It is common knowledge that stretching can help elongate muscles and reduce stiffness, but there are cases where stretching can actually worsen the situation and increase pain. Stretching a muscle that is already “knotted” and is pulled taut can further irritate it. It can be helpful to release the trigger point (knot) prior to stretching for ease of movement and better range of motion. Although you can refer your client to a massage therapist specializing in myofascial trigger point work, using trigger point release in a Pilates session can expedite improvement for immediate results.
The pioneers of trigger point research, Janet G. Travell, M.D. and David G. Simmons, M.D., define a trigger point as “a highly irritable localized spot of exquisite tenderness in a nodule in a palpable taut band of muscle tissue.” Since we have multiple muscle fibers and these fibers are bundled together to serve a united purpose of joint movement, some of the fibers can remain in a contracted position without all being affected. Releasing the culprits causing irritation can allow the group to work better as a whole. The nodule is very tender to the touch and will elicit a response of discomfort and/or pain when touched depending upon its severity. The pain can be localized to the trigger point or referred to a seemingly unrelated location.
An excellent user-friendly resource for studio or home use is The Trigger Point Therapy Workbook: Your Self-Treatment Guide for Pain Relief by Clair Davies. This manual takes you through the process of how to find and release the trigger point with diagrams depicting the areas of referred pain. If you want your client to consistently address trigger point release at home, it can be helpful to show your client a picture of the affected muscle and where the referred pain can be found.
Although pressing your fingers into the affected spot can release the tightness, there are tools available that can make this process easier. A tennis ball, Thera Cane, Wooden Knobble, myofascial release balls or foam rollers can all be useful. Doing the work without equipment can improve your ability to find the trigger points by touch, but over time using tools can prevent excessive wear and tear on your hands. In addition, the tools encourage more consistent practice, because your clients are able to use them at home.
Although it seems counterintuitive to press on a spot that provokes pain, the discomfort diminishes once the trigger point has been loosened. The muscle fibers are holding for a protective purpose, which may have been applicable during a situation of stress, excessive load or trauma. Once that situation has changed, the muscle sometimes needs an outside stimulus to break the loop.
It is helpful to have an ongoing dialogue with your client during trigger point release. Since everyone has a different level of pain tolerance, it is worthwhile to have your client communicate with you throughout the process. Let your client know that the pain should register about a “7” on a scale of 1-10 with 10 being the most intense. As you press on the trigger point, you can have your client count you in “5, 6, 7” so you don’t push beyond the appropriate level of tolerance. If you press in the intensity of a 9 or 10, you will not have good results because the body will resist, and, if you do not press hard enough, there will be insufficient pressure for release to occur.
You can also coach your client to inhale and tighten the muscle breathing into the pain and then relax the muscle during the exhalation. Instead of holding the trigger point consistently throughout, pushing on the trigger point on the inhalation and releasing pressure on the exhalation can at times make it easier for the client to let go. You know if the process is working when you continue to press with the same intensity and your client’s perception of the intensity decreases. It also gives the client a level of comfort to know that going INTO the discomfort has actually DECREASED the feeling of pain providing a positive experience.
Trigger point release in a Pilates session is a means to an end. Your objective is to release the offending trigger points, so that the chosen exercise can be performed with greater ease and range of motion. If the work required is extensive, refer your client to a massage therapist trained in this method. Although it does take time to get the “feel” for trigger points, knowing how to release them can provide immediate benefits to your clients.