trigger point therapy palma de mallorca

Trigger Point Therapy – Releasing Muscle Knots

Trigger points are one of the most common causes of chronic musculoskeletal pain. At our practice in Palma de Mallorca, Dr. Diedrich offers targeted trigger point treatment as a specialist in orthopaedics and experienced manual therapist.

Trigger Point Treatment

Trigger Points

Trigger Points

Acupuncture

Trigger Points

Trigger Points

Acupuncture

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Trigger Points

Trigger Points

Acupuncture

Common Trigger Point Patterns

Head and neck pain: Trigger points in the trapezius and sternocleidomastoid muscles are among the most common causes of tension headaches and migraines. Referred pain can affect the temple, forehead or back of the head.

Shoulder pain: Trigger points in the rotator cuff (infraspinatus, supraspinatus) frequently mimic rotator cuff tears and are a reason why some shoulder operations do not achieve the desired outcome.

Back pain: Trigger points in the quadratus lumborum and paravertebral muscles cause deep back pain that can radiate to the buttock and leg — similar to a disc herniation.

Treatment Methods

• Manual trigger point therapy — Targeted pressure treatment (ischaemic compression) that deactivates the trigger point through local ischaemia followed by reactive hyperaemia.
• Dry needling — Thin acupuncture needles are inserted into the trigger point. The resulting twitch response effectively deactivates the point.
• Shockwave therapy — Focused shockwaves can reach particularly deep or treatment-resistant trigger points.
• Infiltration — For very painful trigger points, a local infiltration with local anaesthetic can facilitate treatment.

Holistic Approach

Trigger point therapy alone is often not sufficient. As a qualified sports scientist and orthopaedic specialist, Dr. Diedrich combines treatment with manual medicine, posture analysis and individual exercise programmes to address the root causes of trigger points.

Dry Needling — Scientific Evidence

Dry needling has emerged as one of the most intensively researched interventions for myofascial trigger points over the past two decades. Unlike traditional acupuncture, which follows meridian-based principles from Traditional Chinese Medicine, dry needling targets specific anatomical structures — the taut bands and contraction knots within skeletal muscle that define myofascial trigger points. At our practice in Palma de Mallorca, Dr. Diedrich applies dry needling as part of an evidence-based, multimodal treatment approach.

Mechanism of Action

When a fine acupuncture needle is inserted into an active trigger point, it typically elicits a local twitch response — a brief, involuntary contraction of the taut muscle band. Research using electromyography (EMG) has confirmed that this twitch response is associated with a significant and immediate reduction in the electrical activity of the trigger point, indicating deactivation of the dysfunctional motor endplate. Histological studies suggest that trigger points involve localised areas of sustained sarcomere contraction with impaired blood flow (energy crisis hypothesis). The needle disrupts this self-sustaining cycle, restoring normal blood flow and metabolic function to the tissue.

Neurophysiological research has also demonstrated that dry needling modulates pain processing at the spinal cord level through segmental inhibition, and may influence descending pain modulation pathways from the brainstem. This explains why patients often experience pain relief not only at the needle site but also in referred pain areas distant from the trigger point.

What the Research Shows

A landmark Cochrane-style systematic review published in the Journal of Orthopaedic & Sports Physical Therapy analysed thirty-three randomised controlled trials and concluded that dry needling provides statistically and clinically significant reductions in pain intensity and improvements in range of motion when compared with sham or no treatment. The effect sizes for pain reduction are comparable to those achieved with corticosteroid injection, but without the side effects associated with repeated steroid use — an important consideration for athletes and active patients.

For specific conditions commonly seen at our practice, the evidence is particularly strong. Studies on chronic neck pain demonstrate that dry needling of the upper trapezius reduces pain scores by forty to sixty per cent after a course of treatment. Research on plantar heel pain shows that dry needling of the gastrocnemius and soleus trigger points — which refer pain to the heel — is as effective as corticosteroid injection at six-month follow-up. For tension-type headaches, dry needling of cervical and suboccipital trigger points reduces headache frequency and intensity significantly.

Safety Profile

Large-scale safety studies confirm that dry needling is a low-risk procedure when performed by trained practitioners. The most common side effects are minor post-treatment soreness (lasting twenty-four to forty-eight hours) and mild bruising at the needle site. Serious adverse events are extremely rare. At our practice, Dr. Diedrich — who holds specialist qualifications in both orthopaedics and manual medicine — performs all dry needling treatments personally, using single-use sterile needles and strict hygiene protocols.

Trigger Points and Sport

Athletes are particularly susceptible to myofascial trigger points due to the repetitive, high-intensity nature of sporting activity. Overuse, eccentric muscle loading, inadequate recovery and sport-specific postural demands all contribute to trigger point development. In Mallorca — one of Europe's leading sports destinations — we see a high volume of sport-related trigger point conditions, particularly during the peak training seasons.

Cycling

Cycling is Mallorca's most popular sport, with thousands of amateur and professional cyclists training on the island's roads each year. The fixed posture on the bicycle creates predictable trigger point patterns: the upper trapezius and levator scapulae develop trigger points from sustained neck extension (looking up from the dropped handlebar position), the piriformis and gluteus medius from prolonged hip flexion on the saddle, and the quadriceps and iliotibial band from repetitive pedalling loads — particularly during the steep climbs of Sa Calobra and the Puig Major.

Dr. Diedrich frequently treats cyclists with a combination of dry needling to the most active trigger points, followed by whole-body cryotherapy at -110°C for systemic inflammation reduction and accelerated recovery. This protocol allows riders to return to training more quickly than with conventional treatment alone.

Tennis and Golf

Racquet and club sports involve explosive, rotational movements that load specific muscle groups intensely. Tennis players commonly develop trigger points in the infraspinatus (causing deep shoulder pain during the serve), the extensor carpi radialis brevis (contributing to lateral epicondylitis), and the rotator cuff muscles. Golfers present with trigger points in the thoracolumbar erector spinae from trunk rotation, the forearm flexors (contributing to medial epicondylitis), and the subscapularis from the follow-through phase.

In both sports, trigger points in the elbow region are extremely common. Active trigger points in the forearm extensors and flexors can mimic or exacerbate tennis elbow and golfer's elbow respectively. Deactivating these trigger points with dry needling often produces dramatic improvement in patients who have not responded to conventional treatment.

Hiking and Running

The Serra de Tramuntana offers world-class hiking but also places significant demands on the lower extremity. Trigger points in the quadratus lumborum and multifidi develop from carrying a loaded backpack over uneven terrain. In the legs, trigger points in the vastus medialis and tensor fasciae latae contribute to anterior knee pain on steep descents, whilst gastrocnemius and soleus trigger points refer pain to the Achilles tendon and heel — conditions that can end a hiking holiday prematurely if left untreated.

Self-Help for Trigger Points

Whilst professional treatment is essential for persistent or severe trigger points, there are effective self-management strategies that patients can use between appointments and as part of long-term prevention. Dr. Diedrich routinely teaches these techniques to patients as part of a comprehensive treatment plan.

Self-Massage with Pressure Tools

Foam rollers, massage balls and specialised trigger point tools allow patients to apply sustained pressure to accessible trigger points at home. The principle is the same as clinical ischaemic compression: apply moderate pressure to the tender point for sixty to ninety seconds until the pain intensity decreases by at least fifty per cent. This technique is particularly effective for trigger points in the upper trapezius, the thoracic paraspinal muscles, the gluteal muscles and the calf complex.

Technique: Position the tool so that it presses directly onto the most tender spot within the taut band. Apply enough pressure to create a moderate pain level — roughly a five or six on a scale of zero to ten. Hold this pressure without moving. The pain should gradually diminish. If the pain increases rather than decreases, reduce the pressure or reposition the tool. Repeat on each point two to three times daily.

Stretching Protocols

Sustained, gentle stretching of muscles containing trigger points helps restore normal resting length and improve blood flow to the affected tissue. The stretch should be held for thirty seconds and repeated three to four times, ideally after applying warmth or immediately following self-massage. For back-related trigger points, gentle spinal flexion and rotation stretches are effective. For the neck and shoulders, lateral cervical flexion and doorway pectoral stretches address the most common trigger point locations.

Heat Therapy

Applying warmth to muscles containing trigger points promotes local blood flow and relaxes the taut bands. A warm shower, a heat pack applied for fifteen to twenty minutes, or a warm bath can significantly reduce trigger point tenderness. Heat is most effective when applied before stretching or self-massage, as it prepares the tissue for mechanical treatment.

Posture and Ergonomics

Many trigger points develop or persist because of sustained poor posture — prolonged sitting at a desk, looking down at a mobile phone, or sleeping in awkward positions. Addressing these perpetuating factors is essential for long-term resolution. Simple adjustments such as raising the computer monitor to eye level, using a supportive chair, taking regular movement breaks every thirty minutes, and sleeping with a supportive pillow can prevent trigger point recurrence.

When Self-Help Is Not Enough

If trigger point pain persists for more than two to three weeks despite consistent self-treatment, if pain is worsening, if there is associated numbness or weakness in the arms or legs, or if the pain is significantly affecting sleep or daily activities, professional assessment is advisable. Dr. Diedrich can determine whether the symptoms are truly myofascial in origin or whether an underlying structural condition — such as disc herniation, nerve entrapment or joint pathology — requires a different treatment approach.

Contact and Appointments

Book your appointment at our practice in Palma de Mallorca. Call us: +34 971 68 43 45. We speak English, Spanish and German.