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An In-Depth Guide to Neuromuscular Therapy:
Expert Trigger Point Massage in Los Angeles

Trigger Point (TrP): A focus of hyperirritability in a tissue that, when compressed, is locally tender and, if sufficiently hypersensitive, gives rise to referred pain and tenderness and, sometimes, to referred autonomic phenomena and distortion of proprioception. Types include myofascial, cutaneous, fascial, ligamentous, and periosteal trigger points.

Trigger Point Massage
Serving in

Los Angeles | West Hollywood 
| Beverly Hills

If you're experiencing pain from trigger points or feeling like a pinched nerve, a Neuromuscular Massage Therapist near you may be able to help by using precise massage to reduce muscle tension and pressure. Let me assist you in finding the right painful spot for your relief. Neuromuscular techniques can provide a non-invasive solution for treating conditions such as Myofascial Pain Syndrome and Pinched Nerve for pain management. Consider this effective and natural treatment option if you're in Los Angeles and seeking relief from nerve pain and discomfort.

Specialty Massage Therapy for Trigger Points is also known as Neuromuscular Therapy.

Treatment Techniques: Trigger point massage therapy can involve applying sustained digital pressure on identified TrPs to inactivate them. This might also include specialized techniques like cross-fiber flat, deep traverse friction, or pincer palpation.

What is Neuromuscular Therapy?

Neuromuscular Therapy is a therapeutic approach that aims to manage, rehabilitate, and prevent pain. This medical massage therapy uses deep-tissue massage techniques to reduce soft tissue pain, pinched nerves, myofascial pain syndrome, trigger points, and microscopic spasms near the junction where the nervous system communicates with a muscle. Trigger points can cause pain, weakness, and discomfort in an area of referred pain.

Neuromuscular therapists use manual techniques to promote healthy neuromuscular junction function, which helps break the stress-tension cycle. Doing this encourages a parasympathetic response in the body, reducing resting muscle tension and spasms. Additionally, these techniques facilitate the removal of metabolic waste products from muscle tissue fibers, which can irritate nerves.

Manual Trigger Point is a non-invasive and non-pharmacological pain management technique that effectively addresses pain without requiring injections. It is considered the best type of massage therapy for treating painful spots as it targets the root cause of the pain by addressing muscular imbalances, pinched nerves, and myofascial pain.

Exploring Myofascial Trigger Points:
Insights into Causes, Symptoms,
and Effective Therapies

What are Myofascial Trigger Points?

Myofascial Trigger Points (TrPs) are hyperirritable spots in a taut skeletal muscle band and facia. These points are sensitive and can cause pain when subjected to various kinds of stress, such as compression, stretching, overload, or contraction. The pain experienced is often not localized but referred to, meaning it's felt in a different area than the trigger point. For example, trigger points can be linked to migraine and tension headaches, a trigger point in the neck might contribute to pain between the shoulder blades

Myofascial Trigger Points (TrPs) are hyperirritable spots in a taut skeletal muscle band and facia. Common TrPs on Trapezius Muscle

Causes and Characteristics of Trigger Points

Trigger points are often the result of various physical stresses such as acute muscle overload, repetitive strain, overwork, fatigue, poor posture, blunt trauma, sports injuries, and exposure to cold. They are typically found in muscles and tendons that are most used in certain activities or sports. Dr. Travell and Simons (1983) defined a trigger point as a hyper-irritable focus in a tissue that, when compressed, is tender and can cause referred pain, tenderness, and sometimes autonomic phenomena and proprioception distortion.

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Symptoms and Types of Trigger Points

Trigger points manifest in several ways:

  • Dull, aching, or deep referred pain.

  • Variable irritability over time.

  • Stiffness and weakness in the affected muscle.

  • Restricted range of motion.

  • Pain during muscle contraction and stretching.

  • Disproportionate pain relative to the pressure applied.

 

There are two main types of trigger points:

  • Active Trigger Points: Constantly painful and can cause referred pain elsewhere without external pressure.

  • Latent Trigger Points: Dormant and only cause pain when pressed or stimulated.

The Concept of Muscle Knots

Trigger points are often described as "muscle knots," a metaphorical term reflecting the tight, tense feeling of muscle stiffness or soreness. However, it's important to note that muscles don't form actual knots.

Controversy and Debate

The existence and nature of trigger points are subjects of debate within the medical community. While some experts question their existence due to a lack of conclusive scientific evidence, others support their clinical relevance based on empirical observations and patient responses to treatments.

The third edition of "Myofascial Pain and Dysfunction: The Trigger Point Manual" does mention Neuromuscular Therapy (NMT) in the context of treating trigger points. It provides an overview of NMT, discusses its clinical applications, patient and intervention selection, and standards and guidelines for its use.

The Evolution of Understanding Trigger Points

  • Historical View: Initially, myofascial pain was attributed to tissue injury, especially damage to the sarcoplasmic reticulum.

  • Current Models: The "energy crisis hypothesis" and the "integrated TrP hypothesis" have reshaped our understanding. These models view Myofascial Pain Syndrome (MPS) more broadly, integrating pain science with clinical observations.

  • Ongoing Research: The field continues to evolve, with new models being developed to provide a more comprehensive understanding of myofascial pain.

Relation to Pinched Nerves

A pinched nerve, which occurs when tissues like bones or muscles exert excessive pressure on a nerve, shares some symptoms with TrPs, including tingling, numbness, muscle weakness, and sharp or aching pain. Pinched nerves are most common in the neck, back, and wrists.

How to massage myofascial trigger points?

Trigger point massage therapy is effective in treating various orthopedic conditions and injuries. The TrP Deep Pressure Release technique is a key method in this therapy, involving direct pressure to deactivate the trigger points and reduce pain sensitivity. This technique is often combined with other methods like deep sliding movements, kneading, broadening, and fine vibration. After deactivating the TrP, stretching techniques are applied to reeducate the muscle to its increased length.

Identification of Trigger Points: Neuromuscular Therapists are trained to locate and identify TrPs in the muscles through detailed palpation techniques

In summary, trigger points are a significant factor in muscle pain and dysfunction. Understanding their causes, symptoms, and effective treatment methods is essential for addressing muscle-related issues. Despite the ongoing debate about their scientific basis, trigger point therapy and neuromuscular techniques remain a widely used and beneficial approach in physical therapy and related fields.

Neuromuscular Therapy, also known as  Trigger point therapy, was pioneered by Janet Travell, MD, in the 1960s. It involves deactivating trigger points (TrPs) in muscle and related connective tissues.

How can I describe Pinched Nerve & Pain?

Different categories are used when describing or attempting to gather information about pain. These include:

  • Location, Site: where the pain is felt(ie Head, Neck, Shoulder, Shoulder Blade, Low Back, Glute, Buttock etc) 

  • Intensity: how severe the pain is (ie  Most pain scales use numbers from 0 to 10).

  • Frequency: how often the pain occurs (ie morning, night time)

  • Quality: the type of pain (ie. Deep, Ache, Dull, Sharp, tender, shooting, etc.) 

  • Duration: how long the pain lasts when it occurs

  • Pattern: what causes the pain and what improves it

  • Movement: what movement causes the pain 

Dull pain is often chronic, lasting a few days, months, or more. Commonly, dull pain results from an old injury or a chronic condition. If you have a new, dull pain that doesn’t improve in two to three weeks, bring it to your doctor’s attention. 

Understanding Neuromuscular Therapy Techniques

Neuromuscular techniques encompass a variety of methods, including  Trigger point, Positional Release, and Proprioceptive - muscle energy techniques, designed to address muscle tension and spasm that restricts the range of motion and or makes that movement painful effectively. These hyperirritable areas within a muscle can be treated through hyperstimulation, lengthening, softening, and stretching of the surrounding connective tissue. This technique helps to reduce resting muscle tension. The intention is to normalize muscle tone, tension and decrease pain that limit the range of motion.

Identifying and Treating Trigger Points

Once a trigger point is identified, our best Neuromuscular therapist in Los Angeles, Jesse Anoraj, employs a range of techniques such as pressure application, muscle energy, direct manipulation, myofascial decompression, and PNF stretch methods to decrease hyperactivity in the point that reduces resting muscle tension. The intention is to normalize muscle tone, tension and decrease pain that limit the range of motion. Direct manipulation of proprioceptors by pushing or pulling on a muscle belly or its attachments can also be effective. The approach progresses from least to most aggressive, with indirect functional techniques often proving beneficial.

The Power of Positional Release

Positional release (Strain Counterstrain) and appropriate stretching are among the most effective ways to treat tender points. This method involves identifying the painful point and passively moving the body to the position of comfort to ease the pain and reduce the sensitivity. Positional release is the first step in the integrated muscle energy method, which introduces muscle contraction before lengthening. This technique attempts to achieve the most comfortable position possible to relax muscle spasms by reducing abnormal afferent flow from the muscle spindle. If a myofascial trigger point is located in a muscle, a therapist applies gradually increasing pressure on that point until the feeling of pressure becomes a feeling of pressure and pain. Then, there is a passive change of position of the patient performed by the therapist until the tension under the palpating fingers and the pain reduces in intensity. The research supports that strain/counter strain therapy was superior to control groups for patients with marks in the orofacial area to improve pain intensity

Direct Manipulation Methods

Direct manipulation involves pressing the muscle's belly together to affect spindle cells and pushing the tendons apart to affect tendon receptors. If the belly of the muscle is pressed together and the desired effect is not achieved, the next step should be to separate the tissue from the middle of the muscle belly toward the tendons. Lengthening and direct manipulation are gentle methods and should be used next.

Integrated Muscle Energy Method

The integrated muscle energy method is more aggressive than positional release or direct manipulation but less aggressive than pressure or pinching methods and should be the next step. These methods are often effective and worth trying before more intense pressure or pinching techniques. The local area must be lengthened. This lengthening is performed either directly on the tissues or through the movement of a joint.

Pressure Release Techniques

Pressure Release techniques can be tried if the trigger point remains after the less invasive methods have been attempted. The pressure may take the form of direct pressure, in which the therapist presses the trigger point against an underlying hard structure (bone) or, when no bony tissue lies underneath, pinching pressure, as in the “squeezing” of the sternocleidomastoid muscle.

Pressure techniques can end the hyperirritability by mechanical disruption of the sensory nerve endings causing the trigger point activity. When using the direct pressure technique, the massage therapist must hold the compression long enough to stimulate the spindle cells. A variety of massage applications can be employed in neuromuscular techniques, many of which have been included in the protocols of this text. Among many variations, the primary massage techniques are as follows.

Primary Trigger Point Massage Techniques

  • Effleurage: A gliding stroke that induces relaxation and reduces fluid congestion by encouraging venous or lymphatic fluid movement toward the center. Lubricants are usually used.

  • Petrissage: A wringing and stretching movement that attempts to 'milk' the tissues of waste products and assist in circulatory interchange. The manipulations press and roll the muscles under the hands.

  • Kneading: A compressive stroke that alternately squeezes and lifts the tissues to improve fluid exchange and achieve relaxation of tissues.

  • Inhibition: The application of pressure directly to the belly or attachments of contracted muscles or to local soft tissue dysfunction for a variable amount of time or in a ‘make-and-break’ (pressure applied and then released) manner, reducing hypertonic contraction or for reflexive effects. Also known as ischemic compression or trigger point pressure release.

  • Vibration and friction: Small circular or vibratory movements, with the tips of fingers or thumb, mainly used near origins and insertions and bony attachments to induce a relaxing effect or to produce heat in the tissue, thereby altering the gel state of the ground substance. Vibration can also be achieved with mechanical devices with varying oscillation rates that may affect the tissue differently.

  • Transverse friction: A short pressure stroke applied slowly and rhythmically along or across the belly of muscles using the heel of the hand, thumb, or fingers.

  • Cupping Therapy: The use of negative pressure with suction cups create space and decompresses between the tissue layers, allowing each layer to slide one another 

Looking for a massage therapist specializing in trigger point therapy located in Los Angeles?

Jesse Anoraj has been a Certified Member in good standing of Associated Bodywork & Massage Professionals since 2018. He runs a private practice called Artisan Neuromuscular & Sports Therapy in Los Angeles, which focuses on providing therapeutic sports massage for Pain & Stress Management. Jesse is an Advanced Neuromuscular Therapist and an outstanding massage therapist with a great reputation. He has expertise in various soft tissue techniques that can help remedy a variety of conditions, such as anxiety, chronic pain syndrome, emotional stress, musculoskeletal pain, myofascial pain, occupational injuries, and overuse injuries, among others. Please let me know if you would like to book Neuromuscular therapy and Trigger point therapy!

Massage has been shown to have several positive benefits and effects on the body and brain. Here are a few ways in which massage therapy can affect the nervous system to reduce the sensitivity of Trigger points

Reducing stress: Massage therapy can activate the parasympathetic nervous system, which is responsible for the "rest and digest" response. This can lead to a reduction in stress hormones such as cortisol and an increase in feel-good hormones such as serotonin and dopamine.


Relieving pain: Massage therapy can also activate pain-relieving pathways in the nervous system. It can stimulate the release of endorphins, which are natural pain-relieving chemicals, and it can also inhibit the activity of pain-sensing neurons in the spinal cord.


Enhancing immune function: Massage therapy has been shown to increase the activity of white blood cells, which are responsible for fighting off infections and illnesses. This suggests that massage therapy may be able to enhance immune function.


Improving mood: Massage therapy can also positively affect mood and emotional well-being. Research has found that massage therapy can improve symptoms of depression, anxiety, and stress.


Improving sleep: Massage therapy can also help improve sleep quality by helping to relax the body and mind, reduce stress, and lower cortisol levels.


Improving physical function: Massage therapy also can help to improve physical function by increasing blood flow, reducing muscle tension, and promoting relaxation, which can help to improve range of motion and flexibility.

Increased Circulation: Massage can improve blood flow, which can help nourish the nervous system by delivering more oxygen and nutrients to nerve cells.

Stimulation of Nerve Receptors: Massage can stimulate nerve receptors in the skin and muscles, which can improve nerve function and sensory perception.


Overall, massage therapy can affect the nervous system in a number of ways, including reducing stress, relieving pain, enhancing immune function, improving mood and sleep, and physical function

References: 

Guzmán-Pavón, María José, et al. “Effect of Manual Therapy Interventions on Range of Motion among Individuals with Myofascial Trigger Points: A Systematic Review and Meta-Analysis.” Pain Medicine, vol. 23, no. 1, 2021, pp. 137–143., https://doi.org/10.1093/pm/pnab224

Tang, F., Jiang, C., Chen, J., Wang, L., & Zhao, F. (2023). Global hotspots and trends in myofascial pain syndrome research from 1956 to 2022: A Bibliometric analysis. Medicine, 102(12).

https://doi.org/10.1097/md.0000000000033347

Donnelly, J. M., las, P. C. F. de, Finnegan, M., & Freeman, J. L. (2019). Travell, Simons & Simons’ myofascial pain and dysfunction: The trigger point manual. Wolters Kluwer. 

https://shop.lww.com/Travell--Simons---Simons--Myofascial-Pain-and-Dysfunction/p/9780781755603

Fernández-de-las-Peñas, C., & Dommerholt, J. (2017). International consensus on diagnostic criteria and clinical considerations of myofascial trigger points: A delphi study. Pain Medicine, 19(1), 142–150. https://doi.org/10.1093/pm/pnx207

Fraley, A. (2019, September 17). The massage therapist’s Guide to Neuromuscular therapy. MASSAGE Magazine. https://www.massagemag.com/guide-to-neuromuscular-therapy-119085/

Müggenborg, F., de Castro Carletti, E. M., Dennett, L., de Oliveira-Souza, A. I. S., Mohamad, N., Licht, G., von Piekartz, H., & Armijo-Olivo, S. (2023). Effectiveness of Manual Trigger Point Therapy in Patients with Myofascial Trigger Points in the Orofacial Region-A Systematic Review. Life (Basel, Switzerland), 13(2), 336.

https://doi.org/10.3390/life13020336

Choosing the Right Option for Trigger Point Therapy
or Massage Near You

When looking for trigger point therapy or massage, it's important to choose a provider that not only offers the specific treatment you need but is also conveniently located. Here's a quick guide to help you decide:

Massage Therapist:

For targeted muscle relief, consider finding a neuromuscular therapist who is highly skilled in trigger point therapy. They can effectively address specific areas of tension and pain, providing both immediate and long-term benefits.

Massage Spa:

For a relaxing and therapeutic experience, a massage spa offering trigger point therapy is ideal. Here, you can enjoy the dual benefits of a calming environment and professional muscle tension relief, perfect for those looking to unwind and heal.

Wellness Center:

A wellness center is a great choice for those seeking a more holistic approach to trigger point therapy. These centers often combine various health and wellness practices, ensuring a comprehensive treatment plan that addresses both physical and emotional well-being.

Pain Control Clinic:

If you're dealing with chronic pain, a pain control clinic specializing in conservative pain management and physical therapy clinic can offer effective solutions. These clinics focus on alleviating pain through targeted techniques, providing relief, and improving your quality of life.

Thai Massage Therapist:

Choosing a Thai massage therapist for trigger point therapy allows you to experience a unique blend of traditional and targeted techniques. This option is perfect for those who value a holistic approach to muscle tension relief.

Sports Massage Therapist:

Athletes or physically active individuals will benefit from seeing a sports massage therapist. They specialize in trigger point therapy that caters to sports-related muscle issues, enhancing performance and aiding in recovery.

Alternative Medicine Practitioner:

For a natural and holistic approach to trigger point therapy, consider an alternative medicine practitioner. They often incorporate cupping therapy, acupuncture, chiropractic adjustment, and dry needling into a broader range of natural healing practices, offering a comprehensive path to wellness.

Health Club:

Health clubs often offer massage services, including trigger point therapy, as part of their wellness programs. They are a great choice for those who prefer to combine their therapy with other fitness and health activities in a dynamic, supportive environment.

To find the best option, consider the proximity of these services to your location. Choosing a trigger point therapist near you not only offers convenience but also makes it easier to maintain a consistent therapy schedule. Remember to check reviews, ask for referrals, and possibly visit the location to ensure it meets your needs and expectations.

Frequently Asked Question

What is Myofascial Pain Syndrome?

What are the symptoms of Myofascial Pain Syndrome?

What causes Myofascial Pain Syndrome?

What are the risk factors of Myofascial Pain Syndrome?

What are the complications associated with Myofascial Pain Syndrome?

Ready to experience the benefits of
Trigger Point MassageTherapy? 

Contact Artisan Neuromuscular & Sports Therapy 

to schedule your session in Los Angeles or West Hollywood.

Begin your wellness journey with us today.

Get a top-notch massage at Trigger Point Therapy,

8000 Sunset Blvd, Los Angeles CA 90046

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