AAIMT 1 Revised: April 22, 2010

Trigger Points Referral Sensations

TRIGGER POINTS AND REFERRAL SENSATIONS


A trigger point is usually found within muscle tissue, but occasionally it may be found within
tendons, fascia or even in periosteum. There will be a taut band of muscle fiber that is quite
sensitive or tender to the touch. Within that taut band will be a small, hard lump. This nodule is
the epicenter of the trigger point.

This trigger point will likely refer a sensation at a distance in the body. An example of this
would be a trigger point located in an infraspinatus muscle. The person will explain their
discomfort as there being pain in the front of their shoulder. They will most likely point to their
anterior humeral head. So, in this case, the actual trigger point is in the posterior shoulder,
actually on the scapula while the sensation is to the front of the shoulder.

That is the interesting thing about these trigger points; they each have their own referral pattern
that is unique. Most of us show the same patterns, although a person can have a very different
referral pattern from the norm.

Another very important fact about trigger points is that they have the capacity to change
physiology at the referral site. This is why they must be deactivated. Mostly this change will be
a painful sensation, but it could be far more than that. This fact has the potential to be a
dangerous condition for a person.

Muscle with trigger points will not be able to stretch to its full range due to sensation, usually
pain. The trigger points will also restrict a muscles strength and endurance.

There are many types of trigger points, each has slightly different characteristics. First there are
Active Trigger Points. An active trigger point is one that is referring sensation in a distinct
pattern either all of the time or upon use of its muscle host.

Another type is a Latent Trigger Point. This trigger point only sends sensation when pressed
upon. It may become active at any time depending upon the persons stress level versus daily
stress, injury, or overuse.

There are Associated Trigger Points too. These are associated to other trigger points. One type
is a Satellite. This happens when a trigger point in one muscle refers to a different muscle. Due
to the constant stimulation at this different muscle with referral sensation, it too develops a
trigger point. The muscle with the trigger point that controls the satellite is considered a Key
Trigger Point.
AAIMT 2 Revised: April 22, 2010
Trigger Points Referral Sensations


Muscles with Corresponding Key Trigger Points and Satellite Trigger Points

Key Trigger Points Corresponding Satellite Trigger Points

Sternocleidomastoid Temporalis
Masseter
Lateral Pterygoid
Digastric
Orbicularis Oculi
Frontalis

Upper Trapezius Masseter
Splenius Capitis and Cervicis
Semispinalis Capitis
Levator Scapulae
Rhomboid Minor
Occipitalis

Lower Trapezius Upper Trapezius

Scalenes Serratus Posterior Superior
Pectoralis Major and Minor
Deltoid
Extensor Digitorum Communis
Extensor Carpi Radialis and Ulnaris
Triceps Brachii Long Head

Infraspinatus Anterior Deltoid
Biceps Brachii

Latissimus Dorsi Triceps Brachii Long Head
Flexor Carpi Ulnaris


Trigger points become activated directly by acute overload, overwork, fatigue, direct impact
trauma, and radiculopathy. They may become activated indirectly by other existing trigger
points, visceral disease, arthritic joints, joint dysfunctions, and emotional distress.

With enough rest, along with the absence of perpetuating factors, an active trigger point may
become latent on its own. Pain and other sensations disappear, but can reactivate with new
stress. This is perhaps why we see recurrent episodes of the same symptoms over a period of
time with some folks.

As said prior, trigger points usually set up within somatic tissue, they are actually capable of
setting up within any of the bodys soft tissues and visceral organs. Also, most trigger points
AAIMT 3 Revised: April 22, 2010
Trigger Points Referral Sensations

refer from the trigger point in somatic tissue into a referral area also with somatic tissue.
However, it is possible that a trigger point may refer into any area of soft tissue or visceral organ
in the body. There are four distinct patterns of trigger points to referral areas:

From somatic tissue into somatic tissue
From somatic tissue into a visceral organ
From a visceral organ into somatic tissue
From a visceral organ into a visceral organ


When treating trigger points the tissues must be quickly warmed, thumb stripped, fractioned, and
then trigger point pressure is applied. There is a time factor involved in this treatment. When
holding a trigger point trying to alleviate or inactivate it, never hold for longer than 15 18
seconds. Holding for a longer period of time will actually fatigue the nerves. If the pressure is
too much, it will over stimulate the nerves. Too light of pressure will have no effect what so
ever on the trigger point. This work is nothing like a myofascial release of tissue.


This course is for the purpose of the student becoming familiar with the usual pattern of trigger
points within muscles along with the usual pattern of referral from each. Please go to your
Moodle while you are using your Neuromuscular Therapy Manual. You will be discussing
various muscles with trigger points and what you imagine the sensation sent from each trigger
point might feel like to the person who has this condition. Also discuss how easy or difficult it
might be to find the muscle due to its position/depth in the body.



As an example, on page 63 is Figure 5-2 which shows trigger points in the two obliquus capitis
muscles of the suboccipital group. The diagram also shows that the two trigger points refer in
the same pattern to the same place on the head. I might log onto moodle as:

Trigger points in the two obliquus capitis muscles within the suboccipital group refer to the same
area of the head (the side of the head from the eye back past the ear. I imagine that the referral
area will feel like a headache behind the eye and across the lateral head area. It might hurt just to
lie on the side with the head on a pillow.

I can see that it will take time to actually get to these trigger points as the suboccipital muscles
are the deepest of the cervical muscles that attach to the skull. It will also take time as these
small muscles are usually quite sore.



Please choose 20 muscles from the list below and comment like the example given above on
each muscle. Your list must be thorough in order to receive full credit. There is NO discussion
forum with this assignment.

AAIMT 4 Revised: April 22, 2010
Trigger Points Referral Sensations


Muscles Page #

Levator Scapula 64
Sternocleidomastoid 66
Scalenes 68
Occipitalis 74
Frontalis 77
Temporalis 79
Masseter 80
Medial Pterygoid 82
Lateral Pterygoid 83
Trapezius 104
Splenii 107
Supraspinatus 109
Infraspinatus 111
Teres Minor 113
Latissimus Dorsi 115
Teres Major 117
Rhomboids 119
Deltoid 121
Serratus Posterior Superior 123
Pectoralis Major 137
Pectoralis Minor 140
Biceps Brachii 164
Brachialis 167
Triceps Brachii 169
Brachioradialis 171
Supinator 173
Pronator Teres 191
Adductor Pollicis 192
Opponens Pollicis 192
Quadratus Lumborum 216
External and Internal Obliques 219
Transverse Abdominis 221
Rectus Abdominis 223
Iliopsoas 227
Gluteus Maximus 246
Gluteus Medius 248
Gluteus Minimus 250
Piriformis 252
Biceps Femoris 255
Semimembranosus and Semitendinosus 255
Tensor Fascia Latae 257
Rectus Femoris 259
Vastus Intermedius 259
AAIMT 5 Revised: April 22, 2010
Trigger Points Referral Sensations

Vastus Medialis 259
Vastus Lateralis 259
Pectineus 266
Adductor Brevis and Longus 267
Adductor Magnus 268
Tibialis Anterior 286
Peroneus Longus and Brevis 298
Gastrocnemius 301
Soleus 303
Tibialis Posterior 308
Popliteus 310


Thats it folks! This then begins your journey into trigger points. I hope this makes you become
curious about them and you begin to really read the first four chapters of your NMT Manual.