Generally do other therapies before TPT - There will be fewer to do by hand. The following list is based on effectiveness of the therapy.
Trigger Point Therapy - Direct pressure = BEST THERAPY OF ALL YOU CAN DO!
Diathermy - Best and deepest unattended modality, nothing blocks or attenuates it. Penetrates up to 2 inches deep. Does more than heat. Works on a molecular and microelectrical basis.
Ultrasound - Effective for specific surface TPs. Only works about ½ to 1 inch deep. Doesn't penetrate below bone. Attended therapy requires lotion and cleanup.
Intersegmantal Traction - i.e. "Roller Table" - See below for proper therapeutic use.
Spray and Stretch - Must apply to bare skin, good for stretch but not as effective for specific TPs.
Microstim / EMS - Works only on surface muscles. Doesn't penetrate below ½ inch. Principle of fatiguing muscle is nonspecific to TPs and will not affect them effectively.
Interferential Current - Good pain reliever but non-effective for TPs.
Heat - Works to relax muscle but nonspecific.
Ice - Now listed as a non-therapy except in first 24 hours continuous application to prevent swelling or as direct application for analgesia during application (burns). Can actually exacerbate TPs.
Reasons for Failure
Lack of patient commitment
Continuation of precipitating and/or perpetuating factors
Excessive patient zeal
Lack of doctor technique
Lack of familial support
Misunderstanding / lack of doctor-patient education
Proper Use of a "Roller Table"
The proper term for this therapy is Intersegmental Traction. If you traction a joint to patient comfort you will never accomplish the benefits of traction designed to stretch ligaments and open up joints for greater mobility. When putting a patient on the table you should start the table at the bottom or lowest setting and explain to the patient that to get the best benefit of the therapy you will raise the rollers until the patient tells you it is somewhat painful but still bearable and then stop. When that point is reached ask the patient if it is bearable. After experience some patients will want it as high as possible. If yes, explain that the pain will last for about 3 minutes and then subside as the ligaments and joints in their spine begin to stretch out. The therapy should last about 5 minutes. The principles behind this, SOT blocks and an adjustment are the same - open a joint to greater mobility through stretch - only the timing is different.
For trigger points, have the patient shift about 1 inch sideways in the "trough" and lean back into the rollers so that the rollers run up and down the paraspinal muscles. They can actually use the rollers at pain tolerance levels for any body part the rollers can hit. Isolate on the Gluteals by having the patient sit up with the muscle mass in the trough. Work on the legs by having the patient lie with their leg in the trough. Have the patient sit next to the table with their arm getting worked on. You can even isolate on the abdominal cavity but you should be careful with this one. A patient can be on the table for more than an hour getting all the TPs they can. Generally, 5 minutes per area is sufficient to reduce most trigger points. You will need to finish them by hand but there won't be as many to do.
Once you learn how to use a "Roller Table" for TP work you will find a way to buy more. It is one of the most effective and easiest therapies patient actually enjoy and can learn to self administer under a watchful eye.