Myofascial Trigger Points: Hidden Culprit Behind Back Pain

Musculoskeletal Health with Dr D. 

Myofascial Trigger Points: Hidden Culprit Behind Back Pain

Back pain is a prevalent disorder, and more frequently than not, we tend to blame a pinched nerve, herniated disc or arthritis as the cause of the pain. Clinically, however, the majority of back pain is a result of muscle dysfunction and imbalance. A large proportion of back pain is, therefore, the result of the presence of myofascial trigger points (MTrPs). When MTrPs are the cause of muscle pain, we refer to this type of pain as myofascial pain syndrome. In rare cases, the pain may be a result of the problem in the spine itself. However, even in this scenario, the presence of myofascial trigger points in the surrounding musculature is seen as one of the significant contributors to worsening back pain.

 

Clinical experience and research suggest that the presence of trigger points leads to muscle shortening. When muscles shorten, they become less flexible and less responsive to daily demands during physical activities. The affected individual becomes stiffer, and tension begins to build up in the muscles of the back. The pressure will eventually transfer to the discs in the spine. Maintaining muscle tension over the spinal discs may ultimately result in the rupturing of the disc or disc herniation. The presence of trigger points in the shortened muscles can, therefore, be the very root cause of the spinal problems. Additionally, muscles that become short and tight can displace vertebrae and cause compression of nerves.

What are Trigger Points?Which Muscles Are Involved?Treatment optionsOptimize Your Recivery

Lower back pain   

Treatment of the lower back pain can be a very frustrating experience for the patient, but also their provider. In most cases, it is the area of the most intense pain that tends to bear the blame for the origin of the pain. Therapies are, therefore usually aimed at the most painful areas. In reality, however, that is not always the case. In many instances, the presence of trigger points in the area of the mid-back or the buttock muscles is the primary cause for the lower back pain or pain in the sacrum. If the trigger points in these muscles are not appropriately addressed, treatment modalities focusing on the muscles in the lower back will not successfully relieve the back pain.

 

Additionally, trigger points in the abdominal muscles and a muscle called Iliopsoas are very frequent causes of back pain. Unfortunately, these muscles are usually ignored by many health care professionals as a potential cause of back pain. Treating back pain can be therefore challenging and should always include a search for the trigger points not only in the back muscles but also in the buttock muscles and some cases even in the abdominal muscles and the iliopsoas muscle.

Buttock and hip pain

Individuals experiencing pain in the buttock and hip muscles are usually concerned only with the muscles in the buttock and the hip joint itself. Knowing that the referral pattern of the trigger points in the back muscles includes the buttock and the hips may help to identify the real source of the pain in the buttock or the hip joint.

  

Sacral pain

Many patients present to the clinic with lower back pain pointing to the base of their spine. Pain in the sacrum or tail bone is another joint presentation of back pain. While the pain can originate in the tail bone, frequently, the source may originate from muscles located much higher. Quadratus Lumborum, superficial spinal muscles as well as the gluteal muscles are frequent harbingers of trigger points which tend to refer pain to the area of the sacrum. The trigger points in these muscles can be very tender to palpation. If the pressure over these trigger points further aggravates the pain in the sacrum, it is yet another reason for considering them as the main culprit.  Massaging these trigger points can, therefore, bring significant pain relief in the sacral area.  When massaging trigger points in these muscles do not completely resolve the pain or the pain tends to reoccur, chiropractic adjustment of the sacrum may be needed. In this case, massaging the trigger points in the Quadratus Lumborum, Superficial Spinal Muscles and the Gluteal Muscles before the chiropractic adjustment will make the chiropractic adjustment more effective.

The basic approach to self-acupressure

Self-acupressure targeting trigger points is a non-invasive, free of side effects, and straightforward treatment method. It can be adopted and used by every person suffering from back pain. Self-acupressure can be applied to affected muscles several times a day at home or in the workplace. Carrying a lacrosse ball, tennis ball or baseball ball along with you can, therefore, allow for short and frequent treatments throughout the day to ease the pain and promote faster recovery. Targeting the most painful trigger points several times a day with short self-treatment sessions is the most effective way to treat trigger points. Successful management of back pain should, therefore, include the regular application of self-acupressure.

 

You can find more information about acupressure , other treatment modalities and learn the complete home treatment protocol for the management of myofascial pain in the section Treatment Options.

 

To learn more about complementary therapies. Visit National Center for Complementary and Integrative Health

The information provided on these pages is not intended to treat or diagnose any condition and should be viewed solely for education purposes. By no means is this information replacing evaluation by a qualified health care provider. For full Terms and Conditions, as well the use of cookies by this website, please see the sections “Terms and Conditions” and “Privacy.”

by Dr. Michal Domeny DNP, L.Ac, CD/N

Chronic Back Pain: Treatment Options for Chronic Back Pain

Treatment Options for Chronic Back Pain

Chronic back pain continues to be one of the most common musculoskeletal complains seen in primary care.  It is estimated that the incidents of chronic back pain will continue to rise given our increasingly more sedentary lifestyle. While research in the areas of pain management and safer surgical procedures continues, both should be viewed as the last resort.

AcupunctureDry NeedlingAcupressurePhysical TherapyHome Treatment Protocol

Cure or management of chronic back pain?

When discussing the treatment of chronic back pain, it is important to understand, that there is no reliable “cure” for chronic back pain. That is not to say that once an individual develops chronic back pain, they will have to suffer from the pain for the rest of their life. In fact, most chronic back pain can be successfully managed, to allow the individual to live a normal productive life. It should be understood, however, that the nature of chronic back pain is fluctuating periods of no pain or only minimal discomfort with periods of severe worsening of back pain. These fluctuations generally correspond to the demands of daily life.  It is usually not possible to completely avoid the periods of more intense back pain. The frequency and the severity of these episodes can be, however, controlled to a large extent. Conscientious adherence to daily routine which includes specific exercises, stretching and self-acupressure, along with minimizing the exposure to activities that pose undue stress on the back, has been shown to significantly reduce the episodes of worsening back pain.

 

Common treatment modalities

Numerous treatment options have been developed for the treatment of back pain. They range from conservative noninvasive options, which can be applied by an individual at home, to more invasive treatments requiring a visit to a health care provider. In extreme cases, surgical intervention may be necessary.

Self-Acupressure

Self-acupressure can be applied to the specific trigger points in the affected musculature by the patient at home on daily bases. It can be used as a sole treatment for the management of mild to moderate back pain. Self-acupressure can be also used along with any other modality to reinforce the treatment effect and promote faster recovery. More information about acupressure can be found by clicking on the tab on the left-hand side of this page.

 

Physical Therapy

Physical therapy is frequently used as a part of an overall treatment protocol to treat acute or chronic back pain. The goal of physical therapy is to relieve pain, help the body in the healing process, and restore normal functional pain-free movement. A physical therapist can prescribe specific rehabilitation exercises alone or in combination with dry needling, TENS, heat application, soft tissue release or gentle manipulations.  Physical therapy is generally initiated if the injury is not spontaneously recovering with conservative treatments within 2-6 weeks. In case of severe acute back pain, however, a referral to physical therapy can be initiated right away. For more information click on the tab on the left-hand side.

Acupuncture and Dry Needling

Acupuncture and dry needling are both very safe therapeutic modalities. Dry needling is mostly available to the patients through the department of physical therapy. The carefully selected patients which may benefit from dry needling usually receive a series of dry needling sessions as part of their physical therapy treatment plan.  There are some primary care providers who have been trained in dry needling. They may offer this treatment modality to their patients on limited bases given their busy schedule. Acupuncture is available to patients only from licensed acupuncturists or physicians with training in medical acupuncture. For more information about Acupuncture and Dry Needling please click on the tabs on the left-hand side of this page.

 

Pharmacologic management

Pain medications play an important role in the management of chronic back pain for many patients. Some patients rely on a daily dose of pain medication to control their pain and there is a definite role for pain medication in the management of chronic pain. It is important to point out, however, that the medication should not be relied on as the sole long term strategy to keep chronic pain under control. This passive approach generally leads to further deconditioning, the need for increasing the dosages of medication and inherently to more side effects associated with their daily use.  Appropriate use of pain medication can be, however, an integral part of a comprehensive treatment plan when used under the guidance of a qualified health care provider. In general, the pain medication should be used at the minimal effective dose and for the shortest amount of time, unless directed otherwise by the health care provider.

Surgical procedure

No surgical procedure is risks free. Formation of scar tissue and the need for subsequent surgery are known complications. Surgery should be therefore reserved only for rare cases. These generally include instances where all other treatment options have been exhausted. In these cases either the pain cannot be successfully controlled by any other intervention or there is a significant functional deficit that can be improved by the surgical procedure.

The information provided on these pages is not intended to treat or diagnose any condition and should be viewed solely for the purpose of education. By no means is this information replacing evaluation by a qualified health care provider. For detailed Terms and Conditions, as well the use of cookies by this website, please see the sections “Terms and Conditions” and “Privacy.”

 

For more information on Acupuncture and other complementary therapies visit Alternative, Complementary & Integrative Therapies: Acupuncture/Acupressure

by Dr. Michal Domeny DNP, L.Ac, CD/N

Back Pain and Physical Therapy

Physical Therapy and Back Pain

Physical therapy is frequently used as a part of an overall treatment protocol to treat acute or chronic back pain. The goal of physical therapy is to relieve pain, help the body in the healing process, and restore normal functional pain-free movement. A physical therapist can prescribe specific rehabilitation exercises alone or in combination with dry needling, TENS, heat application, soft tissue release or gentle manipulations.  Physical therapy is generally initiated if an injury is not spontaneously recovering with conservative treatments within 2-6 weeks. In case of severe acute back pain, however, a referral to physical therapy can be initiated right away.

Treatment optionsAcupunctureDry NeedlingAcupressureHome Treatment Protocol

Physical therapy did not help my back pain

Many patients frequently complain that physical therapy has not worked for them. They refuse to follow up with the referral made by their provider and demand Xrays or MRIs to find out why their back continues to hurt. While X-ray or MRI is not necessary in the majority of chronic or acute back pain, physical therapists frequently order these studies if the patient's condition is not responding to the treatment protocol. Imaging studies can also be ordered if the physical therapist feels that it will help them create a more specific treatment plan. Imaging studies, however do not cure back pain. It is critical to realize that any treatment modality only works if the patient is an active participant. When it comes to physical therapy, the reality is that most patients are not compliant with the prescribed treatment plan. It is not enough to come to physical therapy once or twice a week for half an hr session and expect to see major improvements. Adherence to prescribed exercise at home as instructed by the physical therapist is the key. Physical therapy sessions at the clinic should be used primarily as an opportunity to assure the correct form and assess the progress.  To get the most from physical therapy, the majority of work has to be done at home.

 

Key factors in the treatment of chronic back pain

While most acute back pain eventually resolves on its own, chronic back pain tends to fluctuate between days with more or less pain. To increase the number of days without pain or with only slight discomfort, something fundamental has to change. There are many factors that impact the successful treatment of back pain.  Two of the most important factors are elimination of aggravating factors and correcting muscle imbalance. Physical therapists are medical professionals with extensive training in skeletomuscular disorders and thus best suited to help patients accomplish both.

Individualized treatment and workout plans

Physical therapists can review with patients their daily routine and help them identify the major aggravating factors that continue to flare up their back pain or prevent the maximal recovery.  They will thoroughly asses the patient’s condition and create an individual exercise treatment plan. Physical therapists can help the patient tailor a specific work out routine that will help them achieve their personal fitness goals without aggravating their back pain. Additionally, physical therapists are the top authority to teach patients the correct execution of individual exercises to prevent future injuries. Incorrectly performed exercises continue to be the leading cause of many exercise-related injuries. Incorrectly performed exercises can lead to permanent joint or back injury.

 

Summary

Physical therapy is an integral part of any comprehensive treatment approach to chronic back pain. In some cases, physical therapy can be, however, beneficial also in acute cases of back pain. Physical therapists often incorporate variety of techniques and tools when designing their individual treatment plan. Imaging is usually not needed in most cases of uncomplicated chronic and acute back pain but imaging studies can be ordered by the physical therapist if it is indicated. Physical therapists are top experts in designing individual workout routines that will help patients achieve their fitness goals without risking further injuries. Lastly, physical therapy only works if patients become active participants.

by Dr. Michal Domeny DNP, L.Ac, CD/N