An upcoming issue of Journal of Bodywork & Movement Therapies will include a new study of trigger point squishing. I was lucky to get a look at a final draft, thanks to connections at The Pressure Positive Company, the massage tool manufacturer that supplied the tools.
This experiment has the simple elegance of a good science-fair project. Dr. Dawn Gulick of the Widener University Physical Therapy Department simply compared the sensitivity of trigger points both with and without a simple treatment of pressure — squishing them, that is. That’s an experiment I’ve always wanted to do myself.
In life, and in a massage therapy office, it seems obvious that sore spots in muscles often get less sore when you apply pressure to them, but this apparent phenomenon is strikingly unconfirmed by any research. And we do need it confirmed, because what seems “obvious” to the fallible human mind is often surprisingly wrong. It’s also important to study it because, even if the treatment works, it may not work for the reason that seems obvious. For instance, what if it’s not actually the pressure that’s doing the job, but simply the touch? Or even the social interaction with the patient? You need some careful testing to suss out that kind of thing.
This experiment tested a specific method of squishing: pressing a trigger point firmly and long enough to starve it of some oxygen (ischemic pressure), repeatedly, for several days. This has long been one of the preferred methods of treatment, and it is specifically recommended in my own trigger point e-book as a best-bet protocol, but I have no real idea if that’s really the best way to get rid of a trigger point.
Dr. Gulick et al. measured trigger point sensitivity before and after treatment in 28 people with two trigger points in the upper back. Their conclusion:
There was a significant difference between the pre- and post-test sensitivities of the treated and non-treated trigger points. The results of this study confirm that the protocol of six repetitions of 30-second ischemic compression with the Backnobber II rendered every other day for a week was effective in reducing trigger point irritability.
Excellent!
This is small-scale science, and hardly the last word on this subject — remember, all knowledge is provisional — but the results are encouraging and certainly consistent with my professional experience.
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The Backnobber
The massage tool chosen for the study, and one of the oldest massage tools around. I own one of these, and it’s a handy device. It’s particularly nice the way it breaks down into a more compact package when not in use. Buy one from Pressure Positive. No, I don’t get a kickback for that: I just like them.
And again! More muscle knot squishing science, different experiment, same results
Odd! Just a couple days after posting about a not-yet-published study of trigger point squishing — quite a rare subject for research — I came across (via @massagetherapy) an almost identical study that is published. They also reported news that makes massage therapists smile:
These studies look so much alike that if you put them both in the same cute little sailor suits you wouldn’t be able to tell them apart. They’re both rather simple and small, they both studied “ischemic pressure” — pressing and holding a trigger point or “muscle knot” until it’s a bit oxygen-starved — and they both produced an unambiguously thumbs-up of a result.
Indeed, this research showed an impressive treatment effect: a score measuring shoulder discomfort went down a whopping 75% in those treated, compared to a mere 30% reduction in people who received treatment in a nearby location. That’s a humongous difference and a great demonstration of a principle I’m always pimping on SaveYourself.ca: therapies should have no problem demonstrating their benefits in a fair test. The results should impress.
And these results impress.
Mostly.
Caveats!
These glowingly positive results will tend to perpetuate assumptions about the nature of trigger points. Even considered together, these two studies cannot be said to actually “prove” anything. They are still too small and their results might not be due to the actual treatment.
One obvious problem, for instance, is that both experiments compared treatment in the right place to treatment in the wrong place. This flings the door wide open for a major confounding factor: patients with shoulder pain would be well aware the sham treatment is a sham, probably dramatically decreasing their satisfaction and expectation of benefit. Meanwhile, people getting treatment in the “right” place will likely feel much better about the treatment and have much higher hopes: rich soil for a placebo effect.
Unfortunately, it is quite plausible that both of these studies simply showed that poking people’s trigger points gives great placebo.
This science stuff is tricky!
Still, we’ll file it all under “promising.” If the effect was a placebo, it was an awfully potent one.