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Alexander Technique and Trigger Points - Dr. Jonathan Kuttner


Trigger Point Therapy - Where to Start?

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Poor posture is a powerful “activator and perpetuator” of myofascial trigger points

All muscles contain a blend of type 1 and type 2 fibers (Janda 2005; Lewit 1999). This has a direct correlation with how chronic symptoms might develop if left untreated.

Type 1 fibers are postural and tend to respond to stress or overuse by shortening and becoming hypertonic.

A trigger point in a muscle with a high percentage of type 1 fibers may often take longer to respond to treatment.

Poor posture is a powerful “activator and perpetuator” of myofascial trigger points (Simons et al. 1998) and is always worth considering in chronic trigger point syndromes.

Postural muscles tend to have a greater percentage of type 1 fibers; this characteristic, as discussed, may lead to a more resistant type of trigger point.

Human beings are four-limbed animals, and like our cousins, we are designed to move around and hunt for food. I am sure that if one put a gorilla in a chair all day, it would get a bad back!


Trigger Point Therapy - Ideal Posture for the Workplace

Ideal sitting posture for those who work with computers - failure to take posture seriously can lead to long term injuries.


Changing Habits in the Workplace

It is a fact that in the developed world many occupations involve prolonged sitting, often at a computer screen.

Ergonomics is a booming industry, focusing on the interactions of people and their working environments; however, not all workplaces can afford to implement proper ergonomic interventions.

For many people, long and monotonous days spent in front of a computer screen often lead to chronic and maladapted postures.

Where possible, it is essential to identify the postural abnormalities and how they impact the patient’s symptoms, and offer to remedy the situation via ergonomic advice, treatment, and/or exercise.

The most common mechanical maladaptations are:

  • Head-forward posture (upper crossed pattern, Janda)

  • Round shoulders (upper crossed pattern, Janda)

  • Head to one side—telephone posture

  • Occupational/ergonomic stressors

  • Slouched standing (lower crossed pattern, Janda)

  • Slouched sitting (e.g. computer screen/ergonomics)

  • Cross-legged sitting

  • Habitual postures

  • “Sway-back” posture (lower crossed pattern,


  • Driving position

  • Scoliosis

  • Joint hypermobility

  • Lifting/carrying

  • Primary short lower extremity (PSLE)


Trigger Point Therapy - Upper Crossed Pattern

Upper Crossed Pattern


Postural Trigger Points

Trigger points are common in the following postural structures: upper trapezius, levator scapulae, sternocleidomastoideus (SCM), erector spinae, musculoligamentous apparatus of the lumbar spine, gluteus medius, and gastrocnemius/soleus complex.


Trigger Points - Postural Muscles


Postural Trigger Points and “Cross Patterns”

Osteopathic, chiropractic, and other physical therapeutic modalities have all observed “cross-patterned” relationships within the body, from upper to lower and left to right.

Janda (1996) recorded the two most common “crossover” postural strain patterns—upper and lower. Myers (2001) has further explored and developed these observations in his seminal book Anatomy Trains.

These myofascial strain patterns have a profound effect on the pathogenesis and chronicity of trigger point development. 


Trigger Point Therapy - Lower Crossed Pattern

Lower  Crossed Pattern


Upper Crossed Pattern Syndrome

This can be observed in the “round-shouldered, chin- poking, slumped posture,” which also compromises normal breathing.

In such cases, pain is often reported in the neck, shoulder, chest, and thoracic spine (these areas are often restricted). An oblique cross can be drawn through the glenohumeral joint, indicating the functional “crossover” changes in muscular relationships.

Lower Crossed Pattern Syndrome

This can be observed in the “sway-back” posture, with weak abdominals and gluteals and overtight erector spinae, quadratus lumborum, TFL, piriformis, and psoas major.











This trigger point therapy blog is intended to be used for information purposes only and is not intended to be used for medical diagnosis or treatment or to substitute for a medical diagnosis and/or treatment rendered or prescribed by a physician or competent healthcare professional. This information is designed as educational material, but should not be taken as a recommendation for treatment of any particular person or patient. Always consult your physician if you think you need treatment or if you feel unwell. 




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