Speaker #0I am Dr. Cyril Fischhoff, a chiropractor and a specialist in musculoskeletal ultrasound practicing in Mauritius. I invite you to listen to a new episode of the Vertebra & Co. podcast every first and third Monday of the month. This podcast is dedicated to the world of musculoskeletal medicine and is for everyone. We discuss the mechanisms involved, diagnoses, treatments, and the prevention of various musculoskeletal pathologies through short clinical stories, the latest scientific research, and interviews with specialists. Hello everyone, so today we're going to tackle a topic that affects almost everyone yet remains surrounded by mysteries and misconceptions, the trigger point, or point gachette in French. We've long reduced this painful spot to a simple tired muscle or a knot that just needed massaging. But in 2026, science tells us a completely different story. It's an interface pathology, a true conflict between your nervous electricity, your internal chemistry, and the mechanics of your tissues. So today, we're going to decode this short circuit. We're going to start by looking at the genesis of the trigger point. What exactly causes this mechanism to appear? Well, a muscle never locks up completely by chance. It's often a defense mechanism that remains stuck in a constant alert mode. We can identify three major causes for this. The first one is acute overload. It's a sudden, brutal impact, a wrong move during sports or that overly heavy box we lift without thinking. Well, to prevent a tear, the muscle violently contracts by reflex and remains, as it were, stuck in this defensive posture. The second cause is due to postural stress. For example, when we refer to the technic syndrome, it's like slow suffocation. For example, by spending hours with your head bent over a screen, your muscles are constantly working to keep your head from dropping. They're not designed for this kind of static effort. The result is that microcirculation in the muscle stops, waste products accumulate, and the muscle eventually freezes to conserve what little energy it has left. Finally, there's the joint protection signal. At that point, it's the brain that takes command. If a vertebra or a joint becomes irritated or lacks its normal healthy mobility, then your nervous system instructs the surrounding muscles to contract, creating a protective safety belt. The trigger point is then nothing more than a clasp, a lock on this very belt. So now, to truly understand what's happening at the trigger point itself, we must delve down to the microscopic scale where the nerve meets the muscle, that is the motor end plate. Imagine your nerve sends its commands to the muscles via special registered letters. This particular messenger is called acetylcholine. Normally, once the message is received, the signal is destroyed so the muscle can relax. Well, in a trigger point, the force it leaks. The nerve sends contraction messages in a loop. The muscle stays in on mode, consuming... all its fuel, ATP. This is called the energy crisis. And then an amplifier comes into play, CGRP, which is a neurotransmitter. Imagine it like a loudspeaker screaming at your nervous system to amplify the pain while simultaneously preventing the muscle from cleansing itself. The affected area then turns into a veritable chemical cesspool. Then, as the muscle is permanently contracted, blood no longer flows, oxygen is lacking, and the area becomes acidic. The pH level locally drops below the threshold of 5. This is precisely where what we refer to as ASICs, the acid-sensing ion channels, come into play. They are ultra-sensitive acid sensors positioned directly on your pain nerves. As soon as the environment becomes too corrosive, these sentinels open electrical gates to the brain. This is why the slightest pressure on a trigger point causes a sharp burning pain. You're not just pressing on a tight muscle, you're physically activating a chemical alarm that screams, Ouch. to your brain. So for decades, it was said that all of this was subjective. Today, we have irrefutable evidence that the trigger point truly exists physically. With B-mode ultrasound, the classic ultrasound, we locate the nodule. It appears as a darker, denser region which distorts the perfect architecture of your muscle fibers. When we use Doppler, which allows us to measure blood flow, well then we have clear proof of asphyxia. We can see on the screen that the blood bounces back as if against the trigger point. Internal pressure is so strong it crushes microvessels. Infrared thermography is quote-unquote the proof of metabolic anger. The active point is a hotspot. Its temperature is half a degree to one degree warmer than the surrounding skin. Finally, another technique still linked to ultrasound called elastography allows us to measure its stiffness. We quantify the rigidity in kilopascals. The trigger point is often twice as hard as healthy muscle. It's like a real steel cord beneath the skin. So how can we repair this? short circuit? Well, in 2026, we'll be combining our forces, for example, procedures like hydro release or hydro dissection. Under ultrasound guidance, the practitioner injects a volume of physiological saline solution or isotonic glucose precisely between the muscle and its surrounding sheath, the fascia. There is a Karcher effect, that is, we're going to detach the tissues that were stuck together, thus restoring their natural gliding. And then there's also a chemical cleaning mechanism. We literally rinse the acid in CGRP. By normalizing the pH, we force the ASIC sensors to close. The pain often subsides instantly. Another older technique is dry needling. A fine acupuncture needle is used to cause a micro-shock. This is the electrical reset. We finally force the acetylcholine valve to close. And then, of course, all of the manual medicine techniques, what we might refer to as an articular reset. If we address the muscle but leave the joint, the painful and restricted, the brain will resend its protective signal tomorrow. It's essential to restore movement so that the nervous system agrees to relax its muscles. In summary, a trigger point isn't a foregone conclusion. It's a distress signal from a body that has become trapped in a vicious cycle. Between the science of acid sensors and the new hydro-release techniques, for example, we now have all the keys to restore your ability to move with pleasure. Thank you for listening to this new podcast from Vertibolisco. Take care of your muscles and, most importantly, straighten up. Join me again very soon for a new episode of the Vertebras and Coblet Podcast. Meanwhile, take care, stay active, and if you ever have any questions for me, please feel free to contact us on the podcast page vertebranco.com.
