When you have muscle pain that nothing seems to help, it's always worthwhile to explore and see if there's a trigger point that's causing all the trouble.

What Are Trigger Points?
Basically, trigger points are muscle knots that are extremely tender to the touch (very little pressure will make you say "ouch!"), and that refer pain elsewhere in the same muscle. They're very common--I don't know any adult who doesn't have some. They are scientifically well documented, though very few doctors seem to know about them. And they can cause significant pain.

They're also very insidious, (or is that perfidious?!) because they refer pain. In other words, the pain that they cause is usually somewhere else in the muscle--not at the location of the trigger point.

For example, I had a pain on the top of my foot that just would not go away. I massaged it, I stretched it, I changed shoes. This went on for several months, with the pain just getting worse. Finally, I explored the front of my calf, about two thirds of the way up, for trigger points. Pay-dirt! I had several. I treated them, and the pain in my foot went away immediately and has never come back. (Not every case resolves this quickly; but a fair amount do.)

The fact that the cause of the pain--the trigger point--is not at the location of the pain can make treatment confusing and difficult. Unless you know about trigger points.

What Is Trigger Point Therapy?
Trigger point therapy is the process of finding likely trigger point culprits for your chronic pain, and then putting deep pressure on that point. A very short, deep massage stroke, repeated about ten times, stretches the highly contracted tissue. Heat applied afterward can help resolve the knot as well.

Trigger points are very sensitive--that's one of main ways I know that I've found one. So trigger point work is uncomfortable, and requires that I maintain close communication with my client. We want to find the pressure level that is therapeutic, but within your tolerance range.

But usually clients have a sense of "Yes! That's the place!" when I locate a trigger point, and welcome the work even though it may be uncomfortable.

Treating Yourself
Trigger point therapy is science, but it's not rocket science. I can easily teach you how to treat yourself at home. This is often necessary for lasting relief from pain.

Here are some great resources for more information:

• The Trigger Point Therapy Workbook, by Claire Davies

• and this great ebook by Vancouver (B.C.) massage therapist Paul Ingraham, Save Yourself from Trigger Points and Myofascial Pain Syndroms.

Always Worth Exploring
In my opinion, trigger point therapy is an incredibly valuable but hugely under-used massage technique. I wish that everyone could be evaluated for trigger points before they have surgery or other invasive or expensive procedures for muscle pain.

It might not be the cause--but isn't it worth exploring every possible conservative treatment option before surgery?