As far as I am concerned this is possible only by deactivating trigger points during therapy. Secondary trigger points reactivate very quickly, if it occurs I try to find a muscle that produces reffered pain into the area of the muscle with secondary TrPs and keeps them active. Deactivation of primary TrPs deactivates secondary ones. I belive activation of secondary TrPs is mediated by central sensitization, as well as reffered pain. So if I have a patient showing increased central sensitization I always suspect that there will secondary TrPs and I start the therapy with deacivating possible primary TrPs first (described in Travell and Simons handbook). 

I stopped doing TPIs as I felt the effect was very short. Comments?

Trigger points and its classification is more controversial topic and still no valid research on it. Though Myofascial therapy given more importance now a days, I dont think there is any valid assessment to find whether it is primary or secondary. Also, there is no specific change in treatment plan to de-activate trigger points by knowing its primary or secondary.

Trigger points and its classification is more controversial topic and still no valid research on it. Though Myofascial therapy given more importance now a days, I dont think there is any valid assessment to find whether it is primary or secondary. Also, there is no specific change in treatment plan to de-activate trigger points by knowing its primary or secondary.

Trigger points I find continue to get a lot of attention, yet their validity is under debate. My thinking on this would be due to nociceptive threshold changes. The vastness of our PNS and CNS, combined as an intricate monitoring system, that is highly adaptive would be more valid as an explanation of sore spots. 

I would also think of this intricate monitoring as a way to monitor threat towards tissues such as reduced blood flow or as previously mentioned threshold changes in nociceptors.

The argument could be that perhaps muscle tissue has altered in someway physiologically but to my knowledge there is no research that I know of to identify this?

Finally I also wonder if primary and secondary trigger points are more likely related to hyperalgesic states and the convergence of nerves as they enter the spine. There is also much interplay between interneurones at the dorsal horn that could also be a contributing factor.

 In my opinion  the primary or secondary designation for trigger points is not the most commonly used. Today we used only myofascial trigger points and I dont think there is any valid assessment to find trigger points in general.

I’m rather surprised by some of the answers to your question.

I find Trigger Points (TrP) and Taut Bands (TB) to be EXTREMELY relevant and a primary component of chronic myofascial pain. I also find a NUMBER of issues/complaints often with a reasonably high percentage of “unknown etiology” to have a soft tissue/TrP/TB aspect. At this point, it’s only anecdotal, but I’m seeing resolution of similar ancillary issues/complaints other than the chronic pain.

I don’t believe TrP/TBs are the ultimate reason for all issues. They are an element as is resolving fascial tension and addressing fibrosis & fascial “cobwebs” that develop as the soft tissue keeps a static aspect. Resolving TrP/TB issues provides an increased function to the muscles and soft tissues. It creates an environment to help promote further healing. The increased function includes strength, range of motion, and greater assistance to move lymphatic fluid throughout the body.

I do NOT use a Satellite or Primary TrP designation. I do find that during the TrP/TB evolution, one muscle may be the FIRST to have been compromised by a TrP/TB. As the function of the FIRST is compromised, the secondary and tertiary synergistic muscles must step in to provide the function and often THEY are then compromised. Addressing TrP/TBs is sometimes like peeling an onion. But as circulation is enhanced, healing continues. As muscle memory and guarding are reminded about increased function through the course of at-home stretching and other sessions, healing continues and lasts.

Assessment is a critical component of the process. During a detailed assessment, I utilize Travell & Simons, along with other sources, to help clarify pain referral patterns, and understand the functional movement limitations and other elements in the history, along with repetitive activities that could contribute to some of the issues. I CAN feel the TrP/TBs. I can feel them through clothes, drapes and warm, moist towels. I CAN feel when/as they release or soften. I know other colleagues who can as well.

I do NOT use Ischemic Compression – I find that modality to be rather barbaric. I work primarily on the Taut Bands. I don’t differentiate between Active or Latent TrPs either. I address what is causing the overall issue. Often that may be multiple elements. I keep the pain level below a 5 on a 10 scale, and communicate frequently to ensure the work is kept within that tolerance level.

I have been finding multiple types of issues/complaints in physiological conditions that appear to be helped with the reduction of TrP/TBs and fascial tension in different areas. While presently anecdotal, the gratitude of the recipients is beneficial in of itself. I have seen improvement in breathing, enhanced lymph movement, fewer to no headaches, reduction in sinus issues, reduction in pre-menstrual discomfort, reduction in urinary urgency, improved gastrointestinal health, and a LOT less pain and continued improvements to daily life and activities.

Muscles and soft tissue are SUCH a significant component/organ within the body. It appears to have such an effect on health, function and physiology negatively or positively, but it is RARELY considered as a component of different conditions – it seems to fall into the category of “unknown etiology.” We appear to have so many specialists in many systems of the body – cardiology, neurology, urology, etc. – yet no Muscle or Lymph System Doctors. We’re still finding new parts of the Lymphatic System – June 2015 – lymphatic vessels in the dura of the spinal cord, October 2017 – lymphatic vessels in the dura of the brain. And the two systems work so closely together. The muscles move the lymph fluid. You’d think we’d find a way to link them together.

I learn from every session. I’m still learning. But Trigger Points and Taut Bands are a critical component in addressing chronic pain or even just this past weekend’s pain.