Do Trigger Points Exist?

The research supporting the basis of “trigger point” therapy is very limited. When “expert” trigger point therapists are tested to see if they agree on the location of trigger points, they don’t.

Here is some research on the topic:

Agamatsu found that four tender spots on the trapezius muscle, where the spots where the spinal accessory nerve inserts into the muscle. Are “trigger points” just nerve insertions?

Anderson (2010) found that when the hardest portion “trigger point”of the trapezius muscle was pressed it was not connected to pain sensitivity.

Lucas (2009) conducted a review of all available trigger point studies, not one study specifically reported reliability for the identification of the location of active trigger points in the muscles of symptomatic participants. Reviews by Myburgh (2008) and Quintner (2014) came to very similar conclusions. There was some moderately positive evidence on the reliability of finding tender spots on the trapezius muscle. While Njoo (1994) found some inter-rater reliability in finding “localized tenderness” of the glute medius and quadratus lumborum muscles.

“Trigger point” inter-rater reliability (the degree to which different raters/observers give consistent estimates of the same phenomenon) is pretty poor. That of course does not mean that trigger point therapy does not work, I’m not making any judgements on that matter.

My thoughts:

There is plenty of grey area in all forms of therapy, and experience has taught me not to be wedded to a specific theory. Is it more objective to treat a trigger point until it disappears, or treat the length of a muscle and test – retest joint range of motion, a squat or a push up? Maybe a neurophysiological response unrelated to breaking up adhesions or trigger points is the reason behind the increase in range of motion or increase in function. Robert Schleip is a highly respected fascia researcher, he has written a neurobiological explanation for treating fascia. He also has written that mechanical deformation of fascia via treatment is very unlikely.

Articles on Active Release Techniques (ART) therapy that I contributed to:

Telegraph, Athletics Weekly, 220 Triathlon, Vigour Magazine