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

Facet Joint Syndrome: A Silent Cause of Chronic Pain

Medicine Corner with Dr D 

Facet Joint Syndrome

Back pain can be caused by degenerative changes and inflammation in the facet joints which is commonly referred to as a Facet Joint Syndrome. The spine is made up of individual vertebral bodies which are stacked one on top of another. On each side of the vertebral bodies are tiny joints called facet joints. Their primary role is to allow the spine to move and make twisting and bending movements. They also keep the individual vertebras from moving too far forward or twisting without limits.  Most facet joint-related pain is seen among individuals over the age of 60 secondary to osteoarthritis. It is, however, not uncommon for younger very active individuals to experience the same pain after engaging for several years in exercises that put lots of stress on the facet joints.

Back StrainSciaticaDisc HerniationSpinal Stenosis

Symptoms

When the facet joints become inflamed because of injury or arthritis, they will generate pain. Acute presentation of facet joint pain may resemble those caused by a herniated disc and at this stage it may be difficult to differentiate between these two. In most case the individual can pinpoint the area of pain indicating involved facet joint. At time, however, the person may experience diffused poorly localized pain in the lower back, hips, and buttocks on both sides. Most patients presenting with pain due to facet joint inflammation have difficulty bending backward which may help to establish the diagnosis. In some cases, the facet joint pain may project pain down to the legs and mimic the sciatic pain. Unlike sciatica, where the pain may project all the way down to the feet, facet joint pain usually terminates at the level of the knees. Only in rare cases the pain may project all the way down to the feet. This is usually seen when osteophyte is causing pressure on the nerve root.

Causes

The major cause for the development of facet joint syndrome appears to be osteoarthritis of the facet joints. Osteoarthritis is generally a consequence of wear and tear. It is characterized by narrowing of joint spaces, loss of joint cartilage and local joint inflammation. This process is similar to the more familiar knee osteoarthritis which is a well-known cause of knee pain among the elderly population. It has been shown that younger individuals suffering from facet joint syndrome tend to have history of strenuous jobs prior to the age of 20 which puts them at high risk for early osteoarthritis of the facet joints.

Diagnosis & Treatment guidelines

Inflammation of the facet joints is generally not well diagnosed by MRI or X-Rays. There is also a poor correlation between the findings on the images, physical exam by the provider and the symptoms that the patient experiences. In most cases injection of an anesthetic medication into the vicinity of the painful facet joint can help to make the diagnosis. If the patient experiences immediate pain relief after the injection, the condition can be diagnosed as facet joint syndrome and steroid injections can then be administered to decrease the local inflammation. The steroid injections are usually administered by pain specialists under fluoroscopy which helps to guide the needle placement. The patient may receive these injections every 3-6 months based on the duration of symptoms relief.

Acupuncture treatment can also be beneficial since needling the musculature in the affected area can improve local blood circulation and decrease the inflammation and muscle tension. Referral to physical therapy to learn appropriate core strengthening and stretching exercise is important in long term management and prevention of further exacerbation.

Avoiding activities that put undue stress on the spine is as important, if not the most important aspect of any long term management of facet joint syndrome. No treatment will be effective if these perpetuating factors are not effectively addressed and appropriate modifications incorporated into daily lifestyle.

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