Taming Your Trigger Points

Trigger points—those tight little knots in the skeletal muscles of your body—can trick you. They often hurt and don’t go away in a few days or a week, even after you apply the usual home remedies, such as pain relievers, ice, gentle stretching or yoga, an Epsom salt bath, and a period of rest. It’s common for the pain or stiffness to migrate to a nearby location in your body a few days later. Some trigger points are large enough to feel when you rub them and painful enough to make your normal range of motion difficult or impossible. Even the smallest trigger points deep in the muscle tissue, identifiable only by tightness or tenderness, can cause problems. If left untreated, trigger points can range from minor annoyances to major pain and restrictions in your range of motion. Nobody likes them, but most athletes have to deal with trigger points sooner or later.

According to Donna Finando, author of Trigger Point Self-Care Manual for Pain-Free Movement, two common causes of trigger points are overuse, such as making repetitive motions, and overload, such as lifting something too heavy. Most athletes perform actions like these all the time and many develop painful trigger points. Home remedies provide temporary relief but seldom smooth out the knots permanently. Your next step may be to get help for these pesky problems.

Professional treatment for trigger points includes massage, chiropractic care, acupuncture, injections, and other types of bodywork. All of these treatments will usually release the knot and make the muscle relatively smooth again, but they take time, money, and patience. Wouldn’t it be great if there were a way for you to release your own knots as soon as you notice them? It would be even greater if you could prevent most trigger points from developing in the first place. Can you really take preemptive action to keep your muscles smooth, elastic, and pain free?

You can probably learn to tame most of your current trigger points and then prevent others from occurring or at least from causing big trouble. However, you have to be willing to cause yourself some discomfort or even pain for the first week or two, and you have to work on the trigger points consistently, preferably every day. It’s a little like flossing your teeth. When you first start flossing, or resume after several days off, that sharp little strand of floss can hurt and may cause your gums to bleed. But soon you’re back to where your dentist wants you to be: reducing inflammation and improving overall wellbeing. Not many people love flossing, but they do it if they want optimal health. Not many people love working on their trigger points, but some do it as their only therapy. Others do it in between professional treatments.

Doing trigger point self-therapy takes a little bit of equipment and some knowledge. You can choose among several excellent toolkits, many of which include instructional DVDs. Good kits are available from Austin’s own Trigger Point Performance Therapy (tptherapy.com) or, at a discount, at Amazon.com. Many local running stores and bicycle shops also carry the starter kits. If $70.00 to $220 seems too steep, especially if you don’t know whether you’ll like working on your own trigger points, you can watch any number of trigger point videos on YouTube. Then spend $25 to $40 at a store like Academy, Target, or Wal-Mart for a dimpled (no-seam) softball, a couple of tennis balls for gentle work or lacrosse balls for harder work, and a foam roller. Before you dig in, keep some overall principles in mind:

1. Breathe deeply.

Even if you’re in pain, keep on breathing. Richly oxygenated blood does a better job of removing toxins from tight, restricted muscles.

2. Make sure you are well hydrated.

Water helps lubricate the muscles.

3. Do your best to relax your entire body

 especially the muscle containing the knot. Find a warm (or at least not cold) room to work in and keep on breathing. Use music if it will help you stay relaxed.

4. Be gentle at first.

Apply compression with a ball or roller directly to the tender spot. Lean against a wall or sit on the floor to put enough pressure on the trigger point. If the pain feels too harsh, back off and try a gentler technique.

5. For most trigger point work, it’s usually a good idea to alternate between still pressure and pressure in motion.

For example: Place a ball on the floor and practice sitting on it between the bony areas, first on one side and then on the other. Sit still for several seconds. Then move side to side and back and forth for several seconds.

When you’re ready to get to work, you may find that your piriformis or one of your gluteus muscles is tight or tender, as it is for most runners. You could use a soft racquetball for a few days; when the pain lessens, move to a larger, slightly harder tennis ball. Then use a hard lacrosse ball for a while. It’s possible that later on you could even use a big, hard softball or a hard roller as a preventive tool, though never as the first attack on a painful trigger point that is already inflamed.

There are advanced techniques that move beyond the measures discussed above. It would be very painful to subject a highly tender trigger point to an advanced amount of pressure. Imagine that you have discovered a painful trigger point under your arm. You can modify techniques by keeping your hips on the floor while you move the underarm area only half an inch or so. Another way to modify and soften the advanced technique is to lean your left side against a wall, using your right hand to hold a tennis ball between your trigger point and the wall. Lean against the ball very gently at first and apply more pressure when you can. You can also move side to side as well as up and down so that you compress the entire area. Later on, you might be able to use a lacrosse ball or softball to release knots in this highly sensitive underarm area.

After you have experimented for a few weeks with inexpensive equipment and YouTube videos, you’ll be in a better position to decide whether you should make time in your day and room in your budget for the Trigger Point Performance Therapy kit and DVDs, and maybe even take the eight-hour course in myofascial compression techniques, which is offered about once a year in Austin. A kit removes all guesswork because it shows specific protocols for a dozen trigger points, and the course ensures that you know exactly what you’re doing for your body. When you have mastered the basics, you may want to experiment on the hundreds of additional trigger points that may show up in your body from time to time. You may not be able to regain the supple, fluid feeling of childhood, but there’s no reason to live with pain and restricted movement. Taming your trigger points can help you keep doing the sports you love.

Many highly detailed videos are available on YouTube; for a simple introduction, see this short example of sitting and rolling on a ball.
To watch an advanced technique with a foam roller on the latissimus dorsii, see this short, silent video.