What is a trigger point (or Knot)?

I get asked what a trigger point is on almost a daily basis.

For that reason I thought it would be best to write a short post with some basic information on trigger points.

What is a trigger point?

In the most simple terms a 'trigger point' is a section of muscle that has gone into a localised spasm. This spasm causes the muscle fibres in that area to become contracted.

Why do trigger points develop?

Trigger points can develop for a number of reasons but the most common cause are prolonged poor posture, acute injury or poor biomechanics.

Where do triggers points most commonly occur?

Trigger points can occur all over the body, however the most common area I personally treat is in the neck and shoulders. The calves or gluteus are another area I see on a regular basis.

Why do trigger points cause pain?

Triggers points cause pain in two ways.

The first is due to mechanical pressure that is caused by the tension in the trigger points.

The second is due to chemical irritation, due to the build up of lactic acid (and other waste products) in the muscles.

How can trigger point be treated?

Firstly the underlying reason for the trigger points development must be addressed. For example poor posture must be corrected.

Secondly trigger points respond well to (relatively) deep pressure. Trigger point therapy is very effective as the 'mechanical' pressure will be released. Alongside this extra lactic acid can be removed using varying soft tissue techniques.

Neck and Shoulder Pain? Read this!

***See below for a free printable exercise sheet to reduce pain and improve posture***

General neck and shoulder pain is one of the most common complaints I see in the clinic.

A significant percentage of this neck pain is related to poor posture.

The type of posture I'm specifically talking about is the 'hunched over the computer' type posture we all have a tendency to fall into.

The upper body is hunched, the shoulders are rounded and the head is forward (see the 'evolution of man' picture below).

Unfortunately we ALL spend far to much time in postures similar to this.

We are most at risk of this type of postural pain when we are driving, working at our desk and sitting on the sofa reading.

With many people this type of posture has become habitual.

It can become 'difficult' or 'hard work' to sit with correct posture.

This is because the body has adapted over time; poor posture has become the 'default' option for the body.

Poor posture has now become the 'easy' option to adopt.

The problem with this type of posture is that over time it causes huge imbalances in the muscular tissue around the neck and shoulders.

The chest muscles become tight and shorted, the muscles between the shoulder blades become weak and lengthen.

The knock on effect of these changes can lead to several problems.

These problems can range from the build up of trigger points in the muscles, nerve compression around the neck and shoulder, altered respiration, impinged blood supply as well as extra stress on the discs and joints in the neck.

The list of potential problems goes on and on.

The good news is that in many cases pain around the neck and shoulders can be resolved

successfully by simply focusing on improving your posture.

There are a number of practical steps that can be taken to gain some balance back in the shoulders and neck.

As a start I have included a sheet below of exercises specifically selected to reduce pain and improve posture in the upper body.

There are 4 exercises on the sheet, which includes both stretching and strengthening exercises.

These exercise are great if you have general neck and shoulder stiffness, if you have acute pain

they may not be suitable for you.

The complete exercise plan should take no longer than 15 minutes in total and should be performed every day (ideally in the evening).

Please print a copy off and put it up somewhere in your office or home where it will remind you to perform them daily.

Warning: DO NOT complete these exercises if your pain is high (or very acute).

Click here for a printable pdf sheet with 4 simple exercises that you can perform daily to improve your posture and reduce your neck and shoulder pain.

NB. This is a general program, more specific exercises and treatment methods may need to be used for differing issues however this is a good starting place for most postural based problems.

As always if you have any questions about your neck and shoulder pain or more specific questions about the exercise plan please do email.

(Evolution of man poster - are we going backwards?)

ACL Rupture? What is it & what should you do?

The ACL is the Anterior Cruciate Ligament, which is one of the four major stabilising ligaments in the knee.

The ACL prevents the lower leg bone (the tibia) translating forward on the femur (the upper leg bone). A complete rupture of the ACL will mean the ligament has completely separated, leaving the knee in a very unstable state.

A complete rupture can be diagnosed by a Physiotherapist or Sports Therapist in the clinic - this is done through a physical examination. However this diagnosis will often be confirmed with additional imaging (scan).

The injury typically occurs when the foot is in contact with the ground and there is a twisting force at the knee.

***Here Micheal Owen ruptures his left ACL in the 2006 World Cup match against Sweden. Watch the youtube clip here.

Symptoms of the injury include:

• A loud pop / crack at the time of the injury
• Immediate swelling at the knee
• A feeling of instability in the knee
• The knee giving way
• Problems fully straightening the knee
• Tenderness on palpation of the front and inside aspect of the knee

If there has been a complete rupture of the ACL, surgery will be required in most cases. The elderly and the less active may avoid surgery, however most reasonably active people will be advised to have surgery. The recovery time following an ACL rupture, will vary but can be any where from 6 months to as long as 12 months.

The recovery time will be dependent upon the surgeons approach and whether any other structures such as the knee cartilage or other ligaments were also damaged in the injury.

Rehabilitation following surgery will focus on reducing the swelling, increasing the range of motion and restoring full strength around the knee.