I remember in massage therapy school when my classmates and I were taught that trigger points do exist, if the myofascial instructor was teaching that day. Not so much if the kinesiology instructor was teaching that day though. Why is there such a polarizing opinion on trigger points in the massage therapy world? Some truly believe in the research, practical studies, and techniques that Dr. Janet Travell teaches. She defines a trigger point as "a hyperirritable locus within a taut band of skeletal muscle, located in the muscular tissue and/or its associated fascia." Manual therapists can palpate the muscle with adequate, focused, specific techniques to identify trigger points within that muscle. As the therapist palates, they locate the specific muscle that is shortened and then locate the specific band within the muscle that is taut. This is where the client may twitch, or jump, when the therapists uses ischemic compression, which means they compress the trigger point for 15 to 20 seconds, and then massage the surrounding bands of muscle tissue to reduce local constrictions and taut muscular bands. The client may feel immediate pain relief and may not have pain in a specific area for a long time after that. Sounds great, right? Some say not at all. Many therapists are fed up with the so-called "knot" or "trigger point." They would argue that there are many muscles that have tendinous attachments, or overlap one another, and may feel "knotty" to the touch, but they are just fine in reality. The infraspinatus muscle, for example, starts out with a fan shape, folds into tendon, and wraps around the back of the shoulder. This is a great example of how the feel of it may trigger you to think it is a knot. But it's not. Love a good pun! So what do I believe? I believe do whatever works for you and your client. As long as the therapist has educated palpation techniques and has understanding hands with informed touch, the client may experience great relief. On the other hand, it is important to not guesstimate pain origins or trigger points, go aggressively too deep and too hard, which would create a worse-off situation for your client, and for yourself because they will not rebook with you! I personally have the Trigger Point Therapy Workbook, by Davies and Davies, and have found great relief with use of the theracane as well, to pin point certain problem areas. On the other hand, I understand that the lack of hard science and studies may turn some therapists away from incorporating this technique into their practice. If it comes down to nomenclature, I say tomato-tamato, do what feels good. What say you?
