Pain Free Performance

There is one thing that all athletes have in common.  If you play long enough, every single athlete will deal with pain and discomfort.  It is the nature of the beast.  You push yourself to your physical limits during training and competition.  It takes a toll on your body.  Some of the pain and discomfort comes from injuries that you have sustained.  As much as we can try to prevent them, injuries are going to happen.  I dealt with my fair share of injuries in college, anywhere from concussions to meniscus and MCL tears in my right knee.  I consider myself extremely lucky compared to other athletes.  I know a former athlete that has had four separate ACL tears.  I have worked with athletes that have had Tommy John surgery for UCL ruptures in the elbow, experienced labrum tears in the shoulder and have fractures in the lower back.  Athletes play at such high speeds that injuries are bound to happen.

The pain and discomfort that does not need to happen comes from Trigger Points.  Trigger points are just a fancier way of saying that you have knots in your muscle.  Athletes (and non-athletes alike) often deal with the pain and discomfort of trigger points, chalking it up as a byproduct of hard work.  No pain, no gain. Right? Wrong.  These little “knots” can cause serious problems if they are ignored, which will sap your performance on and off the field.  Let’s break down what trigger points are, why they occur, their consequences and some ways to alleviate the pain and return to full health.



Chris Howard, of Cressey Sports Performance, recently hosted a webinar discussing trigger points.  He classifies trigger points as “hyperirritable spots in taut bands of skeletal muscle”.  This is why they are called “knots” in layman’s terms.  These spots are usually quite painful to the touch and can limit a person’s range of motion.  There is usually a distinct referred pain pattern that is associated with trigger points. For example, if an athlete has a trigger point in their latissimus dorsi (a back muscle) they may experience pain in the trapezius muscle or triceps.



As previously stated, trigger points can be painful and reduce the range of motion for movements.  They can also lead to increased muscle tension.  These spots can also lead to altered muscle activation patterns.  This means that the trigger points will affect how we move.  For instance, the presence of trigger points in our back may alter scapular movement when lifting our arm overhead.  This trigger points leads to a faulty movement pattern because we will rely more on our trapezius muscle to raise our arm overhead.  These faulty movement patters can lead to imbalances and injury.  Trigger points may cause issues such as: back pain, tendinitis, frozen shoulder and migraines.  I recently had an athlete that was dealing with Jumper’s Knee, which is tendinitis that presents itself in the patellar tendon. His doctor confirmed that there was indeed inflammation of the patellar tendon.  A few days later, the athlete complained of calf pain.  Little did he know that there was a trigger point in his calf that was leading to the discomfort.  After a few sessions of trigger point therapy, the knot was gone and his knee steadily improved.  Now this is not to say that trigger points are always the underlying cause of more serious conditions, but sometimes they are.



The simple answer is: muscle tissue abuse. Trigger points occur when we tax our muscles without providing adequate rest and recovery.  This does not just mean in the gym or on the field.  This abuse of the muscle often comes from “muscle overload” that can occur at school, work, the gym or the court.  Continuous activity at the workplace or at school, such as typing, can lead to the formation of trigger points.  The Cinderella Hypothesis aims to explain why this is the case.  It states that “muscle damage can occur when the muscle fibers which are activated first are also the last to deactivate” (Norman Marcus Pain Institute).  Much like Cinderella, these muscles are constantly at work with inadequate time to recover.  Also a heavy workload in the gym is a cause for trigger points.  Acute overload and overwork fatigue can lead to the buildup of trigger points.  This is true especially when we place emphasis on the eccentric portion of the exercise because this leads to the greatest amount of muscle damage.

The development of trigger points can be explained by the Continuous Injury Cycle. This cycle is a repair process that is initiated after your body experiences mechanically stressful actions such as poor posture, repetitious motions or chronic muscle overuse.  After the trauma occurs, there is tissue inflammation and spasm, which lead to the development of soft tissue adhesions.  These adhesions are the trigger points. The reduction of elasticity of the soft tissues can lead to altered neuromuscular control, muscular imbalance and permanent changes to the structure of the soft tissue.

There are many factors that lead you to become more susceptible to trigger point development.  Poor nutrition is a factor in those that are prone to knots.  If we are lacking in minerals and vitamins we are at greater risk for development.  There are metabolic and endocrine system factors such as diabetes and obesity that heighten our chances for trigger points.  Those that are struggling with emotional distress are also at risk.  Finally, there are physical stressors that are major factors.  Factors include our posture, our sleeping habits, the amount of time we spend sitting, and how we drive our cars.  I recently drove back from New York to Philly one night.  What usually is a painless 2-hour drive turned into a 4-hour nightmare after I popped a tire in New York.  Not only was I unable to drive over 50 mph on a donut, but I was also unable to relax because I was constantly checking my speed and concerned about how the spare tire was holding up.  I could feel the tension in my neck building up as I drove home because of my worrying.  I didn’t get in until 3:15 am so I got zero sleep.  As a result, I dealt with some serious neck discomfort for the first time in my life.  Sure enough I had developed a serious of trigger points in my neck.  After a few days of uneasiness, I finally deactivated the points and was relieved.  But it wasn’t fun.



There are ways to manually deactivate trigger points.  Leaders in the field provide us with three techniques that we (or a trusted friend) can use to turn these spots off:

  1. 1.Flat Palpation: Your finger applies pressure across the muscle fibers at right angles to their length. Continue doing this technique in the same direction the entire time.

  2. 2.Pincer Palpation: Usually done in the bigger muscles like the lats; pinch the muscle between your fingers. In the beginning, grab more area than needed and slowly release some muscle, shortening the distance between your fingers to pinpoint trigger point and apply pressure.

  3. 3.Snapping Palpations: Find the band of taut muscle and pluck it like a guitar string.

You can also apply pressure to the trigger point and go through an active muscle contraction.  For instance, if you have a knot in the infraspinatus (in the shoulder), you can palpate the knot and perform internal and external rotation of the shoulder.


If you follow the Pittsburgh Steelers linebacker James Harrison on Instagram (@jhharrison92) then you will see him getting dry needling.  This is a therapy, performed most often by acupuncturists (sometimes physical therapists), that involves a small needle placed in the trigger point.  This will cause the muscle to violently twitch, which occurs when the point is deactivated.  You should expect soreness for a day or two following dry needling.  Wet needling is a similar therapy except that the pins have anti-inflammatory properties that are released in the muscle.  This is used to reduce the pain and soreness that usually accompanies needling.


Chris Howard also gave out some handy guidelines when performing SELF MYOFASCIAL RELEASE (SMR).  SMR is basically self-massage that aims to decrease muscular tension and alleviate trigger points.  His tips include:

  1. 1.Use a tool (foam roller, lacrosse ball, golf ball, etc.)

  2. 2.Go deep into the muscle

  3. 3.Use short repeated strokes

  4. 4.Stay in one direction

  5. 5.SLOW DOWN (don’t rush)

  6. 6.Keep the pain at a 5 on the 1-10 scale

  7. 7.Perform SMR for 1-2 minutes per trigger point

  8. 8.Be consistent


Serious athletes are bound to get trigger points.  We need to do our best to allow ourselves enough recovery time to try and avoid them.  But inevitably, the physical and environmental stressors are going to take a toll.  Therefore, we have to identify the trigger point and deactivate it before it builds into a larger issue.  We need to manage pain by being aware of our bodies and taking note of movement quality.  From there we can target the problem areas that need to be addressed.  By pinpointing and deactivating trigger points we will be able to hit the gym, and court, full tilt.

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