Neuromuscular Massage Therapy

Neuromuscular massage therapy, also called myofascial trigger point therapy or myofascial release, is a specialized form of massage that involves the application of firm, sustained, and controlled pressure over painful, taut bands of muscle, called myofascial trigger points, to release tension and facilitate blood flow.

How Trigger Points Develop

A trigger point is described as a local region of profound tenderness in a skeletal muscle, making it tight and painful. Trigger points develop as a result of direct trauma or repetitive microtrauma due to overuse of the muscle. In the lower back, chronic repetitive microtrauma to the low back muscles may occur due to lack of exercise, using unsupported posture, prolonged bending over a table for work, or sitting in chairs with poor back support.¹Alvarez DJ, Rockwell PG. Trigger points: diagnosis and management. afp. 2002;65(4):653-661.^,2Shah JP, Thaker N, Heimur J, Aredo JV, Sikdar S, Gerber L. Myofascial Trigger Points Then and Now: A Historical and Scientific Perspective. PM R. 2015;7(7):746-761. doi:10.1016/j.pmrj.2015.01.024

Read more about Office Chair, Posture, and Driving Ergonomics

How Trigger Points Cause Low Back Pain

Myofascial trigger points are like small knots in a thick rope, which represents the muscle fiber. The presence of the knot makes the rope shorter—and the length of the rope becomes shorter as the number of knots increases.³Massage and trigger points | massage therapy journal. American Massage Therapy Association. Accessed October 24, 2022. https://www.amtamassage.org/publications/massage-therapy-journal/massage-and-trigger-points Since trigger points make the overall length of the muscle fiber shorter than normal, their presence limits the lengthening and shortening of the muscle.

Trigger points in a muscle fiber can cause pain, weakness, or both.⁴Hong CZ. Myofascial pain syndrome. In: Encyclopedia of the Neurological Sciences. Elsevier; 2003:330-332. They may be active and cause pain spontaneously or with movement, or latent, which are more common and are not always painful (unless they are pressed or triggered) but may cause muscle weakness and restriction in movements.⁵Mehta NR, Scrivani SJ, Maciewicz R. Dental and facial pain. In: Raj’s Practical Management of Pain. Elsevier; 2008:505-527.

Trigger points may also cause referred pain in distant areas, making those areas sore and potentially weak.⁴Hong CZ. Myofascial pain syndrome. In: Encyclopedia of the Neurological Sciences. Elsevier; 2003:330-332.

The Role of Neuromuscular Massage Therapy in Treating Trigger Point Pain

Neuromuscular massage or trigger point therapy aims to relieve stress and release tension in the trigger point by placing firm pressure directly over the taut tissue for 30 seconds to 2 minutes.⁶Takamoto K, Bito I, Urakawa S, et al. Effects of compression at myofascial trigger points in patients with acute low back pain: A randomized controlled trial. EJP. 2015;19(8):1186-1196. doi:10.1002/ejp.694 The goal of applying sustained pressure is to manually “soften” the fibers and make them “loose.”⁷Davis CM. Complementary therapies for the aging patient. In: Geriatric Rehabilitation Manual. Elsevier; 2007:477-480. After the fibers are loosened, blood flow is stimulated into the area (which was previously deprived of adequate blood and oxygen) to foster healing and eventually relieve pain. Massage therapists trained in neuromuscular massage can pinpoint trigger points by understanding the pain patterns of the patient.³Massage and trigger points | massage therapy journal. American Massage Therapy Association. Accessed October 24, 2022. https://www.amtamassage.org/publications/massage-therapy-journal/massage-and-trigger-points

It is important to note that pressing a myofascial trigger point will elicit pain, and it’s essential for patients to effectively communicate with their therapists if the pain is tolerable or not. The pain should fade shortly after the pressure is released. Mild soreness may occur in the treated area for a few hours, which may be alleviated with topical pain medication or ice therapy.

A therapist trained in trigger point massage can examine the muscle and evaluate the number of therapy sessions that may be needed to improve tone, balance, and muscle strength.

Potential Long-Term Benefits of Trigger Point Therapy

Trigger point massage therapy may help loosen tight muscle tissue(s) and improve muscle balance, allowing patients to have better posture and support their spine. The range of motion of joints is also enhanced due to the improved health of muscle tissue that attaches to the joints.⁷Davis CM. Complementary therapies for the aging patient. In: Geriatric Rehabilitation Manual. Elsevier; 2007:477-480.

Massage therapy provides a noninvasive, holistic approach to treating lower back pain and may be used as complementary and alternative medicine (CAM) to traditional first-line treatments. Massage is usually tolerated by most patients and provides localized and systemic benefits, improving overall well-being and quality of life.