Treatment of Myofascial Trigger Points
Self-Massage, Acupuncture, Medication and Other Treatments
Aug 27, 2009
Yoga, meditation, other forms of relaxation, stretching and exercise are usually not helpful for trigger points, even though they can help in the prevention. Against conventional wisdom exercise, even stretching, can make trigger points even worse, though rest is not a good treatment either.
There is a safe form of stretching for areas affected by myofascial trigger points, called "spray and stretch". It involves first using ice or vapocoolant spray to numb the trigger point, then stretching and applying heat on the area afterwards. This can obviously be quite cumbersome to pull off regularly.
Trigger Point Massage
Self-applied massage therapy, also known as myofascial release, is the easiest way to treat trigger points. After the trigger point is located it is strongly "kneaded" with fingers, knuckles, another body part (such as knee or elbow) or with a massage tool, such as the TheraCane. A tennis ball or a smaller ball used against a wall, chair or bed works well for many trigger points.
Trigger point massage is unfortunately painful, but it will usually result in quick relief. The treated area may get even more sore and remain that way for a couple of days, but it is no cause of concern. To alleviate the pain it is important to work on the actual trigger point, not the area where it refers pain.
A single massage session does not have to be long, even less than a minute is enough, but it should be done several times a day until the trigger point is no longer sore. All trigger points in the affected area should be located and treated for the best efficacy.
Normal massage therapy is usually not very helpful for myofascial trigger points, but luckily many massage therapists understand how to treat trigger points. Some older sources recommend static pressure (ischemic compression or ischemic pressure) on the trigger point, but this is usually no longer recommended.
Other Ways to Manipulate Trigger Points
Acupuncture can help with deactivating trigger points. Most acupuncture points correspond with trigger points and the concept of "meridians" in traditional Chinese medicine appears to correlate with the ways the trigger points refer pain to other areas.
In conventional medicine trigger point injections are the most common treatment. Usually lidocaine or another local anaesthetic is injected directly into the trigger point. This can produce long-lasting relief. Corticosteroid injections have not been shown helpful. The jury is still out on the efficacy of botulinum toxin (botox) injections, as studies have produced very conflicting results.
Another method is dry needling, where a needle is used but nothing is injected, similar to acupuncture. It is appears to be as effective as lidocaine injections, but results in more soreness after the procedure.
Based on some studies laser therapy, ultrasound therapy and repetitive magnetic stimulation (rMS) may be useful for chronic myofascial pain. Repetitive magnetic stimulation should not be confused with normal "therapeutic" magnets.
Medications and Herbs
Painkillers are rarely very effective in the treatment of chronic pain caused by trigger points. NSAIDs and acetaminophen (paracetamol) generally prove completely useless, although they can relieve headaches caused by trigger points.
Certain muscle relaxants like tizanidine (Zanaflex), clonazepam (Klonopin) and baclofen (Lioresal) may provide relief, as can cannabinoids. The drug diltiazem has been proposed as a potential treatment. Some herbs like lavender and lemon balm may be useful for chronic myofascial pain.
Besides lidocaine injections, lidocaine can be used topically on trigger points as a cream or patches, though this is less useful than injections. Another local anaesthetic called dimethisoquin may be even more effective than lidocaine. Capsaicin has been found helpful for trigger points located in surgical scars.
Neomycin is a topical antiseptic drug, often available OTC, which may help trigger points by a mechanism unrelated to its antibiotic action (blockage of N-type calcium channels). Because of the high toxicity of neomycin it should not be used in large quantities and never on broken skin.
If trigger points are caused by an underlying condition such as anemia or another nutritional deficiency, hypothyroidism or adrenal insufficiency, treatment for the condition may be helpful, but deactivation of current trigger points is still needed.
References
Davies Clair. The Trigger Point Therapy Workbook: Your Self-Treatment Guide for Pain Relief (Second Edition). 2004.
McPartland JM. Travell trigger points--molecular and osteopathic perspectives. J Am Osteopath Assoc. 2004 Jun;104(6):244-9.
Dorsher PT. Myofascial referred-pain data provide physiologic evidence of acupuncture meridians. J Pain. 2009 Jul;10(7):723-31.
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