manner, they generate additional trigger points and severe muscle damage limiting range of motion and increasing stiffness, injuries, and trauma.
If you would like a more comprehensive conversation on precisely what you’re experiencing and are interested in learning more about myofascial trigger-point therapy to relieve musculoskeletal pain or any ailment – reach me for an in-office consultation.
Having a Chiropractic background since the year 2000, Dr. Kaminsky offers many methods of treatment with an emphasis on Craniosacral Therapy in NYC.
Craniosacral Therapy (CST) is a method focusing on the link between the cranium (head) and sacrum (the second to last bone at the base of your spine), scientifically proven to work in unison to pump fluid throughout the body, an unknown disruption of which can cause many health issues. The craniosacral mechanism pumps vital fluid called cerebro-spinal fluid (CSF) through the body and in a sense energetically lubricates the joints, tissues, organs, basically all cells of the body. It is the driving force of all your body’s systems of function, including maintaining the tone of your muscles.
The Central Nervous System (brain and spinal cord) are surrounded with CSF generating energetic rhythmic impulses of fluid delicately pumping throughout your body’s parts “breathing” the movement of life. This measurable rhythm of moving fluid, like the heart rhythm, pulse rhythm, breathing rhythm is the foundational “blueprint” and primary principle of our real-time state of our health.
Compromises of our rhythmic movements of fluid flow correlates to the impulse restrictions in the system which the body is unable to overcome or self-correct. This is the reason why we have “dis-ease”, symptoms, conditions, basically all ailments. This is where the skill of an experienced craniosacral therapist becomes valuable. By placing his or her hands on your body the practitioner can feel, detect, evaluate, and facilitate correction of these restrictive arrhythmic impulses.
The craniosacral therapist helps your rhythm restore and renew in compromised areas allowing for healing to take place of sensory, motor, musculoskeletal, neurological disorders, symptoms, conditions and pain. To learn more, visit the other pages on this website. Call to schedule your healing treatment with Dr. Kaminsky.