Myofascial Trigger Points: Hidden Culprit Behind Back Pain
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.
Buttock and hip painIndividuals 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.
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-acupressureSelf-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.”
Gluteus Medius and back pain: The Muscle that may cause your back pain
Buttock Muscles
Gluteus Medius
Location The gluteus medius muscle is one of the three gluteal muscles in the buttock. The other two gluteal muscles are gluteus minimus and gluteus maximus. Gluteus medius is located more in the outer part of the buttock and for the most part, it is covered by much larger Gluteus maximus. Gluteus medius is not covered by gluteus maximus at the upper outer portion of the buttock. This is the area where injections are usually administered.
FunctionGluteus medius is not a very big muscle, but it is a thick and strong muscle that plays an important function in allowing us to walk upright. With each step, the gluteus medius muscle on the supporting leg has to contract, to keep the opposite side of the pelvis from dropping down when we lift the opposite leg to make the next step. That translates to generating a force twice the bodyweight every time we take a step. It is not hard to imagine that this muscle tends to get severely overworked when we carry additional weight for prolonged periods of time. This is one of the reasons why many people present with worsening of their back pain after hiking with a heavy backpack or when ruck marching with full gear without proper train up. While it is not intuitive to associate buttock muscles with back pain, this muscle is one of the most important players in the low back pain.
Gluteus Medius and back pain
When gluteal muscles get severely overworked, they become tight and develop trigger points. At this point many people begin to waddle to transfer their body weight fully over the supporting leg when taking a step. This is simply a protective and compensatory mechanism since the gluteus muscles cannot fulfill their function of contracting and relaxing when walking. The reason why we may feel back pain when gluteus medius is affected, is because the trigger points in the gluteus medius refer pain into the lower back. (please see the images). Certainly, gluteus medius is not the only muscle responsible for back pain. More frequently than not, another muscle called Quadratus Lumborum is affected along with gluteus medius. These two muscles work in tandem and the referral pattern from their respective trigger points overlap. Therefore it is important to always check for presence of trigger points in both of these muscles. Quadratus Lumborum will be discussed in a separate section, but you may remember that one of the hallmarks of involved Quadratus Lumborum is pain when turning in the bed, when coughing or sneezing.
Most characteristic pain caused by trigger points in Gluteus MediusThe pain referred from trigger points in the gluteus medius is mostly felt right above the beltline, but strong sensation can be also felt in the sacral area (please see images). In many cases, pain in the outer part of the hip, known as trochanteric bursitis, has a strong component of involved gluteal muscles, and gluteus medius being one of the main muscles involved.
Location of trigger points & Acupressure tips
To locate the trigger points in the gluteus medius, please refer to the detailed description below. In general, however, they can be found along the iliac cress which is the top part of the pelvic bone. The best way to deactivate the trigger points in the gluteus medius is by leaning against the wall and using a baseball or a tennis ball. Alternately, you can place the ball on the floor and lay down on top of the ball to create more pressure. Using a foam roller is not the best method to address these trigger points, because the foam roller cannot deliver the specific pinpoint pressure through the layers of the fat tissue in the buttock muscles.
Summary
SymptomsPain in the lower back just above and below the beltline
Pain often extends into the buttock and hip
Pan in the hips can make it hard to find a comfortable sleeping position
Pain in both the hips & lower back can make walking almost impossible
Location of trigger points
Find the bony prominence above your groin (ASIS)
The first trigger point is about 2” behind ASIS
Locate the 2nd trigger point about 1 hand breath behind the 1st one
Find the 3rd trigger point next to the sacrum
Pain radiation
To the sacrum
The outer part of the hip
Buttock and lower back above the sacrum
Occasionally along the IT band & back of the thigh
Causes for development of trigger pointsObesity or pregnancy
Carrying heavy weight while walking
Weight lifting
Sitting on a wallet in the back pocket
Habitual weight bearing on one side
Carrying a child on the same hip
Trigger points self-acupressureLocate the 1st trigger point
Place the ball between the wall & the buttock
Move the ball horizontally over the tender spot
Find a new tender spot behind the 1st spot
Repeat rolling over the tender area
Find the 3rd spot next to the sacrum & repeat
General recommendationsMove ball over the tender area 15-20 times
Find a new spot & repeat the process
Apply this massage at least 2-3 x a day
Several short daily sessions are preferable
Do not apply very strong pressure
Follow up after trigger point massage The benefits of acupressure can be greatly enhanced with a few additional techniques applied after completion of acupressure. One of the most important modalities in the treatment of myofascial pain is heat. Application of moist heat to the area of trigger point after trigger point massage will dilate local blood vessels and improve blood circulation. Improved blood circulation helps to flush out the inflammatory substances which irritate local nerves and cause pain. Improved blood circulation will also promote healing and loosen up tight muscle tissue. Apply heating pad for 10-20 min, take a hot shower or bath. After massaging and warming up the muscles, you can gently stretch them. Stretching is another essential aspect for recovery from and prevention of muscle injuries. Lastly, apply topical analgesics such as Bengay or Tiger balm.
Acupressure
Stretching Exercises
Back Strain: Symptoms, Causes and Treatment Strategies
Back Strain: Symptoms, Causes and Treatment Strategies
Back strain is probably the most common form of acute back pain. It affects the muscles and their tendons which attach them to various structures in the back. In general, muscle strain refers to a small tear in the muscle or its tendon. Most muscle strains tend to develop in the lower back area where the muscle changes into the tendon, but they can develop anywhere.
SymptomsA strain of the back muscles mostly causes localized pain in the area of the muscle/tendon injury accompanied by stiffness, limited range of motion and difficulties maintaining straight posture. Timing is very important when it comes to muscle strain.
Most muscle strains usually happen while lifting something very heavy or doing a sudden movement. Many individuals experiencing back pain due to muscle strain may feel a popping sensation at the moment of the injury which usually prompts them to seek medical attention.
They may have difficulties straightening their back up after the onset of the pain and usually maintain a semi bent position to avoid severe pain. That is not to say that muscle strain cannot come gradually. Even in this case, however, the individual can usually remember the moment when he felt sudden uncomfortable pain in the back which became progressively worse with activities.
Most individuals will also complain of muscle cramps in the area of their lower back. Additionally, coughing and sneezing usually brings on bouts of severe pain during acute back strain. The back muscles which tend to be the most affected by muscle strain are those right next to the spine.
Frequently, however, the pain can also be felt around the base of the spine and in the buttock area. Occasionally, pain may radiate into the buttocks. Under normal circumstances, pain due to back strain does not radiate down to the legs.
Pain radiating down to the legs is usually associated with nerve compression, but it is also frequently seen as a result of trigger points in the gluteal (buttock) muscles. Back strain is not a serious condition and most individuals with acute back strain recover spontaneously within 1 to 2 weeks.
CausesWhen muscle strain is caused by a sudden movement, it is generally a result of preexisting tightness in the back muscles which has developed over a period of time. Tight muscles are less flexible. Decreased flexibility results in limited ability to respond to sudden demands for muscle extension beyond the normal daily activity.
Therefore when the muscle is required to suddenly extend beyond its limits, such as when catching a falling object or catching ourselves from falling down, a strain can develop in the muscle or the tendon. To prevent further injury, the body triggers protective mechanism which manifests as muscle spasm.
The final outcome is stiffness and significantly limited range of motion with great amount of pain when trying to move in any direction.
Back strain can, however, develop also due to muscle overuse. In this case, the muscles and/or their tendons become strained due to repetitive movements in absence of sufficient time for recovery and repair.
Activities involving excessive forward bending of the spine constitute one of the most common misuses of the back leading to increased vulnerability to a variety of injuries. The forward bend position stretches the muscles and tendons of the back to a point where very little control can be exercised over the spine’s position.
Therefore lifting objects in forward bend positions can easily strain these muscles and their tendons. Additionally, forward bend position creates an uneven pressure on the spinal discs making them significantly more prone to injury.
Poor posture
Poor posture is one of the main underlying causes for the development of back strain. It generally refers to either too large or too small curvature in the area of the lower back. Over a period of time, poor posture leads to muscle imbalance and strain of the muscles/tendons in the back.
Spending extensive period of time in uneven position such as being twisted sideways or bent forward, also puts great stress on the spinal discs predisposing them to injury.
Poor physical fitness
poor physical fitness, excessive weight, sedentary lifestyle and lack of flexibility are also among the leading factors predisposing individuals to back strain. The result is poorly conditioned back muscles that lack sufficient strength and endurance to respond to increased physical demand when called upon.
This is why sudden unexpected movement, or performance of new repetitive task requiring the use of back muscles, easily result in back strain.
More information is available on this page.
Summary
Main SymptomsSudden onset
Localized pain & stiffness
Limited range of motion
Difficulties maintaining straight posture
Muscle cramp in the area of the lower back
CausesSudden movement
Tight muscles and lack of flexibility
Muscle overuse
Activities involving excessive forward bending of the spine
Lifting objects in forward bend position
Poor posture
Working in uneven position - twisted sideways or bent forward
Poor physical fitness,
Excessive weight
Sedentary lifestyle
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.
Self-AcupressureSelf-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 NeedlingAcupuncture 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 procedureNo 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
