Trigger points are small knots of muscular contraction within a muscle that can cause tension and pull on muscular insertions. This tension and pulling creates pain that radiates away from the source (the trigger point). The muscular knot also reduces circulation and oxygen flow to the area of tension and perpetuates the trigger point. At times, it becomes difficult to distinguish the source of pain (the trigger) from the symptom (the pain). If the symptom is treated rather than the source, pain either continues or recurs. This may be the cause of failed treatment or surgery that focuses on the site of pain rather than the cause of pain.

In the 1983, Travell and Simons published the definitive medical text on trigger point therapy - Myofascial Pain and Dysfuntion: The Trigger Point Manual. Dr. Janet Travell was the White House physician during the Kennedy and Johnson administrations. Dr. Simons was an air force flight surgeon who set the world altitude record for manned balloon flight in 1957. Travell and Simons quote studies in which up to 93% of pain symptoms seen in pain clinics are caused by trigger points. In spite of these numbers, trigger points are poorly understood by the medical community and often not treated.

Several recently published books attempt to take the scientific and medical information from the lengthy 2-volume text by Travell and Simons and arrange it in a more readable format.

Clair Davies wrote The Trigger Point Therapy Workbook in 2004. Davies was a successful piano tuner who eventually developed debilitating pain and a frozen shoulder. Davies developed an interest in trigger points when he was able to self-treat his pain using trigger point massage. Because of his extensive interest in this treatment technique, Davies changed careers to become certified in therapeutic massage and bodywork. He currently specializes in trigger point massage for the treatment of pain.

After several introductory chapters that explain trigger points, each chapter in Davies' self-help workbook focuses on a particular section of the body. The chapter begins with a body map and a list of pain areas. After determining where your pain is located, lists of the muscles whose trigger points commonly refer within that pain pattern are listed. It is recommended by the author that you assess all the listed muscles for the best therapeutic result.

Several chapters in this workbook are particularly relevant for computer users. Chapter 4 addresses head and neck pain. Chapter 5 addresses shoulder, upper back, and upper arm pain. Chapter 6 addresses elbow, forearm and hand pain. Simple anatomical drawings display the muscles, their trigger points and the referred pain pattern. Massage and treatment techniques are also well-illustrated. As an added bonus, Chapter 3 discusses massage technique and methods of self-treating that do no place additional stress on the hand and arm.

This 300 page self-help trigger point guide is well worth the investment. Some of the techniques discussed will require additional equipment such as a tennis ball or a therapy cane to perform without assistance.
Marji Hajic is an Occupational Therapist and a Certified Hand Therapist practicing in Santa Barbara, California. For more information on hand and upper extremity injuries, prevention and recovery, visit Hand Health Resources.