Acupuncture for Trigger Points
Learn how to release tight muscles and relieve muscle tension
Pain is a common occurrence in our daily lives. According to the Journal of Pain, 11% of Americans suffer from daily pain and over 126 million Americans reported feeling pain in the last 3 months. When we are in pain, our quality of life decreases and we are unable to do the things we want to do. Muscle tightness and trigger points are common reasons that people feel pain and are often misdiagnosed.
Learn how trigger points form and how acupuncture can be effective for releasing trigger points and relieving pain naturally.
How do muscles work?
When we think of muscles, we are generally talking about skeletal muscle. They act voluntarily unlike smooth and cardiac muscle. Skeletal muscle is made up of elastic-like muscle fibers and most muscles attach to bones via tendons. When a muscle is activated via motor neurons, the muscle contracts, which means it shortens or brings the attachment sites closer together. After a contraction is complete, the muscle fibers lengthen and relax, or reduce tension. The image below shows how the biceps and triceps work together to flex and extend the elbow.
Source: http://www.projectnext.net/wp-content/uploads/2017/12/biceps-and-triceps.jpg
Why do muscles get tight?
Muscles can get tight for a number of reasons:
Being stuck in a contracted, lengthened or neutral state. A muscle can get stuck in any of its phases, and when that happens there is restricted movement and reduced blood flow because the muscle is not functioning the way it’s supposed to. This can happen from things like poor posture, being in one position for too long (like sitting), repetitive motions, or over use. Since muscles work together with antagonist muscles (ones that perform opposite actions - like biceps and triceps above), there will also be muscles that remain in the opposite flaccid state that also become weak and have trouble firing. It is important to assess antagonist muscles to look for imbalances that can lead to further pain and restricted range of motion. Over time these imbalances can lead to structural changes in the body since muscles attach to bones and can pull them out of alignment.
Lack of hydration and nutrients. Muscle fibers require hydration and calcium to contract. If those things are deficient or lacking there can be pain in the form of cramping when the muscle tries to contract and also difficulty lengthening due to a lack of nutrients.
Due to fatigue and small tears in the muscle. Overuse of muscles leads to depletion of nutrients which can lead to tight muscles. Exercising past our muscle’s capacity will often lead to small tears in the muscles which is often felt as Delayed Onset Muscle Soreness (DOMS). This usually goes away in 48-72 hours following exercise and can be helped by things that promote blood circulation like warmth, light movement, massage, or acupuncture.
Source: https://www.acefitness.org/education-and-resources/lifestyle/blog/1478/why-do-muscles-tighten-up
Why does muscle tightness cause pain?
Muscle tightness can cause pain due to the following reasons:
Ischemia: Tight muscles can restrict blood flow, leading to oxygen and nutrient deprivation, causing pain and discomfort.
Trigger points: Tight muscles can develop knots or trigger points, which are hyperirritable bands of muscle tissue that cause specific local or referred pain when compressed.
Inflammation: Tight muscles can cause micro-tears in muscle fibers, which leads to inflammation and pain.
Nerve compression: Tight muscles can put pressure on nearby nerves, causing pain, numbness, and tingling in the affected area.
Joint compression: Tight muscles can cause imbalances in the body, leading to improper alignment of joints and increased wear and tear, causing pain and discomfort.
Therefore, treating muscle tightness and maintaining proper muscle flexibility can help reduce the risk of pain and injury.
Acupuncture and dry needling offer an effective way to treat all of the reasons that muscle tightness can cause pain in the same treatment.
What is a trigger point?
According to Dr. Janet Travell, a trigger point is,:
“a hyperirritable spot in skeletal muscle that is associated with a hypersensitive palpable nodule in a taut band. The spot is painful on compression and can give rise to characteristic referred pain, referred tenderness, motor dysfunction, and autonomic phenomena.”
The term "trigger point" was first introduced by Dr. Travell in the 1940s, and it refers to a specific type of muscle pain that results from the contraction and tightness of a specific muscle. The idea of trigger points is based on the theory that they are points of local pain or tenderness in a muscle that can cause pain elsewhere in the body, known as referred pain. This theory has been widely accepted in the medical community and is used in the treatment of various muscle and joint pains. Over the years, various techniques and therapies have been developed to treat trigger points, including massage, acupuncture, dry needling, stretching, and physical therapy.
As mentioned above, when a muscle is tight or in a contracted state for a long period of time, it stops going through the cycle of contracting and relaxing which means that less blood flow and nutrients are being delivered to the muscle. This leads to knots or tight bands in the muscle that can cause pain. A trigger point is often felt as a tight painful knot in a muscle, and when pressed, reproduces the pain that may have seemed unrelated.
Finding trigger points according to Dr. Travell:
“Clinically, the TrP is identified as a localized spot of tenderness in a nodule in a palpable taut band of muscle fibers. Restricted stretch range of motion and palpable increase in muscle tenseness (decreased compliance) are more severe in more active TrPs. Active TrPs are identified when patients recognize the pain that is induced by applying pressure to a TrP as "their" pain.”
Poor posture is a common “activator and perpetuator” of myofascial trigger points and is important to consider in chronic pain conditions. Some postural issues are caused by things like having the tilted head forward (cell phone use), slouching, driving position, computer screen placement, desk posture, sleep position, and lifting/carrying.
Common trigger points related to posture include the upper trapezius, levator scapulae, gluteal, paraspinal, lumbar muscles, gastrocnemius, and soleus muscles.
Source: Travell, J. G., & Simons, D. G. (1999). Travell & Simons' myofascial pain and dysfunction: The trigger point manual (2nd ed., Vol. 1, Upper Body). Baltimore, MD: Williams & Watkins.
What causes trigger points to form?
Trigger points are thought to form due to a combination of physical, chemical, and psychological factors. Some common causes include:
Physical trauma: Trauma such as a sports injury, car accident, or repetitive strain injury can lead to the formation of trigger points.
Overuse: Repetitive movements or postures, such as typing or playing a musical instrument, can lead to trigger points forming in the muscles used.
Stress: Emotional stress can cause muscle tension and increase the likelihood of trigger point formation.
Dehydration: Dehydration can lead to muscle tightness and trigger point formation.
Nutritional deficiencies: Deficiencies in certain vitamins and minerals, such as vitamin D and magnesium, can contribute to muscle tension and trigger point formation.
Poor posture: Maintaining poor posture for prolonged periods of time can lead to trigger points forming in certain muscles.
Chronic disease: Certain chronic diseases, such as fibromyalgia, can increase the likelihood of trigger point formation.
It's important to note that trigger points can also be caused by a combination of these factors and can be unique to each individual.
What chemicals are involved in trigger points?
Trigger points are thought to form as a result of increased accumulation of various substances within muscle fibers. These substances include:
Lactic acid: Accumulation of lactic acid due to muscle overuse or inactivity can lead to the formation of trigger points.
Calcium: Increased levels of calcium in the muscle fibers can cause muscle contractions and contribute to trigger point formation.
Substance P: Substance P is a neurotransmitter that is involved in the transmission of pain signals. Increased levels of substance P within muscle fibers can amplify pain sensations and contribute to trigger point formation.
Myosin: Myosin is a protein that is responsible for muscle contraction. In trigger points, myosin can aggregate and cause muscle fibers to become abnormally contracted.
Other chemicals: Other chemicals such as cytokines and neuropeptides have been implicated in the formation of trigger points, but more research is needed to fully understand their role.
These chemical changes in the muscle fibers lead to the activation of pain receptors, which in turn cause the sensations of pain associated with trigger points.
Bradykinin, Substance P, and Calcitonin Gene-Related Peptide (CGRP) are three chemical mediators that are thought to be involved in the development and maintenance of trigger points. Bradykinin is a potent pain-inducing chemical that increases blood flow and causes increased sensitivity to pain. Substance P is another chemical involved in pain transmission and is believed to be involved in the development of chronic pain conditions. CGRP is a peptide that is involved in pain signaling and is also thought to play a role in the development of chronic pain.
These chemicals are thought to be released from nerve endings near the trigger point and contribute to the sensitization of the trigger point, leading to the development of pain and discomfort. Additionally, the release of these chemicals can also cause local inflammation, which can further contribute to pain and muscle tightness. Overall, the involvement of these chemicals helps explain why trigger points can cause chronic pain and why they can be difficult to treat.
Trapezius Trigger Point - Example
The trapezius muscle is one of the most common trigger points that I see in my practice. Patients will complain about things like tension or stress headaches, neck, and upper back pain. It is often caused by postural issues from excessive cellphone and computer use. I see many patients with right sided trapezius trigger points from using the mouse at their computer. Things like carrying a bag on one shoulder can also cause trapezius trigger points.
The diagram below shows areas of likely trigger points for the trapezius muscle. The blue dots represent possible trigger points, while the red areas represent the referral patterns and areas that the patient will be experiencing pain.
Source: Niel-Asher, S. (2014). The concise book of trigger points: A professional and self-help manual. Chichester, England: Lotus Publishing.
Can acupuncture release trigger points?
Yes. Acupuncture releases trigger points by finding the most tender and tight band of muscle and using an acupuncture needle to poke the muscle and get it to involuntarily contract. Many acupuncture points correspond with areas where trigger points form so there is some link between ancient Chinese medical theory and more recent trigger point findings. Releasing a trigger point gets the muscle out of the shortened state and usually after a few contractions it softens and remains in a more elongated and relaxed state. As an acupuncturist I can feel the resistance at the needle soften as trigger points and muscles are being released. Some patients describe the feeling as “popping a tension bubble” or “melting away tightness and tension.”
What happens when a trigger point is released?
Trigger point release causes the muscle to contract or spasm involuntarily out of a tight, shortened state into a more relaxed and healthy state. After a trigger point release, the muscle tissue will feel more supple which will improve range of motion, promote circulation to the local tissue, and reduce pain. When muscles are really tight they are unable to function properly, and blood flow and nutrient flow is restricted through the muscle.
Is dry needling the same as acupuncture?
Trigger point acupuncture is also known as “dry needling,” which is a term coined by physical therapists to attempt acupuncture without the same rigorous training that an acupuncturist goes through. Some states allow physical therapists to practice acupuncture by calling it dry needling and claiming that because they are not working with energetic Chinese medicine principles that it is not acupuncture, even though they are using acupuncture needles and inserting needles in textbook acupuncture points using techniques that were described for muscle release thousands of years ago.
Most states have very lax requirements before a physical therapist can use an acupuncture needle to perform dry needling - often less than 100 hours or just a few weekends. Their training generally involves needling each muscle once or twice before they are “certified” to practice on real patients without having seen one in a supervised setting while putting together an assessment, diagnosis, and treatment plan.
A 2020 survey of dry needling by physical therapists found that 78% of PTs that utilize dry needling only treat 0-3 patients a day and that 67% of the treatments were only 15 minutes or less in duration.
In contrast, acupuncturists have over 1,000 hours of hands on training during their 3 years of training, including treating patients in a supervised setting. Acupuncturists that are training in the trigger point acupuncture or dry needling technique perform needling treatments on all of their patients and treatments are often 30-60 minutes long and include a more holistic assessment of a patient’s issue.
Ultimately, it is up to patients to decide if they want treatment from practitioners with just a few weekends of training that only utilize dry needling for a small fraction of their day, or from practitioners that specialize in using needles in their treatments and spend their whole day practicing acupuncture and dry needling.
How many acupuncture treatments do I need to release trigger points?
Some trigger point conditions may resolve in one treatment while others may need five or more treatments for the muscle to reprogram itself. If it is a chronic condition and there are ongoing lifestyle factors that contribute to the issue it can take more time or reoccur if treatment is not frequent enough. There can be soreness in the muscle for up to 72 hours after trigger point release that feels like the muscle soreness after a workout.
What should I do after a trigger point acupuncture treatment?
It is recommended to apply warmth and engage in gentle movements in the days following trigger point release to help reduce soreness and promote blood circulation in the affected area. When a muscle is pain-free and unrestricted, it can move in its full range of motion will helps the body’s structural alignment.
What else can I do to relieve trigger point pain?
It is important to identify the lifestyle issues that may have led to the trigger point and referral pattern formation. A muscle can return to its normal state but if the factors contributing to the trigger point remain, it is likely that it will return at some point in the future. Some ways to help prevent trigger points from returning are to avoid being in one position (like sitting or twisted) for a long time, focusing on good posture, avoiding overuse, and performing exercises to keep the muscle in a neutral, elastic state. Physical therapy and strength training can help improve range of motion and strengthen imbalanced areas in conjunction with acupuncture.
Acupuncture treatments for trigger points often include traditional Chinese acupuncture points coupled with local trigger point release. Electroacupuncture, cupping, gua sha, external herbal liniments, and internal Chinese herbs can also be used during treatment if needed.