The “Why” of Trigger Point Massage

As you may have noticed [insert audible groans here], I talk an awful lot about trigger points on this blog. A few obvious reasons for this: One, it’s the type of treatment I specialize in. And two, it’s the basis for most of the muscle pain that we experience, which makes it rather important for understanding where muscle pain comes from.

But I realized that I don’t talk all that much about trigger point massage, per se. You know what trigger points are and how they develop, but why is massage an effective treatment?

I could just point to my clients and say, “Of course massage works – just ask them!”, but I’d rather have something beyond examples to prove my point. To help me out with this, I took a look at the “bible” of trigger points: Myofascial Pain and Dysfunction: The Trigger Point Manual by Travell and Simons. Every muscle and every trigger point is described in detail in these two volumes. But because the authors are both medical doctors, the treatments they write about involve vapocoolant spray or local anesthetic injections. They do, however, briefly mention why massage therapy is also an effective treatment.

From the “Responsiveness To Treatment” section of the introduction (pg 27):

“Ischemic compression, which is firm digital pressure applied to the TP [trigger point], deep stroking massage (stripping), kneading massage and vibratory massage, can be effective. Each of the first three cause blanching (ischemia) with hypoxia, followed by a reactive hyperemia.”

That sounds scientific enough, but we need to define some terms before we can make any sense of it.

Ischemia is the loss of blood flow to an area. When I press on the trigger point, I block the flow of blood to that spot on the muscle. Hypoxia is the loss of oxygen to the an area. Without the blood flowing in, oxygen (which travels via hemoglobin) can’t get in either. But once I release the pressure off of the trigger point, hyperemia – excessive blood flow to a specific area – occurs.

The extra blood flow causes temporary inflammation, which is why the skin can be warm, red, and maybe a little swollen after treatment. But, as the name implies, this inflammation is only temporary, and it’s for a good cause. The extra blood brings extra oxygen to the area, and both of these things help the trigger points break down.

You can think of trigger point massage as a continuous ischemia-hypoxia-hyperemia cycle. I press on a trigger point and release it after several seconds. Press on it again, release. I don’t expect the trigger points to go away immediately, but I know that repeating this cycle in small intervals will do more to loosen the trigger points than pressing down continuously for an extended period time (which is more likely to cause bruising).

Following the treatment, I’ll usually suggest that the client apply ice to the trigger point areas. Ice, as I’ll talk about later, is really good at reducing inflammation. Now that the temporary inflammation has done its job (that is, has brought excess blood and oxygen to the area), ice will reduce the swelling and calm the area down. The muscle will feel looser, and the pain will be reduced.

But, as I’ve said before, the trigger points won’t disappear after just one session. The client may feel better for several days following, but as the effects of the hyperemia diminish, the problematic areas will be tender and painful again. After several sessions, though, the trigger points will start to break down and release completely. It might be a slow process, but it’s definitely an effective one. And now you know why!

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