What are the so-called trigger points?

Today the musculoskeletal disorders constitute one of the main causes of medical consultation and visits to physiotherapy clinics. Regarding its invasive treatment, the dry needlingIt is one of the few invasive techniques in physiotherapy and the one with which the best results are obtained when there is pain of myofascial origin.

Trauma, bad posture or habits during the workday or routine activities of our day to day cause our muscles to not be able to relax and Myofascial pain Syndrome appears. Skeletal voluntary muscles make up 40% or more of an individual's body volume and each of our muscles can be affected by myofascial pain, so we understand that it is a very common pain.

This pain is caused by the appearance of some tender nodules called trigger points that lead to dysfunctions in our body. Probably, if you have ever gone to the physio, you have heard about these trigger points and your dry needling treatment. It is an invasive and innovative treatment with which very good short-term results are obtained if applied properly. Next, we will explain in detail why it is a therapy that is being used more and more.

What is a trigger point?

The myofascial trigger point is a nodule that is palpable on the skin and is located in a tight band of muscle. This causes pain with a characteristic pattern and can be found all over our body. Trigger points are described as they are always located in the same parts of the body. Where they are most abundant is in the back muscles because they are muscles with postural characteristics and these tend to fatigue more.

How do I know if the pain is from a trigger point?

If we press on this nodule, the pain appears intensely at the same point, but if it is very sensitive, it may until the pain is reproduced in a distant place (referred pain). Sometimes you can also visually appreciate a spasm or contraction when pressure is applied to the area. This phenomenon is called the local spasm response and it is also an indicator that the point is very active.

Myofascial pain causes weakness (heaviness, tiredness) and movement restriction generating dysfunctions of the musculoskeletal system such as shoulder, knee, headaches, etc. It is common for myofascial pain to be confused with pathologies such as migraine, vertigo or. This is due to the fact that the patterns of referred pain characteristic of trigger points can cause symptoms similar to pathologies that we already know. For example, referred pain from the trigger point of the infraspinatus muscle coincides with the pain suffered by having a tendinopathy of the shoulder, or referred pain from the trapezius muscle and the cervical musculature in general, can be mistaken for a migraine as the pain radiates to the head.

Why is a trigger point activated and what are the causes?

muscles are made up of many muscle fibers and these same fibers They are full of sarcomeres that are the ones that allow contraction. During contraction, these sarcomeres are shortened, when one or a group of them is permanently shortened (contraction) due to muscle overload, they cause the appearance of the zone trigger point activation. Consequently, the blood flow, the arrival of nutrients and the drainage of toxins are not carried out correctly in the affected area, which is why it leads to a inflammation and pain, locally or referred. Possible triggers:

• Physical factors: postural fatigue due to maintained postures (the back muscles tend to fatigue). Direct or repetitive trauma or fatigue from repeated contractions when performing a repetitive action.
• Emotional factors: stress, anxiety ...
• Visceral factorsStomach or liver problems from poor diet or stress can activate trigger points in the upper back.

What is your treatment?

The treatment of trigger points can be approached with different. exist conservative techniques based on manual therapy such as the digital pressure of the trigger points, kneading of the muscle through deep massage therapy, stretching and cryotherapy (application of ice). Regarding its invasive treatment, the dry needling, say it is one of the few invasive techniques in physiotherapy and one of the best results obtained when there is pain of myofascial origin.

How is the dry needling applied?

The dry needling technique consists of the application of needles over the trigger point. It pierces the skin and even the muscle with the intention of breaking the adhesions of the nodule, also creating a new inflammation that will restore blood flow in the area again, as well as the arrival of nutrients and the drainage of waste substances from the metabolism that, as a whole, will favor and speed up the regeneration of the affected tissue. Is a painful technique as the pressure or insertion of the needle into the trigger point node produces severe pain. However, as already mentioned, it is a technique very effectiveAt 24-48 hours, the pain has decreased favorably and the muscle has managed to relax, recovering its normal state.

Can any physical therapist perform dry needling?

The answer is no. So that one can perform the dry needling technique has to be trained and registered in your college of physiotherapists as it is accredited to perform this invasive technique. It is advisable to always ensure that the professional who is treating you with an invasive technique has the corresponding training.

• The dry needling technique consists of the application of acupuncture needles on the trigger point.
• It is a painful technique as the pressure or insertion of the needle into the trigger point node produces severe pain. But it is very effective, and after 24-48 hours the pain has decreased favorably and the muscle has relaxed recovering its normal state.
• In order for a physical therapist to be able to perform the dry needling technique, they must be trained and registered with their college of physical therapists as they are accredited to perform such invasive technique.

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yasmina Santiago Physiotherapy Specialist Collaborating Physiotherapist of Advance Medical