Trigger Points are frequently discussed in chiropractic practices. As you know, there are three types of trigger pain: active, latent and satellite. Active: actively causing pain. Latent: not actively causing pain until the spot is palpated. Then pain is felt. Satellite: these are in the areas of Active and Latent trigger points. They may not be the primary issue. However, when addressing Active and Latent trigger points they make themselves known.
Of course, the SITE of the pain is not necessarily the SOURCE of the pain. Pain is often referred when we apply pressure to a trigger point. Travell and Simons have useful tools for identifying trigger points.
What happens when you press on a trigger point?
- Lessen the pain feedback pathways
- Interrupt the pattern of pain and spasm
- Stretch out tight muscles or knots
- Stimulate blood supply
What are trigger point treatments? Popular treatments include stretching, exercise, acupressure, acupuncture, injections, dry needling, massage, ultrasound, electric stimulation, light therapy and laser therapy.
Lasers treat myofascial trigger points while releasing a cascade of healing mechanisms. The laser floods the damaged, inflamed tissue with photons. They energize the cells, promote increased blood flow as well as production of pain reduction chemicals such as endorphins and enkephalins from the brain and adrenal gland.
Lasers operate on a photochemical, not a photothermal effect. Hence, no damage to tissues from the heat by-product of a continuous wave laser. Ultimately, the mitochondria produce ATP.
The cascade of healing effects is key to reducing longer term joint restrictions and chronic myofascial pain syndromes.
The laser can treat off or on the skin based upon the guidelines from the laser manufacturer. If the patient is being actively treated in a hands on manner, then the laser handpiece can perform double duty by combining techniques.
The handpiece is pressed into the trigger point to apply pressure in addition to releasing billions of photons of light energy into the area.
Moving the handpiece across the impacted area is similar to deep stroking massage. Meanwhile, holding the handpiece in one place is similar to inhibition compression technique.
As a bonus, lasers are safe to use over implants. The wavelengths of the therapeutic laser do not get absorbed by the implants and, therefore, would not cause heat buildup.
Plantar Fasciitis: Having worked with many healthcare providers it is the author’s experience that palpating both the affected and unaffected leg often reveals trigger point pain. It is recommended to start at the popliteal and the heads of the gastrocnemius and move down the calf to the ankle. In the non-affected leg, resolve the trigger point pain before beginning to treat the affected leg. The result will be the patient standing more uniformly without the strain on the plantar fascia.
Iliopsoas: The iliacus and psoas major are generally grouped together as the “iliopsoas” when referring to the function of either individual muscle. Typical pressure release techniques are not always effective on the psoas major since it is located deep in the abdominal cavity. However, utilizing the laser handpiece as a pressure tool helps to reach the targeted area. Tissue and blood are moved away from the area through the pressure of the laser handpiece. The trigger point is more easily accessed and the healing photons of light can now reach more deeply into the abdomen.
Other Key Ingredients
After treating the patient, it is advisable to discuss lifestyle changes to help prevent future injuries. For example, Epicondylitis, whether presenting as Tennis Elbow or Golfer’s Elbow, can be prevented or at least mitigated by spreading the load to the shoulder and upper arms, warming up muscles and gently stretching before playing, and avoiding overgripping while playing sports.
Nutrition also pays a role in healing. Searching PubMed you will find various studies have shown that low amounts of folic acid, iron, vitamin and mineral deficiency slow recovery. Supplements in conjunction with the suggestions presented in this article may speed recovery.
In conclusion, trigger points present in your patient population each and every day. Expand your range of tools and techniques to resolve trigger points and their associated pain pathways.
Rob Berman is a partner at Berman Partners, LCC, a medical device sales, service, and marketing company. He helps healthcare providers improve patient outcomes while increasing provider income. He has held a variety of sales and marketing during his career, which include building and managing a marketing department, directing product development and product management for multiple organizations, and serving as a general manager for a variety of business units. He can be contacted at 860-707-4220 or [email protected], or through bermanpartners.com.