A Trigger Point Is Not Where Roy Rogers’ Horse Stands

I frequently mention trigger points in these ramblings, as in, who has them, and where they are located, and the treatment thereof, though always in passing, as if I assume everyone knows what a trigger point is.

Every good massage therapist knows this, of course, but I should say a few words about trigger points for everyone else, so I will.

You have them, and by you I mean anyone reading this. Trigger points are merely places in everyone’s musculature that get wrapped up too tightly from time to time, and grab hold of nerves and squeeze them so that the nerves think they are supposed to do something, so they clench any other muscles they might be attached to.

So then what happens is, you’ve got a whole bunch of muscles clenched for no good reason, which, even if it isn’t actually painful, makes a person feel unnecessarily tight and stressed.

All these trigger points are located in about the same places on everybody’s body. But the good news is that not all your trigger points are clenched at any given time, and in fact most of them are not clenched at all on most people, and then too, there are degrees of clenchiness.

For instance, if I push on a trigger point and the client whimpers, I can be pretty sure that that trigger point (and let’s call it a TPT from now on, like I do in my client notes) is wrapped up pretty tightly and will need some serious sorting out in order to let go, assuming the client can stand the discomfort.

Because the way I sort out a TPT is to mash the dickens out of it, with a thumb, finger, elbow, or possibly knee, though I have never had to go that far.

Mashing the TPT further stimulates already overstimulated nerves within the TPT, eventually to the point that the nerve is so overstimulated it literally cannot take anymore and gives up, releasing not only the muscle it innervates, but also the muscles that are innervated by nerves that THAT muscle was squeezing and causing to clench.

These other muscles that the TPT is making clench could be several inches or even farther away. If the TPT is squeezing the nerves that go to this distant muscle hard enough to cause discomfort, we call that ‘referred pain.’

Even if the client doesn’t feel the pain in that distant location in the normal course of things, very often he or she will feel it keenly when I squeeze the TPT. There is a TPT, a cluster of them in fact, right at the top of the shoulder, where the trapezius attaches, which, when pressured, the client will feel up the neck to the ear and scalp, or down the shoulder and arm to the fingers, or both.

In fact, most of the active TPTs I find are in the shoulders and upper back, and that is not surprising since that’s where all of us keep our tension.

Another really likely spot, especially for folks with low back pain and stiffness, is in the QL, the quadratus lumborum. This is the most posterior, that is, farthest back, abdominal muscle. In fact it’s so far back it’s right up against the very lowest bunch of muscles that border both sides of the spine.

And so quite often I find really strong, nasty TPTs underneath the lower spinal muscles, between the top of the sacrum and the lowest ribs. These TPTs really hurt when I have to mash them, and I usually warn the client that I’m going in after them.

But when I do get those suckers to let go, the whole back relaxes, bottom to top, sacrum to cranium.

Of course I do have clients who can’t take that kind of pain, or prefer not to, and for them I will coddle the nastier TPTs, stroke and caress rather than pin down and maul into submission. Usually I can get the TPT to let go somewhat if  I give it a lot of time and patience, but the release is never as complete as if I slammed it full force.

Still, if that’s what the client wants, that’s what I will do. 

Another place I find a lot of active TPTs is in the gluteal muscles, as in the gluteus maximus, gluteus medius, and so on. These are wide, strong, thick muscles at the center of the body. Everyone’s big bits pivot around the gluteals – both of the legs, as well as the whole torso, so of course this area is going to be stressed, even if you do nothing but sit down and stand up all day.

When the glutes are strained, tense, hypertonic, they feel tough and crinkly beneath the skin, like old leather that has got wet and then dried. If I feel that, I know there are active TPTs in the gluteal.  These are not hard to find because they feel like little clumps of weeds, or like half a small grape.

And fortunately, most gluteal TPTs are quick to release, though not always.

But when released, whether it’s one or two, or eight or nine (yes, unfortunately I have seen this) the TPTs let go of the entire rest of the muscle, and then the entire cheek, to use the vernacular, can rest easy. The difference in texture that I feel in the overall muscle tone, once the TPTs are silent, is quite literally that between stiff leather and silk.

Now most people don’t even know they have the stress they do, or at least to the extent they do. I often hear people say they had no idea they hurt so much until I touched them in those spots.

Which is quite all right. Because when it quits hurting, even if you didn’t realize it was hurting until it wasn’t anymore, it feels ever so much better.

Doesn’t it?

That is all.

Mark out.