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This book is written for you. It’s divided into sections, each covering a different
aspect of trigger points, and what you can do about them.

Introduction

What are trigger points

Trigger Point Manual
Written by
Why we get Trigger Points
Dr Jonathan Kuttner
Where you get Triggers MBBCh, Dip O&G, FRNZCGP, Dip Sports Med, Dip MSM, FAFMM.

How to Recognise
Triggers
What’s in this Manual?
What’s Coming Next
What trigger points are

Basic cause of trigger points

What symptoms trigger points have

Where trigger points are found

How to recognize trigger point pain

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What are Trigger Points?
Trigger points are an incredibly common cause of chronic muscle pain. They are so common that
most people will have painful trigger points at some stage of their life. These often last only for a
short time.
Introduction
However they can commonly appear as recurrent episodes of pain in the same part of the body.
What are trigger points Occasionally they can cause severe, unremitting pain which is as severe as other causes like can-
cer or nerve pain and may be destructive to any quality in life for that person.
Why we get Trigger Points
The full medical description is myofascial trigger points.
Where you get Triggers
Myo – means arising from skeletal muscle and Fascial- is the fibrous layer over muscle. This is
How to Recognise a strong shiny layer of tissue that acts like ‘glue’ to hold muscles together and coordinate their
Triggers actions. This layer is richly invested with nerves which explain the complex patterns of pain that
occur.
What’s Coming Next
Most people have painful trigger points
at some stage of their life
There is a long history of myofascial trigger points. They were originally described by ancient
Greek texts and were noted throughout the Middle Ages. However they masqueraded under
many names. These include – fibrositis nodule, myelogenosis, non-rheumatic arthritis etc.

They were finally codified by Dr. Janet Travell in the 1970’s. She was a remarkable woman who
was the personal physician to President John F Kennedy and was one of the main people who

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helped him recover from injuries in World War II. She created the name of ‘myofascial trigger
points’ and with Dr. David Simons, mapped out the many myofascial trigger points over the body.

A trigger point is defined as a “hyperirritable locus within a tight band of skeletal muscle.”

But what does this mean?

Introduction

What are trigger points

Why we get Trigger Points

Where you get Triggers

How to Recognise
Triggers

What’s Coming Next

Let’s look a little closer at how muscles work. In the picture above there is a small knot of muscle
– labeled CTrP- this is the myofascial trigger point. When you have a trigger point, your muscle is
in spasm, it is irritable and tender.

It pulls a thin band of taut muscle which runs the length of the muscle fibre. This feels like a
guitar string within the bulk of your muscle.

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Introduction

What are trigger points

Why we get Trigger Points

Where you get Triggers

How to Recognise
Triggers

What’s Coming Next

The picture above is a photomicrograph of a myofascial trigger point within skeletal muscle. In the
lower half you can see parallel bands of so-called I-bands & A-bands.

They are evenly spread. In the upper half there is a central elliptical area where the bands are
squeezed incredibly tightly together. This is the myofascial trigger point. The band of fibres on
either side of this are stretched further apart than normal.

This is where the trigger point is.

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Introduction
The diagram on the right shows that each of these
What are trigger points small areas of spasm is called a ‘contraction knot’.

Why we get Trigger Points Actually a number of these are present in each
myofascial trigger point.
Where you get Triggers
When you run your fingers over a muscle that has
How to Recognise triggers you can feel them as thickened bands,
Triggers ‘knots’ or tight chords like a guitar string

What’s Coming Next At first it may take a bit of practise, but once you
know what to look for, you’ll be able to locate trigger
points reliably.

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Why do we get Trigger Points? The cause of myofascial trigger
points is shown in this picture. The
key structure is the muscle spindle
fibre.
Introduction
This is a nerve arranged in a spiral,
What are trigger points looking and behaving like a spring.
It is found in parallel with your
Why we get Trigger Points muscle fibres.

Where you get Triggers When it is stretched, it fires a

message to your brain.
How to Recognise
Triggers Therefore if the muscle fibre
reaches beyond a critical length, the
What’s Coming Next spindle will fire.

The message then goes up your

nerve to the spinal cord and zooms
straight back to the muscle fibre -
causing it to contract.

The Key Point here is that the cause of trigger points is a natural process in our body. It’s
necessary for muscles to be able to contract quickly as a protection that stops damage to the
muscle, and also to your joints and bones. For example if you trip over, your neck muscles will
tighten immediately to prevent yourself from hitting your head on the ground.

This simple reflex arc and the message from the muscle spindle usually does not go higher. This

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means that the spindle sets the length of your muscle, and controls how tight or flexible the
muscle is.

There are millions of these muscle spindles throughout the body and they are there to allow the
complex movements and postures that your body performs without your conscious thought.
Introduction
Problems (and trigger points) happen when your muscle spindle becomes sensitised - for example
What are trigger points after your have been injured. Then it will not allow the muscle fibre to lengthen at all and will cause
a localised knot of spasm. This localised spasm is the myofascial trigger point.
Why we get Trigger Points

Where you get Triggers

How to Recognise
Triggers

What’s Coming Next

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Where do you get Trigger Points?
This picture shows the point where the
nerve enters your muscle. This is called the
motor end plate and is where Myofascial
Introduction trigger points usually occur.

What are trigger points As we have muscles all over our bodies, we
can also get trigger points all over our
Why we get Trigger Points bodies.

Where you get Triggers Trigger point pain can range from a deep,
dull ache to a sharp, stabbing pain.
How to Recognise
Triggers You can get triggers in your head, jaw,
neck, shoulders, legs, stomach, arms,
What’s Coming Next hands, pelvis, back, thigh, calf and foot.

There are other symptoms trigger points

can cause that can be confused with other problems.

For example triggers can cause:
- Tension headaches
- Tightened muscles which then compress nerves. For example the scalene muscle can compress
the nerve bundle that runs down your arm, causing tingling and numbness in your arm.
- Pain deep in your back/abdomen/pelvis. This can be sometimes mistaken for organ pain
- Tooth pain - several muscles in your head and jaw refer pain into the teeth

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Introduction
This is the motor end plate enlarged. Messages
What are trigger points from the nerve are transferred to the muscle by
neurotransmitters.
Why we get Trigger Points
This means that this part of the muscle is
Where you get Triggers particularly active and therefore more vulnerable to
abnormal spindle fibre activity.
How to Recognise
Triggers

What’s Coming Next This is a special stain showing where the motor
end plates enter the muscle and therefore where
myofascial trigger points are found.

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How do you Recognise Trigger Points?

Trigger points act like the trigger of a gun

Introduction
- when the gun is fired, the bullet causes pain
elsehere. Similarly, when a trigger point is ac-
What are trigger points
tivated, it sets off a pain pattern - sometimes
causing pain far from the site of the trigger.
Why we get Trigger Points
Each pain pattern is specific to that trigger
Where you get Triggers
point. There are hundreds of triggers scattered
around the body. Remarkably, each trigger
How to Recognise
point pattern has been shown to be consistant
Triggers
over thousands of people.
What’s Coming Next
This is a trapezius muscle myofascial trigger
point and the red area is the specific pain
distribution pattern.

As you can see, this trigger causes pain that

shoots up into your neck and base of your
skull. This is a very common trigger point.

Once you have learned the patterns, then

finding the triggers becomes much easier.

Trapezius Muscle Trigger point and Pain Pattern

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Introduction
Here is another common pain pattern from a gluteus
minimus myofascial trigger point. Note how the pattern
behaves like sciatica. Sciatica is usually caused by
irritation of the sciatic nerve by a prolapsed disc.

However in this case a myofascial trigger point causes the

pain pattern. A MRI could show a normal disc and
What are trigger points treatment of the trigger point would stop the pain.

Why we get Trigger Points It’s important to note here that trigger points can
occur in conjunction with other problems. For example,
Where you get Triggers this person may have a prolapsed disc, as well as gluteus
minimus trigger points.
How to Recognise
Triggers To gain proper pain relief, you would need to treat both
problems.
What’s Coming Next
You can also get clusters of triggers. What usually
happens here is that one or two primary triggers set off
pain and tension.

Secondary triggers then form around the painful area.

When this happens, all triggers need to be found and
Gluteus Medius Muscle deactivated in order to fully release the area.

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A simple way to recognise trigger point is this - by pressing on an active trigger point, you should
be able to recreate the pain pattern.

For example, if you find the trapezius trigger from the picture on page 10, if it’s active and you
press on it, you should feel pain up in your neck.
Introduction
It’s always important to conduct a full medical examination for other underlying problems. Chest
pain can be caused by trigger points in the pectoralis major. It can also be caused by heart
What are trigger points
problems, so you need to rule that out first.
Why we get Trigger Points
Once you’ve switched off a trigger point, it can return. Usually switching off a trigger turns it from
an active to a latent trigger point.
Where you get Triggers
If a trigger point is latent, then it is sitting there like an accident waiting to happen. Continuing to
How to Recognise
stretch and treat the site of a latent trigger point will help prevent it coming back.
Triggers
Stiffness can often be a symptom of latent trigger points, so treating them proactively can improve
What’s Coming Next
flexibility. As with most muscle related problems, gentle, regular exercise, stretching and good
nutrition can help prevent triggers coming back.

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What’s Next?
If you got this manual as part of my free email course, here’s what you’re going to get next:

Introduction
Message 2 - Great free tool to easily Find Triggers anywhere in your body
What are trigger points Message 3 - ‘Getting Rid’ of triggers - why you can’t and why it’s a good thing
Message 4 - 6 Steps to help Stop Triggers Coming Back
Why we get Trigger Points Message 4 - Are You Creating Triggers? (How to make sure you aren’t)
Message 5 - 3 Core Muscle Strengthening Exercises
Where you get Triggers Message 6 - The Really Advanced Stuff
Message 7 - How to Switch Off Triggers - Pain Free Technique
How to Recognise
Triggers If you haven’t signed up for this free email course, here’s where you can go to sign up:

What’s Coming Next The Life After Pain Trigger Point Treatment Email Course

Best Regards,

Dr Jonathan Kuttner.
MBBCh, Dip O&G, FRNZCGP, Dip Sports Med, Dip MSM, FAFMM.

Life After Pain

 DISCLAIMER

The information contained in this manual is based on sources and information reasonably believed to be accurate as of the
time it was recorded or created. However, this material deals with topics that are constantly changing and are subject to ongo-
ing changes related to technology and the market place as well as legal and related compliance issues. Therefore, the complete-
ness and current accuracy of the materials cannot be guaranteed. These materials do not constitute legal, compliance, medical,
Introduction
or related advice.
What are trigger points
The end user of this information should therefore use the contents of this manual and the materials as a general guideline and
not as the ultimate source of current information and when appropriate the user should consult their own accounting, con-
Why we get Trigger Points
struction or other advisors.
Where you get Triggers
Any case studies, examples, illustrations cannot guarantee that the user will achieve similar results. In fact, your results may
vary significantly and factors such as your health, medical condition and many other circumstances may and will cause results
How to Recognise
to vary.
Triggers
Privacy Policy: I never sell, rent, trade or lend any information about my subscribers to anyone, for any reason, whatsoever. I
What’s Coming Next
assure you that your privacy is respected and well protected.

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