The trigger point (TrP) management or therapy is a debated topic in the PT community. Some are hardcore supporters of its effectiveness while others don’t see it as anything more than a placebo. That could be because the inter-rater reliability of the different TrP features varies.[i]
Quick tip: Interrater reliability is a measure of how much multiple testers agree on a certain matter. A good value is above 90 Kappa. This helps us determine how valuable a tool, test or treatment is when applied by different testers, in different or similar situations.
However, most PTs do believe that TrPs do exist. And specific therapeutic techniques can help treat them.
In this article, we will look at the latest scientific literature to evaluate the effectiveness of current TrP treatments applied in physical therapy.
At the end of this post, I trust that you’ll have a good understanding of what trigger point therapy can do and what its limitations are.
You should visit the source links and read the studies in-depth to get an even better understanding of the topic.
Let’s begin.
What is trigger point therapy in PT?
Trigger point therapy is the combination of neuromuscular techniques designed to treat TrPs and speed up recovery. This helps resolve the key symptoms associated with trigger points such as pain, limited ROM and muscle imbalance. The therapy can be applied in both acute and chronic conditions with some variations.
Physical therapists use several different techniques to apply pressure on and resolve trigger points. Some of these include:[ii]
- Trigger point therapy
- Self-massage and Foam rolling
- Ischemic compression techniques
- Ethyl Chloride Spray and stretch
- Manual lymphatic drainage
- Post isometric relaxation
- Ultrasound, Hot and Cold pack
There are different types of trigger points classified according to the location, level of tenderness, active or latent, diffuse and so on. And some of these require a different approach for treatment than others.
The effectiveness of PT trigger point therapy also varies according to the type of TrP.
Scientific evidence for the efficiency of trigger point therapy
The effectiveness of trigger point therapy is a common question PTs face regularly.
You need to have a good understanding of it yourself before you can answer patients’ questions or convince other professionals of its usefulness.
Here are some key researches that elaborate on the clinical effectiveness of TrP therapy. We’ve categorized them into five subsections so it’s easier to understand.
This is by no means an exhaustive list of research on TrP. Rather; these are only the recent ones that explain the true scope and effectiveness of this therapy.
1. It tends to improve pressure pain threshold at trigger points
A randomized control trial by Moraska et al. (2018) showed encouraging results of trigger point massage therapy. Their subjects had a significant increase in pain tolerance immediately after the treatment started and also after 12 weeks.
Not only that, but they also concluded that TrP therapy continues to produce additional benefits with multiple massage treatment sessions.
Another RCT found similar results in tension-type headache patients. The investigators applied TrP massage therapy to the cervical muscles. The study showed a greater reduction in pain in the group that received the therapy as compared to the placebo group. However, there was no difference in the frequency of tension-type headaches with TrP therapy.[iii]
2. Ischemic compression is effective for latent trigger points
A study by Montañez-Aguilera et al. (2010) found short term improvements in cervical range of motion and trigger point sensitivity after ischemic compressions. As we’ve covered above, ischemic compression is a technique for trigger point therapy used by physical therapists.
This effect could be because ischemic compression improves blood flow to the area. Hence, it brings more nutrients to the site of insult and speeds up the resolution of the trigger point.[iv] A 2019 RCT found ischemic compression to be more effective than dry needling in treating the latent TrPs in the athletic population.
A systematic review on the myofascial trigger points showed immediate symptomatic relief after trigger point therapy, particularly the ischemic compression technique.[v]
The studies included in this review had moderate to strong evidence. This technique also has favorable results in chronic neck pain patients according to Morikawa et al. (2017).
The ischemic compression technique is highly effective as a home program as well. Hanten et al. educated their study subjects about the technique. Later, they found a significant reduction in the TrP sensitivity and pain intensity.
3. Manual pressure release and muscle energy technique are highly effective
There have been many studies on the effectiveness of manual pressure release and muscle energy techniques. Most of them have concluded that these techniques are highly effective in treating myofascial TrPs.
Manual pressure release and muscle energy techniques are useful for treating active trigger points. Bodes-Pardo et al. (2013) applied these to patients with Cervicogenic headaches. They saw a reduction in headache and neck pain intensity a week after treatments.
Manual pressure release and muscle energy techniques are useful for treating active trigger points.
Not only that, but they also reported an increase in motor performance of cervical musculature, active ROM, and pain threshold.
Kashyap et al. (2018) compared these two trigger point management techniques and found a significant reduction in pain and muscle tenderness around the TrP. These also improved cervical range of motion and neck disability in the patients. The investigators concluded that both techniques were equally effective in managing trigger points in physical therapy practice.
Another study on manual pressure release found that it reduces perceived pain and increases the tolerance of treatment pressure.[vi]
A recent case report by Lydia Juchli, RMT showed us that trigger point therapy on active TrPs can have moderate to long term effects. Her patient had a reduction in pain and functional impairments for up to five weeks. We didn’t find any recent studies that showed long term benefits of manual pressure release.
4. Recommended for reducing active TrPs
We’ve already established above that manual pressure release is effective in reducing active TrPs. But some more studies show that other techniques of trigger point management in physical therapy are also useful to reduce active TrP.
Akbaba et al. (2019) applied ischemic compression on myofascial trigger points in patients with rotator cuff tears. Although they found that this treatment had no significant change in pain, ROM and function, it did reduce the total number of myofascial trigger points. Hence, it’s an appropriate treatment for active TrPs.
5. Combination of PT treatments reduce trigger point pain
Physical therapists rarely apply just one therapy technique to treat patients. That’s because the outcomes improve when a few reliable techniques are used together according to the patient’s condition. The same is the case with trigger point therapy.
Renan-Ordine et al. (2011) did an RCT where they compared the efficiency of trigger point manual therapy and self-stretching with self-stretching alone in reducing plantar heel pain. The results showed a greater improvement in function and reduction of pain in the group that received combined therapy. However, this study could only prove short-term benefits.
Similarly, a 2013 study applied massage and trigger point therapy to treat carpal tunnel. They too found that a combination of treatments is a better approach for resolving trigger points.
Trigger point therapy in PT– In summary
We’ve discussed many research, scientific papers and case studies on trigger point management in this article. While some researches refute the effectiveness of trigger point therapy, there are many more that maintain its usefulness in managing painful symptoms.
It’s better than placebo according to most randomized controlled trials. That could be because TrP has a strong psychological component as well. But multiple studies cited above did also use objective testing instruments such as the pressure algometer to determine the trigger point sensitivity and other outcomes.
While some researches refute the effectiveness of trigger point therapy, there are many more that maintain its usefulness in managing painful symptoms.
It’s better than placebo according to most randomized controlled trials.
Hence, trigger point therapy techniques used in physical therapy are effective. Some techniques are better for certain types of trigger points than others. So the PTs should make the choice of the technique based on individual cases.
Nevertheless, all these techniques can help reduce the pain and disability associated with trigger points.
[i] https://pubmed.ncbi.nlm.nih.gov/9060014/
[ii] https://www.physio-pedia.com/Trigger_Points
[iii] https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4286457/
[iv] https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3529849/
[v] https://pubmed.ncbi.nlm.nih.gov/19121461/
[vi] https://www.bodyworkmovementtherapies.com/article/S1360-8592(05)00022-7/fulltext
