How Exactly Does That Work?

That was a question from one of my clients last week. Pressing on a point in his shoulder, he felt it shoot up to the back of his head, which is where his headaches originate. Wondering how that works is certainly a fair question, but one that is much more complicated than most people realize. There are two levels to this, the "what" and the "how". 

On the "what" side, a trigger point is an area of hyper-sensitive tissue that refers sensation elsewhere. You may have noticed this when on the table. Pressing on a sensitive spot in one area produces (or replicates) an achiness or discomfort somewhere else. In the research world, these sensations can be replicated by injection of a tissue irritant, such as hypertonic saline. Moreover, 4 out of 5 people will get the same referral. 

The "why" question is far more difficult and ultimately, not known. These referral patterns do not follow a nerve pathway, a typical muscle pattern, or any other obvious explanation. This lack of explanation drives some people nuts! I get it, but as a clinician, I accept that I cannot explain everything. In fact, the mechanism by which anesthesia works is not known, yet hospitals use it every day. Why? Because it works and results matter. 

Many of you have been the recipient of trigger point work at the office and you know how effective it can be. It is not uncommon for symptoms to disappear for years after successful treatment. You have probably also experienced how hyper-precise the work is; close does not count. The actual tissue disruption is 3mm by 3mm, about the size of a grain of rice. This is not easy to locate- it takes excellent palpation skills on the part of the therapist. This is also why more general approaches-even injections by a physician, can fail. Skill and attention to detail matters. 

There is a You Tube video that has a nice explanation for trigger points. You may find it useful. Trigger points are just one aspect of the total approach to soft-tissue therapy that we at BWA employ. They are not the answer to every question, but can be an important source of frustrating muscular pain and discomfort.