He had just finished his off-season conditioning and was about to start his senior year as a high school basketball player. His complaint was pain in the front of his shoulder.  He had endured this debilitating pain during the last few weeks of weight training at a local fitness facility but kept it to himself until he had to do something about the pain. Pain medication, a muscle relaxant, two weeks of PT, and rest – nothing relieved his pain.  Now he was desperate.  School would be starting very soon and he needed to be ready to practice. 

I ask him to lie facedown on the table.  His questioning look told me that he thought I was nuts!  After all, the pain was near the front of his shoulder.  How could I work on his pain if I couldn’t touch it? 

I touched a spot on the medial border of his scapula.  He winced.  I asked him to rate the pain on a scale of 1-10, ten being the worst. 

“10!” he said, without hesitation. 

I applied more direct pressure, then some cross-fiber friction for a minute or two.   

“How’s the pain now?” I asked. 

“Gone!” he said, incredulously.  I worked around his upper back and shoulders to assure everything was ok before he got off the table.  He started moving his shoulder in all directions.  He and his dad just stood there speechless. 

I pulled the trigger and stopped the pain. 

His pain was caused by several trigger points in the rhomboid muscles where it attached to the medial border of the scapula. 

Trigger points are hypersensitive knots of tissue that form between other tissue causing contraction of the surrounding soft tissue.  Each trigger point has its own distinct pattern of pain.  There are trigger points possible throughout the body and each one of them, once activated, can cause pain, inflexibility, and can affect the work of other muscles. 

Trigger Point Therapy was pioneered by Janet Travell, MD and her associate,  Dr. Simon.  Dr. Travel served as White House physician during the Kennedy Administration. Both physicians wrote the acclaimed two-volume book Myofascial Pain and Dysfunction: The Trigger Point Manual In 1968.  Many other trigger point resources have been published since but this two-volume set remains the Trigger Point bible. 

It is commonly believed in the complimentary therapy world that trigger points contribute to about 75% of all soft tissue injuries and chronic myofascial pain conditions.  Yet, the traditional medical world chooses to ignore this fact.  Triggers do not show up on MRI’s so they are considered non-existent!  And because most traditional medical personnel focus on the sight of the pain, it stands to reason they wouldn’t acknowledge trigger points. 

Trigger Points exist throughout our muscles. When a muscle is traumatized from an injury or physical or emotional stress, the Trigger Points become 'hot' or active. The belly of the muscle forms an adhesion within the muscle fibers in response to the trauma and creates a "knot." On the cellular level, the exchange of oxygen, fresh blood and the waste removal slows down and lactic acid builds up, causing decreased circulation, inflammation and pain in the area. Because Trigger Points are full of toxins, they feel sore to the touch. 
 
The pain caused by a trigger may actually be in a different place.  For example, if you have pain in your wrist, the pollicus near your elbow has probably shortened; causing the tissues to pull and thus you feel pain in the wrist and not at the elbow. The root of the problem must be addressed in order for the injury to heal.  This is one of the most important considerations for athletes.  Most medical practitioners will focus on the site of the pain.  But the source of that pain may be elsewhere. 

A major problem caused by trigger points is that the tissue cannot be stretched until such triggers are removed.  Strength training does not work, either, as the tissue is too taut.  This is one of the reasons that physical therapy is often unproductive.  If the trigger is removed first, then physical therapy treatments are far more useful and productive.  Stim and ultrasound do not eliminate trigger points. 
 
High school athletes suffer from trigger points for a variety of reasons including improper stretching, overuse, poor hydration and nutrition, stress and fatigue.  Trigger points can be found in hamstrings and quads, often causing knee pain.  Triggers in the shoulders can cause pain in the arms, neck and chest.  Low back and hip pain is often the result of trigger points.  These muscle contractions cause postural problems and poor posture causes injuries.  Athletes try to play through these issues but could improve their performance dramatically once trigger points are identified and erased. 

Athletes should be encouraged by coaches and trainers to include trigger point therapy in their over-all plan to stay healthy and injury-free before they experience pain.  Trigger point therapy is a highly effective preventive program as well as an injury-healing process