Another Approach for Trigger Points
Trigger points have always been a source of fascination for Physiotherapists. Nobody can clearly explain the feeling when a Therapist can palpate a trigger point getting smaller and disappearing. Different treatment approaches have been used for trigger points and have been variably effective. I recently tried two different protocols on 4 different people and the results were amazing, to say the least.
Firstly, I had never truly appreciated the value of active and satellite trigger points till I came across two cases which were unresponsive to all treatment modalities that I could use. One particular case, Ms. X, presented with pain in her Left forearm which kept growing throughout the day. I assessed for Tennis Elbow and found the Cozen’s test positive, but I wasn’t too sure. I treated her for Tennis Elbow and worked on a taut band she had in her Extensor Carpi Ulnaris and ECRB. When 4 sessions later, she showed no improvement and her pain persisted, I went back to square one and started again. It struck me at that time that Trigger points in the Scaleni can radiate to and form Satellite Trigger Points in Extensor Carpi Ulnaris and forearm. I assessed the Scaleni and as expected, I found a trigger point in the Anterior Scalene on the same side. Once I started working on this point, her pain vanished over the next 2 sessions and from the 5th session onwards, I started working on her breathing pattern and her posture. Another case, Mr. Z, had persistent pain around the Left eye which was non responsive to all treatment. I advised him to get his eyesight checked and reduce work hours on the computer. A week later, when he reported to me with the same pain and no change in his eyesight, I thought of looking at his Sub occipital muscles and Upper trapezius. I found 2 triggers in his upper trapezius and rectus capitis posterior major. Once I started treating these points, his pain started reducing.
Dry Needling and Kinesiotaping
Among the various treatment techniques for trigger points, soft tissue work and PRT have been found to be the most effective in research. I used PRT and stretching in 2 people and Dry Needling along with Kinesiotaping in 2 others. Dry needling showed excellent results and the pain decreased immediately and the effects were more long term. Following Dry Needling, I taped the involved muscle using the appropriate kinesiotaping technique to maintain the correction. PRT and stretching also showed great results and picking out of the two methods is difficult. As a conclusion, the decision on what treatment technique is to be used is the Therapist’s choice and what he/she is comfortable with.
I would personally recommend the use of Dry Needling for releasing trigger points.