How we do Trigger Point Therapy – This is How (and Why) We Do It
I recently promoted a Trigger Point Therapy workshop being taught by a Morales Method® Certified Instructor and I was posed an interesting question.
It went (sort of) like this: “How is your approach different from the classic approach to Trigger Point Therapy?”
This is a great question. But before I go there, I want to say that I fully acknowledge that Trigger Points are still a mystery and current (and past) research has found their existence difficult to prove. From my experience, I know that the concept and approach discussed below are effective, which is the main reason why I share it with students and colleagues.
To get back on track, one of the main differences in how we Morales Method® Therapists work a Trigger Point is that we use the concept of Directional Resistance and Directional Ease. In the Morales Method®, Directional Resistance is a big part of how we work and is the foundation for the different variations in our work, such as addressing Trigger Points.
In Classic Trigger Point Therapy, the main approach is to place downward direct mechanical compression on a Trigger Point and wait for it to ‘release.’
In the Morales Method® approach, we find a Trigger Point and use a variety of methods to get the muscle tissue in question to de-contract. As mentioned, Directional Resistance and Directional Ease are the basis for our methods.
Below I will discuss both foundational techniques of Directional Resistance and Directional Ease as well as other supplemental techniques that can be added to Directional Resistance and Directional Ease to address Trigger Points. I believe these techniques are what differentiates the Morales Method® approach from classic Trigger Point Therapy.
Directional Resistance (D.R.) D.R. is the palpatory sensation that a practitioner feels when they sink into tissue at end range and feel that it is resistant in one direction more so than in another.
Working at end range is key. This term is used to describe how deep we sink in to the tissue. End range is the level of depth we go to in the tissue without being forceful or exerting too much pressure. It would feel natural to sink down to End Range. It is important to work at end range because, in my experience, it provides us with the most effective results.
Over the years I’ve found that palpating to feel for Directional Resistance and then working IN the direction of resistance helps to directly address tissue tightness and the possible dysfunction that may be related to this tightness.
So, when we find and palpate a Trigger Point, we first sink into the End Range of the Trigger Point and then feel for Directional Resistance.
That in itself is one method to working with Trigger Points in the Morales Method®.
Directional Ease (D.E.) The other method we use is to feel for Directional Ease which is the opposite of Directional Resistance. In D.E., we feel for where the trigger point tissue moves easiest.
Note, even though D.E. is the exact opposite of D.R., this does not mean that the D.E. moves in the exact opposite direction as the D.R. We still need to palpate in order to feel for D.E.
Now that we have those two foundational methods, we can build on them with other techniques to address extra tricky Trigger Points.
Skeletal Slack The first supplemental technique is to use an appendage (an arm or a leg for example) in order to shorten the tissue from the exact opposite direction of the D.R. or D.E. towards the Trigger Point.
Tissue Slack The second supplemental technique to our Trigger Point Therapy work is to bring tissue from the exact opposite direction towards the Trigger Point. This can also occur if the practitioner is working in the D.R. or the D.E. This differs from Skeletal Slack as we are not manipulating the skeletal system (by using appendages) to create slack. In this technique, we are simply moving two points within the area in question closer to one another to create slack in the muscle fibers.
In all, the Morales Method® approach gives us various possibilities for working Trigger Points as opposed to the single downward compression technique provided by the classic approach. The matrix is as follows:
Trigger Point Therapy Matrix
What is actually happening? Because we don’t have the evidence to prove the existence of Trigger Points, we are then left to wonder about how we are actually affecting the tissue when we work in all of these ways. My best guess is that we are affecting the mechanoreceptors in the tissue of the Trigger Point. Any one of these approaches may ‘trigger’ them in a way that they send a signal for the muscle tissue to de-contract, thus easing the Trigger Point. Because this may also involve the surrounding fascia and muscle tissue itself, I call this a Neuro-myo-fascial approach. The topic of fascia and what may or may not be happening to it under this work is a topic for another time.