Trigger Points: What Are They?

Massage Therapy is a very confusing field now. Not being covered under insurance leaves the door wide open to what falls under the heading. A given massage therapist practices anything from spa relaxation to physical therapy type work.

To clarify what I do, the type of massage therapy modality I specialize in is “Neuromuscular Therapy” or “Trigger Point Myotherapy.”

What’s a Trigger Point & Why Work It?

“Trigger points” (TrPs) are tender points in soft tissue that radiate or refer pain to distant areas. These are found all over the human body usually in the belly of a muscle. Once formed, they radiate pain out from the belly similar to a wrinkle in a sheet or a ripple on the water, this is the referred pain felt. Trigger points are produced by muscle stress, such as overwork, repetitive motion, or sudden excessive stretch.

There are four types of trigger points:

  1. Active TrP – one that is spontaneously producing referred pain.
  2. Latent TrP – one that produces pain when pressure is applied during palpation.
  3. Primary TrP – one that is caused by muscle stress.
  4. Satellite TrP – one that is produced secondarily by a primary trigger point.

How Do They Go Away?

Trigger points generally stay inside the muscle until manipulated away. Get rid of them today with medical massage therapy in Des Moines Iowa.Trigger points generally stay inside the muscle until manipulated away. In layman’s terms, when a muscle is over-stressed it feels compromised and immediately protects itself. This tightening process forms TrPs within the muscle. Muscles are very stubborn and don’t forget experiences easily, hence the term “muscle memory”. Muscles will hold on to this protection until a manual process occurs which tells the brain to send a signal to the muscle that it’s safe to relax and return to a normal resting length. This is what I do.

Pressure is placed directly into a tight or sensitive trigger point area, which often causes radiating pain, and held until the tenderness disappears. This process repeats running along the rippled path of the TrPs. There is a delicate balance between applying enough pressure to release it and applying so much pressure that the TrP worsens. Releasing the points encourages increased circulation to the area allowing the underlying tissue to soften. This is the point when clients say, “I didn’t even know that hurt until you found it! How did you know that was there?”

What Is Neuromuscular Therapy?

Neuromuscular Therapy is also called Trigger Point Myotherapy. This technique alters the length muscles to teach them how to operate correctly. Muscles are manipulated back into the shape originally intended. Less is more during this treatment session to avoid bruising and soreness. This type of therapy consists of alternating levels of concentrated pressure on the areas of muscle spasm to release the lactic acid from the muscle, resulting in increased blood flow and oxygen. Fascia is also stretched to keep the body loose. If the shell of the body is loose, the muscles can loosen and relax back into their natural form.

Causes of Trigger Points

The common cause of trigger points results from various forms of trauma, ranging from a direct injury, excessive stretching, heavy lifting and twisting, or even emotional stress. These sensitive regions will often activate pain in referring areas. Once we eliminate the trigger point, massage aids in removing the waste products and restore circulation to the area.

Some trigger points will be more severe than others and patience is the key factor during the session. Less severe TrPs will release almost immediatley. More severe ones need worked longer. The reason the experience is so worth it, however, is that there is an immediate relief as soon as the TrP dissipates. There’s no waiting 3-5 days to see if the session was a success. You know right away.

Some severe trigger points can reform after a session. I always recommend icing the area worked after a session. The ice will increase circulation to the area and decrease inflammation, minimizing the odds of the TrP reforming.

Carmen Satre, LMT, CMMT, CMLDT, OMTDr. Janet Travell is the person most often associated with trigger point therapy. She’s quoted as saying, “Active trigger points cause pain. Normal muscles do not contain trigger points. Individuals of either gender and of any age can develop trigger points.” Simple enough. Another great reminder that you don’t have to live with the pain. Come in and get those stinkers gone so you can feel good in your skin again.

See you on the table!

TMJ Disorder – Do You Have It?

Countless people suffer from chronic pain stemming from TMJ Disorder. The symptoms are nagging and constant. But TMJ Disorder is a condition easily confused with muscle tightness in the jaw. Fortunately there is lasting relief from both types of pain with massage therapy. So what’s the difference between the two and how does someone know which they have?

What Is TMJ?

Massage therapy mixed with stretching and exercise frees the jaw of TMJD pain and discomfort.TMJ stands for the temporomandibular joint. Easy rule of thumb: everyone has TMJ, but not everyone has TMJ Disorder. TMJ is the hinge joint that connects the lower jaw (mandible) to the temporal bone of the skull, in front of each ear. These joints are flexible and allow the jaw to move smoothly up and down and side to side, allowing us to chew, talk, yawn, etc. The muscles attached and around the joint control the position and movement of the jaw.

What’s TMJ Disorder and Its Symptoms?

Temporomandibular joint disorder (TMD for short, thankfully) occurs as a result of problems in the joint (and disc) where the jawbone meets the skull. One of the common symptoms is clicking, popping, or grating sounds in the jaw joint when talking or chewing. Pain could be involved but not necessarily. Other symptoms include:

  • Pain or tenderness in the face, jaw joint, neck and shoulders. Pain could also occur in or around the ear when chewing, talking, or opening the mouth wide.
  • Inability to open the mouth wide.
  • Jaw becoming “stuck” or “locked” in either the open or closed-mouth positions.
  • A feeling as if the upper and lower teeth are not fitting together properly.
  • Swelling on the side of the face.
  • Possible toothache, headache, neck ache, dizziness, earache, hearing problems, upper shoulder pain, and tinnitus (ringing in the ears).

How is TMD Diagnosed?

There are many other conditions causing similar symptoms to TMD, therefore it is very important to have a dentist conduct a careful examination of the entire area. The dentist will look for specific limitations in range of motion or jaw locking as well as a wearing away of the joint. X-rays may be involved as well as CT scans or MRI.

What Causes TMD?

There are many causes of TMD such as injury causing whiplash, jaw abnormalities, and poor posture. Other causes include:

  • Constant teeth grinding or clenching, which puts pressure on the TMJ.
  • Dislocation of the soft cushion or disc between the ball and socket of the joint.
  • Osteoarthritis or rheumatoid arthritis in the TMJ.
  • Stress resulting in a constant tightening of the facial and jaw muscles.

What’s the Fix?

Some medical professionals may recommend surgery and orthodontics to correct the problem, however more natural solutions are long-lasting and much less invasive and expensive. The National Institute of Dental and Craniofacial Research recommends gentle stretching and relaxation exercises to increase jaw movement. Massage therapy mixed with stretching and exercise of the muscles involved significantly loosen up the entire area, freeing the jaw of pain and discomfort. After only one or two sessions people find such relief that many have put away their mouth guards and report a better quality of life.

What If It’s Only Muscle Tightness?

Massage therapy mixed with stretching and exercise frees the jaw of pain and discomfort.Outside of TMJ issues, the main muscles involved in everyday jaw tightness or discomfort are the masseter muscles. The masseter muscle is the primary chewing muscle. With regular talking, chewing, and stress these muscles develop “knots” (or adhesions) and trigger points just like any other muscle in the body. Most people don’t realize these muscles play a part in headaches, neck aches, and shoulder tension. After flattening out adhesions and removing trigger points the muscle loosens and returns to its natural resting length. It’s so fun to loosen these during a session and hear people say, “Wow I didn’t realize how tight I was in there. I feel so much better!”

I work on both conditions of muscle tightness and TMD daily with high success. With a specific combination of modalities for each, the jaw area immediately loosens up, decreasing stress and tension in the head and neck. After a session, I offer daily exercises and stretches for the jaw to keep the area from tightening.

Another wonderful sigh of relief that you don’t have to live with the pain, even if it’s only nagging. Feel good in your skin again today.

See you on the table!


Say No To Scar Tissue

I admit it, not everyone is as excited about scars as I am. I collect and count them as badges of honor. Much like tattoos, scars are visual stories leaving their marks on our physical bodies reminding us how we survive and strengthen. However, some scare are viewed as unsightly and distracting and some might not want the reminder of the experience. Good news! Scars can easily be broken up and minimized.

Scar Tissue Overview

What is it?
Scar tissue is the growth of new tissue: skin or fascia, after injury.

How is it recognized?
Scar tissue on the skin often lacks pigmentation and hair follicles.

Is massage indicated or contraindicated?
Massage is contraindicated during the acute stage of any injury in which the skin has been damaged. In the subacute stage massage may improve the quality of the healing process.

What Is Scar Tissue?

Scar tissue is a special kind of fibrous connective tissue that forms when tissues are injured. It is unique because, unlike those in tendons and ligaments, the collagen fibers are not arranged in a parallel pattern. Because of the abundance of dense and irregular collagen fibers, scar tissue is strong but not as pliable as normal, healthy tissue. Serving as a replacement for other injured tissue, it cannot perform the functions of tissue it replaces, and its blood supply is minimal.

Extensive scarring can restrict normal movement, reduce or prevent normal circulation of blood and lymph, and impede or even prevent injured tissue from functioning properly. The structure of scar tissue depends upon where the injury occurs, but it usually has the same components as the original tissue, accompanied by an abundance of extra collagen fibers.

Types of Scar Tissue

There are two types of scar tissue, internal and external.

When soft tissues are compromised or injured, the body automatically responds to repair the damage. In phase II of the healing mechanism, collagen fibers are produced to splint the area and prevent further damage. New collagen fibers are relatively easy to align with the fibers of the original tissue, given gentle movement throughout phase III. Collagen fibers continue to be produced during phase III, and without enough movement, they become sticky and hard. As a result, the collagen fibers are difficult to realign and they easily develop into connective tissue adhesions, or scars, with far-reaching effects.

  1. External – the scars are visible when the integument (skin) is injured,
  2. Internal – but tissues beneath the surface of the skin can also develop scars. Invisible scars are equally capable of affecting structures in other areas of the body.

What Does Massage Do?

Once a scar or adhesion is created in one area, it begins to pull on the fascia throughout the body. Remember – it’s all connected!

In the subacute and chronic stages of a skin injury, massage is indicated and can be very beneficial. Soft tissue work is the recommended treatment for superficial scar tissue and may be initially applied.

The quicker the adhesion is treated, the less likely it is to affect the rest of the body. Because of its patchlike nature, there is a tendency for all other tissues to pull in the direction of the scar, which can lead to more compensation patterns and fascial restrictions.

Once the scar has formed, massage on and around the scar tissue can increase the speed of healing by increasing circulation to the area, which prevents fascial restriction and increases mobility of the tissue. Scar tissue may have reduced sensation, so providing the therapist with regular feedback throughout the session is extremely helpful.

Methods to Release Scar Tissue

Releasing scar tissue is a very specific technique, both for internal and external scarring. I use a few methods to breakup both kinds of tissues including cross fiber friction, massage cupping, and Gua Sha tools.

Client Study: LH, External Scar

Last year LH had skin cancer removed just under her right nostril. Obviously she wanted that scarring diminished. The raw, untouched before/after photos below shows our progress in only 3 sessions of 15 minutes within a five-day period.

Massage therapy is effective in releasing scar tissue.

LH’s scar tissue before session 2.


Massage therapy is effective in releasing scar tissue.

LH’s scar tissue after 3 sessions.

LH Testimonial:

“I had a basal cell carcinoma removed on my face that required 14 stitches. As I am in my 60’s, I was concerned about healing time and permanent scarring. Carmen has a scar treatment that gave me impressive results. With a small number of 15-minute sessions, Carmen was able to achieve rapidly discernable results. Carmen is competent, calm and gentle. In her hands the treatments were enjoyable and soothing, with no discomfort.”

Testimonial: Kim W., Internal Scarring

“Carmen is fantastic! After years of going to whatever massage therapist had an opening and always feeling underwhelmed I’ve finally found a keeper! Carmen believes in treating the cause of the problem rather than providing short-term relief and thank goodness she does. I have scar tissue and knots that have been around for half my life and have always caused me problems. Carmen worked with me to create a treatment plan that would address my problem areas and ultimately lead to an overall reduction in my scar tissue and muscle congestion. After only a handful of visits I’m already feeling relief where I’ve never felt relief before and am feeling better overall. Also, she doesn’t ask that you come in for an hour each time. She can spot treat your problem areas in 15-30 min if that’s all that’s necessary. The flexibility is key. I still have a long ways to go in my treatment but I feel I’m making great progress.”

Scars are just like pain, you don’t have to live with it and their effects can be greatly minimized.

See you on the table!

Introduction to Massage Therapy, second edition, Mary Beth Braun, BA, MT, NCTMB & Stephanie J. Simonson, BS, MT

Massage Therapy 101: The Mysterious “Myofascial Adhesion”

Myofascial adhesion (MFA) is a term rarely used outside of the massage therapy industry. They are a major contributor of pain to most of the world’s population yet the average person is not aware of the term.

The longer chronic pain exists, the longer the rehabilitation period. As a rule of thumb, for every year of chronic pain, it takes at least a month of rehabilitation to restore balance to the body. For this reason, chronic pain is often never relieved. The body adapts and we accept living with the pain.

Fascia is a connective tissue within the body. Think of your entire body wrapped in fishnet hose both internally and externally including each individual bone, nerve, and muscle. Over time, fishnet hose get entangled and need adjustment. If not, you develop an impingement. Fascia works in the same way. Knots develop over time known as Trigger Points. The greatest MFA is scar tissue. MFAs occur for many reasons: injury, illness, inactivity, lifestyle, job type, nutrition, dehydration, and the aging process all play a contributing role in their development.

The natural emotional response to a MFA is to develop a guarded nature from the pain. However, this only encourages further development of the adhesions. Movement is essential to breakdown the adhesions.

Massage therapy relieves adhesions by warming and relaxing the body to create an environment for most manipulation with least pain. This is particularly effective in addressing the guarded cause. Adhesions begin breaking down, there is a restoration in flexibility, reduction in nerve impingement and nourished blood flow throughout the body further facilitating the healing process.

There is no quick fix to breaking down MFAs. However, a regular regimen is the likely solution for permanent relief once they develop. Drink lots of water, stretch and exercise regularly, be conscious of your eating habits, enjoy life but weigh the consequences and be aware that moderation may avoid injury.

A body that receives massage therapy on a regularly basis feels entirely different from a body that doesn’t. The primary difference is the level of myofascial adhesions present.

See you on the table!

Reference:, November 19 , 2010, Braxton Dutton

Heat or Ice – Which Is It?

I hear a lot of confusion in the massage room about when to use heat over ice. Of course heat feels amazing but sometimes icing an injury feels good too. The use of heat and ice are equally important in the self-care process of muscle management. They each have specific uses but need applied at the right time or they could exacerbate an issue.

Heat vs. Ice

Icing, or cryotherapy – is for injuries except for low back pain
Heat, or thermotherapy – is for muscles

Icing, or cryotherapy, is for injuries except for low back pain.Choosing ice over heat for injuries is very important as icing calms damaged and inflamed tissues. These tissues are already swollen and carrying heat, a normal process for the body, although painful. Adding heat during this time feels great initially but only creates increased pain
and swelling. Not what you need in a time of trying to resume daily activities.

Choosing heat for muscles is great for muscle spasms or pain from knots and trigger points. Icing muscle spasms or trigger points can actually make them worse. Picture being surprised with someone splashing cold water on you or someone coming in from the cold outside and putting their hands directly on your skin – the entire body contracts. This is what happens when icing trigger points and spasms, both already in a state of contraction. Severe spasms and trigger points can feel like knife blades and it’s a common mistake to run for an ice pack. But icing these tissue issues causes the muscles to contract even harder, and the trigger points to burn more intensely. Trigger points and muscle spasms calm down with heat.

Heat also relieves psychological stress, which is a major factor in pain issues. At the end of a hard day’s work it’s a great idea to throw heat on tight neck and shoulder muscles or on leg muscles after a work-out.

What About A Muscle Strain or Tear?

This one is debatable but ice is generally preferred. If the muscle is truly injured, ice only for the first few days. Use ice to bring down the initial inflammation and help numb the severe pain. Once this phase is over replace with heat.

Always Cold or Over Heated?

Icing, or cryotherapy, is for injuries except for low back pain.It’s not a good idea to use heat if you’re already sweating or overheated. And ice will only make you feel worse if you’re shivering. The brain may misinterpret these situations as an excess and a threat. Shake things up to help out the brain. If you experience an injury but you’re already freezing, warm up in a hot shower and then throw an ice pack on the injury afterward. Or bundle up in a robe and blankets during cryotherapy. Same with heat. If your legs are cramping and you’re overheated from the work-out, jump in a cool shower then slowly turn up the heat to help relax the muscles.

Do Not Ice Low Back Pain!

Except for a direct injury from whiplash or a muscle tear where inflammation is definitely present, do not ice a low back injury. This is a common point of confusion even within the healthcare industry. Common low back pain, the feeling as if the back “is out”, is not from an injury or trauma causing inflammation. Painful trigger points, knots/adhesions, and the low back muscles being weak are the common causes of low back pain. When the low back feels like it’s out, icing will only make that feeling worse. Always Heat.

Hopefully this clears up some confusion. Using the above information as a guideline, choose the therapy that feels right for your body at the time and help speed up the healing process.

See you on the table!