1

Introduction What are trigger points Trigger Point Microgram Trigger Point Explanation Shoulder Trigger Points Gluteus Minimus Trigger Points and Sciatica Conclusion

This book is written for you. Its divided into sections, each covering a different aspect of trigger points, and what you can do about them.

Trigger Point Manual

Written by Dr Jonathan Kuttner MBBCh, Dip O&G, FRNZCGP, Dip Sports Med, Dip MSM, FAFMM.

Whats in this Manual?

What trigger points are Basic cause of trigger points What symptoms trigger points have Where trigger points are found How to recognize trigger point pain

Life After Pain

2
Introduction What are trigger points Trigger Point Microgram Trigger Point Explanation Shoulder Trigger Points Gluteus Minimus Trigger Points and Sciatica Conclusion

What are Trigger Points?

Trigger points are an incredibly common cause of chronic muscle pain. They are so common that most people will have painful trigger points at some stage of their life. These often last only for a short time. However they can commonly appear as recurrent episodes of pain in the same part of the body. Occasionally they can cause severe, unremitting pain which is as severe as other causes like cancer or nerve pain and may be destructive to any quality in life for that person. The full medical description is myofascial trigger points. Myo means arising from skeletal muscle and Fascial- is the brous layer over muscle. This is a strong shiny layer of tissue that acts like glue to hold muscles together and coordinate their actions. This layer is richly invested with nerves which explain the complex patterns of pain that occur.

Most people have painful trigger points at some stage of their life
There is a long history of myofascial trigger points. They were originally described by ancient Greek texts and were noted throughout the Middle Ages. However they masqueraded under many names. These include brositis nodule, myelogenosis, non-rheumatic arthritis etc. They were nally codied by Janet Travell in the 1970s. She was a remarkable woman who was the personal physician to President John F Kennedy and was one of the main people who helped

Life After Pain

him recover from injuries in the Korean war. She created the name of myofascial trigger points and with David Symons, mapped out the many myofascial trigger points over the body. A myofascial trigger point is dened as a hyperirritable locus within a tight band of skeletal muscle. What does this mean? Introduction What are trigger points Trigger Point Microgram Trigger Point Explanation Shoulder Trigger Points Gluteus Minimus Trigger Points and Sciatica Conclusion

As you can see, in the picture above there is a small knot of muscle labeled CTrP- this is the myofascial trigger point. When you have a trigger point, your muscle is in spasm, it is irritable and tender. It pulls a thin band of taut muscle which runs the length of the muscle bre. This feels like a guitar string within the bulk of your muscle.

Life After Pain

3
Introduction What are trigger points Trigger Point Microgram Trigger Point Explanation Shoulder Trigger Points Gluteus Minimus Trigger Points and Sciatica Conclusion This picture above is a photomicrograph of a myofascial trigger point within skeletal muscle. In the lower half you can see parallel bands of so-called I-bands & A-bands. They are evenly spread. In the upper half there is a central elliptical area where the bands are squeezed incredibly tightly together. This is the myofascial trigger point. The band of bres on either side of this are stretched further apart than normal.

Life After Pain

Introduction What are trigger points Trigger Point Microgram Trigger Point Explanation Shoulder Trigger Points Gluteus Minimus Trigger Points and Sciatica Conclusion This diagram on the right shows that each of these small areas of spasm is called a contraction knot. Actually a number of these are present in each myofascial trigger point.

Life After Pain

4
Introduction What are trigger points Trigger Point Microgram Trigger Point Explanation Shoulder Trigger Points Gluteus Minimus Trigger Points and Sciatica Conclusion

The basis of myofascial trigger points is shown in this picture. The key structure is the muscle spindle bre. This is a nerve arranged in a spiral, looking and behaving like a spring. It is found in parallel with your muscle bres. When it is stretched, it res. Therefore if the muscle bre reaches beyond a critical length, the spindle will re. The message then goes up your nerve to the spinal cord and zooms straight back to the muscle bre causing it to contract. This is a simple reex arc and the message usually does not go higher. Therefore the spindle sets the length of your muscle. There are millions of these throughout the body and they are there to allow the complex movements and postures that your body performs without conscious thought. When your spindle is sensitised, then it will not allow the muscle bre to lengthen at all and will cause the localised knot of spasm which is the myofascial trigger point.

Life After Pain

Myofascial trigger points usually occur at or near the motor end plate. This is the point where the nerve enters your muscle as shown in the picture above.

Introduction What are trigger points Trigger Point Microgram Trigger Point Explanation Shoulder Trigger Points Gluteus Minimus Trigger Points and Sciatica Conclusion

Life After Pain

Introduction What are trigger points Trigger Point Microgram Trigger Point Explanation Shoulder Trigger Points Gluteus Minimus Trigger Points and Sciatica Conclusion

This is the motor end plate enlarged. Messages from the nerve are transferred to the muscle by neurotransmitters. This means that this part of the muscle is particularly active and therefore more vulnerable to abnormal spindle bre activity.

Life After Pain

Introduction What are trigger points Trigger Point Microgram Trigger Point Explanation Shoulder Trigger Points Gluteus Minimus Trigger Points and Sciatica Conclusion This is a special stain showing where the motor end plates enter the muscle and therefore where myofascial trigger points are found.

Life After Pain

5
Introduction What are trigger points Trigger Point Microgram Trigger Point Explanation Shoulder Trigger Points Gluteus Minimus Trigger Points and Sciatica Conclusion

Trigger points act like the trigger of a gun affecting a remote target. When it is activated, it sets off a pain pattern which is specic to that trigger point. There are hundreds scattered around the body and each has its own pattern.

This is a trapezius muscle myofascial trigger point and the red area is the specic pain distribution pattern. Once you have learned the patterns, then nding the triggers becomes much more easy.

Life After Pain

6
Introduction What are trigger points Trigger Point Microgram Trigger Point Explanation Shoulder Trigger Points Gluteus Minimus Trigger Points and Sciatica Conclusion Here is another common pain pattern from a gluteus minimus myofascial trigger point. Note how the pattern looks like sciaticawhich usually is caused by irritation of a nerve by a prolapsed disc. However in this case the actual myofascial trigger point causes the pain pattern. A MRI would show a normal disc and treatment of the trigger point would stop the pain.

The quality of the pain is usually deep, dull and aching. However occasionally it may be sharp. The severity can vary from very mild to incapacitating pain.

Life After Pain

7
Introduction What are trigger points Trigger Point Microgram Trigger Point Explanation Shoulder Trigger Points Gluteus Minimus Trigger Points and Sciatica Conclusion For more information and videos on back and muscle pain, go to Dr Jonathan Kuttner. MBBCh, Dip O&G, FRNZCGP, Dip Sports Med, Dip MSM, FAFMM. Myofascial trigger points can be active or latent. If it is latent, then it is sitting there like an accident waiting to happen. In this state, the person will either feel nothing, or can feel stiffness. Stiffness is not a symptom tenderness underestimate. It is one of the main symptoms of growing old and often accompanies a contraction in your life. So treating this effectively can literally break the chains around you. In a later e-book I will explain how to examine for myofascial trigger points and how to treat them.

www.LifeAfterPain.com

Life After Pain

DISCLAIMER The information contained in this manual is based on sources and information reasonably believed to be accurate as of the time it was recorded or created. However, this material deals with topics that are constantly changing and are subject to ongoing changes related to technology and the market place as well as legal and related compliance issues. Therefore, the completeness and current accuracy of the materials cannot be guaranteed. These materials do not constitute legal, compliance, medical, or related advice. The end user of this information should therefore use the contents of this manual and the materials as a general guideline and not as the ultimate source of current information and when appropriate the user should consult their own accounting, construction or other advisors. Any case studies, examples, illustrations cannot guarantee that the user will achieve similar results. In fact, your results may vary signicantly and factors such as your health, medical condition and many other circumstances may and will cause results to vary. Privacy Policy: I never sell, rent, trade or lend any information about my subscribers to anyone, for any reason, whatsoever. I assure you that your privacy is respected and well protected.

Introduction What are trigger points Trigger Point Microgram Trigger Point Explanation Shoulder Trigger Points Gluteus Minimus Trigger Points and Sciatica Conclusion

Life After Pain