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Trigger Points and ESWTMyofascial trigger points, or just “trigger points” are small muscle spasms within the muscle belly.  The smallest units of muscle contraction (the sarcomeres) are stuck in extreme contraction.  This causes blood supply to be cut off to the muscle, waste products to build up  and the trigger point to further contract.  This cycle spirals on itself and trigger points just continue their pattern.

In the laboratory, the trigger points are shown to have an increased electrical charge in comparison to the rest of the muscle.

Trigger points tend to radiate pain or dysfunction to another part of the body.  Here are some examples:

Trigger Point for Tennis Elbow can be helped with ESWT

Trigger point for Tennis Elbow

Trigger Point for Carpal Tunnel Syndrome helped with ESWT

Carpal Tunnel Syndrome TP

Extensor Hallicis Longus Trigger Point helped with ESWT

TP referring to the big toe

Pectoralis Major Muscle Trigger Point

Pectoralis Major Trigger Point


We have been helping people with trigger points in our San Jose and Los Gatos locations for years with manual therapy. However, using the Piezowave 2 (the specific machine we will use on you in our Los Gatos office) on the muscle belly can treat those symptoms and decrease the trigger points as shown on before-and-after MRI studies [1] to be even more effective.  An interesting phenomenon you may note when being treated is that, during the application of the shockwave therapy, your symptoms may be temporarily reproduced.

When treating scar tissue we can see you 1 to 2 times per week or even more spread out than that.  With trigger points, we find that 2 times per week is needed  and prescribed home care is greatly encouraged.  In 2005, a study was done with 30 patients for 7 treatments each and there was an alleviation of pain in 95% of the participants [2].  This is really being proven to be a very effective treatment for trigger points.  There is even evidence of ESWT being as effective as trigger point hypodermic needle injections [3,4].  A lot kinder to your system though.

Even when we are treating conditions like carpal tunnel syndrome, knee pain, golfer’s elbow, etc., the results are better when we work on the trigger points above or below the injured area as well [5].

ESWT for treatement of brachialis muscle trigger point

Dr Fields demonstrates ESWT for a brachialis muscle trigger point


  • Have your posture corrected with Pettibon Chiropractic Care to avoid postural stress, muscle overload and trigger points.  Imagine what a short leg from a pelvic misalignment or forward head posture could do to create muscle imbalance.
  • When going back to exercise, gradually build up the amount of weight used.
  • Take breaks when performing repetitive movements like computer work, assembly line work, gardening, etc..
  • Ask us about proper training to avoid common mistakes that lead to trigger points.
  • Get your trigger points treated with the Piezowave 2 and home care or satellite trigger points develop.
  • Manage stress with relaxing activities, prayer, getting in nature, etc.. Stress increases trigger point activation.  Some of the most stubborn trigger points are in overachievers that don’t stop to look at the sky and breathe.
  • Eat a well balanced diet loaded with raw veggies.  Deficiencies in vitamins B1, B6, folic acid, vitamin C, calcium, potassium and iron can perpetuate trigger points.
  • Have a proper ergonomic evaluation done of your workstation.

*Sometimes trigger points cannot be reached with the shockwave.  Tim Sawyer, PT works in our Los Gatos office and is a published author of research in trigger point therapy.  Most of the research has been focused on the effectiveness of internal trigger point work for chronic pelvic pain and pelvic dysfunction [6,7,8,9].  This has provided hope for people who have traveled from around the globe to see him.  If you have pelvic pain, sexual dysfunction, prostatitis, urinary incontinence, difficulty relaxing or tightening your pelvic floor muscles or have any questions involving that area, we are happy to put you in touch with Tim Sawyer, physical therapist.


  1. M. Gleitz, K. Hornig, Trigger points-diagnosis and treatment concepts with special reference to extracorporeal shockwaves, Orthopade 41 (2012) 113e125
  2. H. Muller-Ehrenberg, G. Licht, Diagnosis and therapy of myofascial pain syndrome with focused shock waves, MOT 5 (2005) 1e5.
  3. J.H. Jeon, Y.J. Jung, J.Y. Lee, J.S. Choi, J.H. Mun, W.Y. Park, C.H. Seo, K.U. Jang, The effect of extracorporeal shock wave therapy on myofascial pain syndrome, Ann. Rehabil. Med. 36 (2012) 665e674.
  4. H.M. Ji, H.J. Kim, S.J. Han, Extracorporeal shock wave therapy on myofascial pain syndrome of upper trapezius, Ann. Rehabil. Med. 36 (2012) 675e680.
  5. A. Moghtaderi, S. Khosrawi, F. Dehghan, Extracorporeal shock wave therapy of gastroc-soleus trigger points in patients with plantar fasciitis: a randomised, placebo-controlled trial, Adv. Biomed. Res. 3 (2014) 99.
  6. Anderson R, Wise D, Sawyer T, Nathanson BH. Source, Department of Urology, Stanford University, School of Medicine, Stanford, CA Results of Internal Trigger Point Wand used in the Wise-Anderson Protocol – Clinical Journal of Pain, 2011, US National Library of Medicine National Institutes of Health, Clin J Pain. 2011 Nov;27(9):764-8.
  7. Anderson RU, Sawyer T, Wise, D Morey A. Nathanson BH.Reports on Trigger Points and Prostatitis / CPPS Journal of Urology, 2009, Oct 16
  8. Rodney U. Anderson, David Wise, Timothy Sawyer, And Christine Chan, From the Department of Urology (RUA, CC), Stanford University School of Medicine, Stanford, Sebastopol, (DW) and Los Gatos (TS),Improvement in Sexual Functioning after the Wise-Anderson Protocol The Journal Of Urology, October, 2006, p. 1534-1538. ABSTRACT, 1: J Urol. 2006 Oct;176(4 Pt 1):1534-8,
  9. Rodney U. Anderson, David Wise, Timothy Sawyer, And Christine Chan, From the Department of Urology (RUA, CC), Stanford University School of Medicine, Stanford, Sebastopol, (DW) and Los Gatos (TS),First Publication of the Success of the Wise-Anderson Protocol The Journal Of Urology, July, 2005, p. 155-160, ABSTRACT, 1: J Urol. 2005 Jul;174(1):155-60,