Trigger point pressure release

Dr. Shah asked me to draw special attention to trigger point pressure release, because in the most recent edition of Myofascial Pain and Dysfunction, David Simons examines most of the techniques just discussed, and he concludes that trigger point pressure release is the state of the art. Here is his description:

"The clinician lengthens the muscle to the point of increasing resistance within the comfort zone and then applies gentle, gradually increasing pressure on the trigger point until the finger encounters a definite increase in tissue resistance (engages the barrier). This pressure is maintained until the clinician senses relief of tension under the palpating finger. The palpating finger increases pressure enough to take up the tissue slack and to encounter a new barrier. The clinician again maintains only light pressure until more of the pressure releases."

But he later notes: "This barrier release approach may fail to afford relief because (1) the trigger point is too irritable to tolerate any additional mechanical stimulation; (2) the operator misjudged the pressure required to reach the barrier; (3) the operator pressed too hard, causing pain and autonomic responses with involuntary tensing by the patient; and (4) the patient has perpetuating factors that make the trigger points hyperirritable and resistant to treatment."(5)

Tandem Point therapy does not fail for any of these reasons. There is no point too irritable for Tandem Point therapy. If the clinician presses too hard, the pressure is simply reduced, and the work continues. Perpetuating factors do not prevent trigger points from releasing, but they may cause trigger points to return.