Trigger Point Therapy - Active, Latent and Transitional Trigger Points

Latent Trigger Points are like land mines - waiting silently under the soil, ready to activate

The article below provides an overview of the different "types" of trigger points. Please see the video above for more information.

Active Trigger Points

Active trigger points can occur directly from an initiating factor (such as repetitive motions) or secondary to another condition, such as arthritis or anything that can induce the energy crisis.

They also result from faulty muscle recruitment patterns.

When a person performs an action—any action—many muscles contract to provide the tension and stiffness required to carry out the task without stressing joints. All the muscles don’t contract at the same time, but in a specific sequence or order.

When “good muscles go wrong,” some muscles contract “too early” and others contract “too late,” with some muscle fibers not contracting at all! This state is called “muscle inhibition.”

Active TrP's tend to generate the well documented referred pain patterns. 

If the active TrPs recur in spite of adequate treatment, look for the perpetuating factor(s).

These are mechanical and metabolic factors that keep the TrP(s) active and produce symptoms. The key to controlling TrPs is control of perpetuating factors.

Perpetuating Factors

Trigger points are activated by acute or chronic overload. Active TrPs may come from a sports injury, inappropriate physical activity, surgery, a fall, an unexpected movement, an auto accident, or a repetitive trauma.

Note however, that even with acute onset TrPs, there may be delay in TrP formation.

Active TrPs can hurt all the time, even at rest. The tendency is to back away from a roaring lion. You restrict your muscle movement and the pain may go away. The trigger point does not; it has become latent.

During the activation process of a TrP, or while it is in the process of becoming latent, spontaneous pain may be present in the area of a TrP, without the typical referral pattern. These are transitional trigger points.

Latent Trigger Points

Latent TrPs are like land mines waiting silently under the soil, ready to activate at any provocation.

Latent TrPs don’t cause spontaneous pain, but they still cause dysfunction. The muscles are still shortened, tight, weak, and in an energy crisis.

Younger people tend to have more active, painful TrPs; older people have more latent TrPs, with restricted ROM and muscle weakness, because, in general, they move less.

They have decreased their range of motion, because it hurts when they stretch TrP-laden muscles.

Then along comes an infection, a fall, or other stressor. Wham! Those latent TrPs activate, and there is an unexpected pain overload.

This may also occur in sedentary people. Often, one event initiates a TrP and another maintains it. For example, a head cold can cause many symptoms, including headache, stuffy sinuses, and a runny nose.

It may also activate TrPs that cause the same symptoms. The TrPs and their symptoms may remain long after the cold is gone.

Indications

The key fact to remember is that latent TrP's do not cause spontaneous pain, but may restrict movement or cause muscle weakness. 

The client presenting with muscle restrictions or weakness will typically become aware of pain originating from a latent TrP only when pressure is applied directly over the point.

In many cases, a “local twitch response” will also be elicited when firm pressure is applied.

Transitional Trigger Points

Trigger points are dynamic in nature. During the activation process of a TrP, or while it is in the process of becoming latent, spontaneous pain (occurring without outside pressure) may be present in the area of a TrP, without the typical referral pattern.

Even when pressure is applied to a transitional trigger point, the pain may only be local.

For example, a temporalis trigger point may cause pain that is restricted to the immediate area, without characteristic referral to a tooth, the eyebrow area, or extended areas of the head.

These transitional TrPs may be missed and the pain misdiagnosed, because the characteristic referral pattern is absent.

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