Trigger Points and Muscle Pain

Myofascial Pain Syndrome                   

The term myofascial pain syndrome was introduced by Dr. Travell in mid 1960’s and describes a focal hyperirritability in muscle. Studies estimate that 75–95 percent of local muscular pain is due to myofascial pain. Myofascial pain is associated with muscle tenderness that arises from trigger points which are focal points of tenderness found at multiple sites in a muscle. What is a Trigger Point?A trigger point can be defined as a painful point that can be felt as a hard nodule or band in the muscle. Often a twitch response can be felt in the muscle by running finger perpendicular to the muscle's direction. Pressing on the affected muscle can often refer pain to distal areas such as fingers or hand. Referred pain from trigger points mimics the symptoms of a very long list of common maladies such as sciatica, herniated discs and joint problems and are very common reason for misdiagnosis. Dr Travell and Simons hold that most of the common everyday pain is caused by myofascial trigger points and that ignorance of this basic concept can inevitably lead to false diagnoses and the ultimate failure to deal effectively with pain.

How Trigger Points form?Trigger points form as a local contraction in a small number of muscle fibers in a larger muscle or muscle bundle. These small local contractions (trigger points) in the muscle shorten the length of the muscle. Imagine making knots on a string. The more knots on the string, the shorter the string becomes. When muscle becomes shorter because of the knots (trigger points), it can pull on tendons and ligaments that attach the muscle to the joints, causing pain deep within a joint where there are no muscles.

What are the consequences of having Trigger points?Decreased athletic performance     The presence of trigger points in muscles make the muscle weak, fatigue more rapidly and severely than other muscles. The muscle also recovers much slower. Combination of all of these  interferes with athletic performance. Pain radiation to other parts of the bodyEach trigger point in a particular muscle has specific pain patterns and follows specific nerve pathways projecting to predictable areas of the body. These pain trajectories can overlap with those originating in different trigger points. For example, pain in a pinky and along the inner aspect of the hand can originate in the Latisimus Dorsi or Infraspinatus muscles.

What causes trigger points?Trigger points can be activated by a number of factors, including acute or chronic muscle overload due to poor posture or over exercising. Additionally, they can also form as a result of disease, psychological distress, homeostatic imbalances and certain lifestyle habits such as smoking. Direct trauma to the muscle region as well as collision trauma such as a car crash which causes whiplash and stresses many muscles in the neck, is another common cause for developing trigger points.

Why some of the trigger points cause pain only when palpated?There are two categories of trigger points:  The active trigger points and the latent trigger points. Active trigger points:Active Trigger Points cause pain even without any applied pressure. This is the case in chronic neck or low back pain. This prevents full lengthening of the muscle and weakens the muscle. When active trigger point is compressed, it reproduces the usual pain the we experience.

Latent trigger points:They typically do not cause spontaneous pain and typically ause pain only when pressure is applied to them. Most people are not aware of their presence until someone presses on them. They have, however all the other clinical characteristics of an active trigger point. They can be felt as taut bands on palpation across the muscle fibers. They increase muscle tension and restricts range of motion.

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