Trigger points are exquisitely tender points within muscles which like to refer pain, usually some distance from where the trigger point is located.1
For example a trigger point within the upper trapezius muscle which sits on top of the shoulder, between the neck and the shoulder tip, typically refers pain to the side of the neck, the temple and even the jaw. They often contribute to a tension type headache, especially if found on both sides of the neck.2
But how reliably can these trigger points be identified on physical assessment? In other words, if I was to assess you and then another physiotherapist were to assess you afterwards, how likely would we both agree that a trigger point either is or is not present?
The results of a reliability study,3 showed that just being trained to find trigger points using a manual palpation technique is not enough. Reliability or ‘agreement’ was only adequately shown when experienced clinicians were taught not only how to assess but also interpret the physical signs they found.
In order of most reliable to least, the study identified the following:
1. Pain recognition i.e if compressing the ‘knot’ or tender point within the muscle brought on the clients recognisable or familiar pain symptoms, this was most likely to result in two or more clinicians agreeing a trigger point was present.
2. Followed by the presence of the characteristic taut band in which the knot is located.
3. Followed by identifying an area which is a tender only.
4. Followed by a characteristic referred or radiating pain pattern.
5. Lastly the local twitch response, which occurs on direct palpation as well as needling.
So if you are suffering from pain which may be caused by a trigger point, you need an experienced physiotherapist who not only knows what to look for on assessment, but how to interpret what they are finding in order to make the correct diagnosis. This is important as it will guide treatment and ultimately treatment outcomes. For example an untrained and inexperienced physiotherapist may waste time treating a trigger point which may not actually exist.
All our physiotherapists at Mount Merrion Chartered Physiotherapy are sufficiently experienced and have been trained in trigger point assessment and treatment techniques, so you can be assured of effective treatment first time.
1. Simons DG. Review of enigmatic MTrPs as a common cause of enigmatic musculoskeletal pain and dysfunction. Journal of electromyography and kinesiology. 2004 Feb 1;14(1):95-107.
2. Simons DG, Travell JG, Simons LS. Travell & Simons' myofascial pain and dysfunction: upper half of body. Lippincott williams & wilkins; 1999.
3. Gerwin RD, Shannon S, Hong CZ, Hubbard D, Gevirtz R. Interrater reliability in myofascial trigger point examination. Pain. 1997 Jan 1;69(1-2):65-73.