Manual Treatment of Trigger Points (TrP)

Manual Treatment of Trigger Points (TrP)

Manual trigger point therapy is a 'hands-on' technique used by skilled physical therapists to release myofascial trigger points (MTrP) in the muscles. This technique requires a lot of finesse, anatomical knowledge, and pattern recognition, where referred pain and transferred sensitivity can give insight into a MTrP as the cause of a problem for a patient.

When a MTrP is identified as a pain trigger, manual trigger point therapy is used, among other techniques. Knowledge about the nature of MTrPs as well as clinical experience demonstrates that pressure releases MTrPs, alleviating tension in the muscle fiber and thus restoring the original muscle length.

Manual trigger point therapy differentiates between techniques that act directly on the MTrP and the taut band, and fascial techniques or release techniques that broadly affect the entire muscle and its fascia.

The direct techniques are applied with high manual pressure using thumbs or fingers, which can make trigger point therapy very painful. However, it is important that the pain remains tolerable for the patient and is ideally perceived as 'pleasant pain.' Certain direct trigger point techniques can be combined with active or passive longitudinal stretching of the muscle to enhance the therapeutic effect.

Indirect fascial techniques, on the other hand, are less or not painful at all. Here, therapists work with the palms rather than with fingertips. The hands apply broad pressure to the tissue and muscles, and these are then massaged.

In most cases, manual trigger point therapy involves a combination of direct and indirect techniques to achieve the desired muscle relaxation and length change.

To maintain tissue changes, it is important that the patient independently stretches while simultaneously rebuilding strength and coordination. Trigger factors such as repetitive movements or incorrect posture and movement patterns should be avoided. Instruction and education are always important parts of treatment and therapy.