Trigger Points: The Shocking Culprits Behind Your Pain
Complementary Medicine
What are Trigger Points ?
In the mid-1960s doctor Travel introduced the term myofascial pain. Over the years, many publications and clinical experience have shown that nearly 80% of local muscular pain can be attributed to myofascial pain. The term myofascial pain has been associated with muscle tenderness that arises from hyperirritable areas in the muscles called trigger points. Muscular pain caused by trigger points has been known to mimic symptoms of a very long list of common maladies. Pain resembling sciatica, herniated discs, joint problems, kidney stones, and even headaches can be caused by the presence of trigger points in the associated muscle groups. Dismissing the concept of trigger points when evaluating common daily pains and aches, can result in incorrect diagnosis and failure to formulate an effective treatment plan to resolve the painful condition.
What is a Trigger Point?A trigger point is usually defined in textbooks as a painful point that can be felt as a hard nodule in the muscle. Clinically, however, a trigger point is more of an area of the muscle, not necessarily a precise point. There may be a palpable nodule, but that is not always the case. A better definition of a trigger point is an area of muscle that feels tight and ropy and usually is tender on palpation. Not every tender area within a muscle, however, is a trigger point. Several other characteristics have to be present for a tender area of the muscle to meet the criteria for the definition of a trigger point. Trigger points are therefore usually defined as areas that are tender on palpation, but also display twitch response when strumming the tight muscle band in a perpendicular direction. Compression of the trigger point also needs to reproduce the patient’s familiar pain. In some cases, when pressure is applied to the trigger point, the pain can be felt in a distant area of the body. This phenomenon is known as referred pain. The typical example of referred pain secondary to trigger points is pain at the base of the spine or the buttock, caused by trigger points in the mid-back muscles, at the area of the lowest ribs. A new definition of trigger points, however, suggests that referral of the pain to the distal area of the body does not need to be present in order to make the diagnosis of a trigger point.
Formation of Trigger PointsWhen a muscle or a group of muscles is subject to repetitive overuse or sudden strain, a contraction will form in a small number of muscle fibers within the affected muscle. We refer to these small contractions as trigger points. The presence of trigger points in the muscle, shortens the length of the muscle, much like making series of knots on a piece of a string. The more knots on the string, the shorter and tighter the string becomes. This analogy can be applied to muscles that become tight due to the presence of trigger points. The shorter the muscle becomes, the more distinct ropy feeling can be appreciated when strumming perpendicularly across the affected muscle. When a muscle becomes shorter because of the trigger points, it will start to generate greater pull on the tendons and ligaments that attach the muscle to the joints and other structures. In the case of the knee joint for example, if trigger points are present in the quad muscles, they will shorten the quad muscles. The quad muscles attach below the knee through a tendon that runs over the kneecap (patella). The shortness in the quad muscles will therefore cause the kneecap (patella) to be compressed over the underlying cartilage whenever the knee is flexed. Greater friction between the patella and the underlying cartilage will over time result in faster loss of the underlying cartilage or formation of inflammation. This condition is called a chondromalacia patella and is experienced by the individual as a deep achy pain underneath the kneecap.
What causes trigger points?In general, trigger points tend to form in the muscle that is subject to a higher load than the muscle can tolerate. There are a variety of factors that have been noted as potential causes for the development of trigger points. The most significant of these include acute or chronic muscle overload due to poor posture or over-exercising. Direct trauma to the muscle, as well as trauma due to a car accident which leads to a whiplash, are another common cause for developing trigger points. Additionally, psychological distress, homeostatic imbalances, and certain lifestyle habits such as smoking, have been identified as important contributors to the formation of trigger points. When an area of muscle is constantly overloaded, the resulting muscle tightness in that area will compress the surrounding blood vessels. This leads to poor local blood circulation with subsequent accumulation of various metabolic by-products and chemicals which sensitize the surrounding nerve endings. The impaired metabolism and blood circulation in the muscle further impair the muscle’s ability to fully relax. Eventually, the muscle develops sustained contraction leading to the development of palpable tight and ropy areas of the muscle defined as trigger points.
Consequences of Trigger points
There are many implications of having trigger points in the skeletal muscles. The most well-known include pain, stiffness, and decreased range of motion of the affected muscles. Decreased athletic performance and pain radiation to other parts of the body are two less known facts about trigger points. Understanding how trigger points affect athletic performance is particularly important for anybody interested in maximizing the benefits of their workout routines. Many top athletes pay large sums of money to experts in myofascial release to keep their muscles free from trigger points.Decreased athletic performance When muscles develop trigger points, their overall capacity to do their job is impaired. Physiologically, the basic function of the muscle is to expand and contract. The presence of the trigger points causes the muscle to assume a constant shortened and contracted state, hindering the muscle’s ability to fully flex and contract. This will manifest as overall muscle weakness, decreased range of motion, feeling of stiffness, earlier fatigue, and intolerance to high-intensity workload. Muscles that have trigger points also recover much slower. The combination of all these factors interferes with athletic performance and leads to suboptimal results despite adequate training and preparation.
Pain radiation to other parts of the bodyThe characteristic feature of trigger points is their ability to refer pain to distal areas of the body, which makes the correct diagnosis of the true origin of the pain challenge. Detailed pain referral pathways have been described for individual muscles and their trigger points. These referral pathways sometimes overlap, therefore a detailed search of all muscles which can refer pain to a particular area, should be conducted, to identify all the sources of the pain. An example of referred pain to the same area from a different muscle is a pain in a pinky and along the inner aspect of the hand. This referral pattern is typical for trigger points in the Latissimus dorsi. In some cases, however, the pain in the pinky and along the inner aspect of the hand can result also from the presence of trigger points in the Infraspinatus muscle.Several non invasive treatment options are available to address and treat trigger points. Some of the most popular include acupuncture, dry needling and acupressure modalities. Follow these links to learn more about each one of the them.To learn more about complementary therapies. Visit National Center for Complementary and Integrative Health
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