The Wolnick Trigger Point Protocol

OK, lame name, I know. I’ll come up with something better soon.

Over the years, I’ve dealt with a lot of trigger points. I just talked about a few of my own in my last post. Now some of these trigger points are just plain nasty. They exhibit the kind of pain that simply wants to make you cry – the “exquisite tenderness” described by Travell & Simons. I’ve seen what’s out there as far as techniques for addressing trigger points and have developed a protocol for deactivating them that has worked very well. Surprisingly enough, I’ve never seen any one source that puts all of these techniques together into a single protocol. If you have, let me know, and I’ll give them credit! This is what I teach my students and use myself. Works like a charm!

Here’s a simple version of my protocol:

1. MET
2. Cross-Fiber Friction
3. Static Compression

In that order!

MET, aka Muscle Energy Technique

MET has to be one of my favorite styles. It has some great advantages, not the least of which that it can address a trigger point without the same kind of excruciating pain as the other techniques. Simply described, MET is a technique that you can use to reset the communication between the brain and the muscle. Often, at least part of the irritation is that the nervous system is maintaining a negative feedback loop that reinforces the dysfunction in the muscle. In my experience, using MET nearly always reduces the irritation of the trigger point before you start using any more painful techniques. This decreases the discomfort of the client, and some trigger points may even disappear entirely without any pain! I love the look of confusion on a client’s face when you do a simple exercise and then their pain has disappeared. They always ask “Are you pressing in the same spot?”

MET involves a thorough knowledge of kinesiology and the ability to apply very slight resistance in precise planes of movement. You establish a clear signal between the brain and the muscle and take advantage of innate reflexes to obtain specific effects. Sounds complicated, and the reasoning behind it is, but in practice it’s fairly simple to actually perform. You can learn more about MET here, a few videos here (1 and 2), and a technical paper here.

Cross-Fiber Friction (CF)

The favored technique of Clair Davies, author of the Trigger Point Workbook, this technique has seen a rise in popularity over the years. While it is still painful to the client, the pain is in short bursts rather than a sustained pressure. This allows the client to tolerate more, but also allows for more of a pumping action in restoring circulation to the area. Davies recommends that only 6-12 good, firm strokes over the trigger point constitutes a treatment – a guideline I agree with. This prevents you from overworking the point and causing the trigger point to go active on you. Ouch.

This technique is one that you can do easily on yourself as well. This is good, since it is better to work frequently and in short bursts on a trigger point than rarely but for a long time. It is something that your clients can do at home. Often, the cross-fiber friction will take care of the trigger point aggravation. If not…

Static (Ischemic) Compression (SC)

Ahh, the good old standby of Neuromuscular Therapy (video here). This technique involves holding sustained pressure directly over the trigger point. This has the effect of increasing the pain sensation and “overloading” the neurological circuit so that it shuts down, kind of like tripping the circuit breaker. The analogy that I like to use is that of a rain bucket. The water in the bucket is the amount of irritability in the trigger point. As it fills, eventually the bucket overflows (the TrP goes active) and starts sending pain elsewhere. SC is like tossing bricks in the bucket. It causes it to overflow, but after you’ve drained some water, when you pull the bricks out there is less water in the bucket.

This is certainly the most uncomfortable of the trigger point techniques – which is precisely why I save it for last. However, there are some trigger points that don’t seem to respond to anything else. The good news is that by the time you get to static compression, the other techniques should have reduced the irritability so that this one isn’t so bad.

To perform this technique, locate the precise point of the pain, sink in to the point until you get to a pain of 7 on a scale of ten (the point where if you go past you’ll need to tense up to resist it), and hold it. If the pain is increasing, release and try something else, if it is staying the same, hold for 8-15 seconds then repeat, if it is decreasing, ride it home until it levels off.

I recommend that you only combine up to 3 treatments of either CF or SC at one time to avoid overworking the point and sending the client home in pain. It is a very common mistake to overwork a point and it is very easy to do.

Happy Trigger Point Hunting!

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