New Insights on Trigger Points

Myofascial release work on “trigger points” in the body has been a hot topic for some time, but much of the evidence supporting the practice is anecdotal. A new study suggests that clinicians may overestimate the presence of these knots.

The goal of this study, published in the Archives of Physical Medicine and Rehabilitation (2016; 97 [1], 67–73), was to use magnetic resonance elastography (MRE) imaging to assess participants’ tissue stiffness. The investigators recruited 65 individuals who were described by clinicians as presenting with “taut bands” (trigger points or knots) resulting in upper-trapezius pain. The researchers wanted to know how accurate the clinicians were in assessing and locating taut bands. To qualify for the experiment, subjects must have experienced pain in those bands for at least 3 months and had the appearance of taut and tender spots in those areas. A physician indicated the location of suspected taut bands on each subject’s skin with a marker.

According to the data, several of the subjects were confirmed to have taut bands. The researchers were able to determine that those bands followed the direction of the muscle fibers. They also learned that the bands were stiffer than surrounding tissues, further validating the presence of trigger points.“One of the more interesting findings in this study was that while the physicians each had more than 20 years’ experience in musculoskeletal medicine, about one-third of subjects they identified as having a taut band were not found to have one on imaging,” the authors said. “Our findings suggest that while clinicians may overestimate, and current MRE methods may underestimate, the presence of taut bands, these bands do exist, can be assessed quantitatively, and do represent localized areas of increased muscle stiffness.”