Trigger Points are tender points in muscle or fascia. There are two main types of trigger points. Active Trigger Points will refer pain to other areas, either spontaneously or when pressed. Latent Trigger Points are painful only at the point.
When latent trigger points are present they can negatively affect athletic performance. The most common complaint will be a feeling of loss of rhythm or timing. Latent trigger points can become active when there is sufficient stress. Massage therapists are in a unique position to find and treat these trigger points.
It can be difficult to find trigger points just by pressing and poking. I find most points by doing petrissage and feeling tight spots in the muscles or by observing the verbal and nonverbal reactions of clients when I go over a trigger point.
Although we find points by massaging, it is important to stop the movement once the point is found. Massaging a trigger point is often counter-productive. The traditional way to work trigger points is to press them very hard until they release. It is important not to move or goad the points as that will increase the circulation. The rationale behind using static pressure is that it creates a local ischemia which will starve the TP of any oxygen and nutrients needed to sustain the contraction. If goading or kneading is done, the TP doesn’t release.
Combining counterstrain techniques with pressing the trigger points causes trigger points to release faster and without pain. This combination of trigger point and counterstrain work is used in Ortho- Bionomy®.
Counterstrain, also known as strain counterstrain, was developed by an osteopathic physician named Dr. Lawrence Jones. It was discovered when Dr. Jones had a patient with back pain that he wasn’t able to see right away. Dr. Jones positioned him so that he was comfor able and later discovered the patient was free from pain, just from the positioning.
Counterstrain involves passively shortening a muscle to allow it to release. The idea is that if a muscle is in spasm it is shortening, and if you put the muscle in that position, you are giving it what it wants so that it can release.
There is a vicious cycle between pain and muscle spasm, in which a spasm can cause pain that can cause more spasm that can cause more pain, etc. A position of passive contraction for a muscle is also a position in which there is minimal pain.This helps break the cycle between pain and muscle spasm.
Counterstrain is effective by itself, as is trigger point work, but the combination of the two therapies is much more effective. Just pressing a trigger point to release it can work, but it is painful. By applying counterstrain, you are bringing the body into a position where there is no pain, so the trigger point may release faster with minimal discomfort to the client.
To combine the two therapies, I will press a trigger point then position the client so they feel no pain. I hold the point for 30 to 90 seconds. Often I can feel the point release as I am holding it. Because no pain is felt while treating a trigger point with counterstrain, I continue to hold the point until I have brought the body back to a neutral position.That way I can be sure I am on the same point, and I can ask for feedback to find out how it released.