Trigger Points – a common cause of pain
I am often surprised at how often people have never heard of trigger points in muscles. This concept is not new 1 . These trigger points are well accepted by chiropractors, physiotherapists, registered massage therapist, sports medicine doctors, physiatrists and other medical specialists as a common cause of pain. In speaking to patients I will often hear them say “Oh, I think it is a muscle pain…” This is not necessarily always the complete picture, however many people are right that part of the symptoms they are feeling are coming from muscles. But when I begin to explain that the pain is caused by trigger points, it is a new concept to them. I hope that this article provides some understanding of this common cause of pain people experience.
Myofascial trigger points, or trigger points, have been described as “a hyper irritable spot, usually within a taut band of skeletal muscle or in the muscle's fascia, that is painful on compression and that can give rise to referred pain, tenderness and autonomic phenomena.”1. Simply said, this describes a sensitive, often extremely painful spot, in a tight muscle or in the connective tissue that surrounds the muscle (the “fascia”). The muscle will feel “tight” and as fingertip pressure is moved along the muscle belly there is a specific point which is often so tender it can actually make the person suddenly jump. The above definition of trigger points describes interesting physiologic responses including referred symptoms, such as pain felt in an area distant to the trigger point. For example, pressure on trigger points in the muscles on the neck may reproduce a pain around the ear or eye which is a common complaint of headache sufferers. Or another example is pressure on the trigger points in the muscles in the shoulder can reproduce a sensation of pain or numbness in the fingers of that arm. In both cases the area being pressed can be very painful, but there are also symptoms in areas that are not being touched. The concept of “autonomic phenomena” refers to the discovery that often there may be changes in the activity of the autonomic nervous system (causing such things as sweating, tearing, goosebumps, etc).
(To see a video of a twitch response in the quadricep muscle click here)
Other interesting characteristics found with trigger points:
- Trigger points can sometimes be “latent” (as opposed to “active”), which means that they are present in the muscles but do not cause any symptoms unless pressure is applied to them.
- Trigger points are also said to be “electrically silent”. Normally, an electrical signal is sent through a nerve to excite a muscle. This excitation is what normally causes the muscle to contract. With a trigger point the band of taut muscle is contracted at rest even though there is no electrical signal.
- When a trigger point is pressed, a brief twitch response is often seen. This twitching is involuntary. Sometimes patients tell me they can feel it, sometimes they cannot, but they are often fascinated when I can show them.
- Trigger points cause the muscle to be weaker and to fatigue quickly.
Patients with trigger points can be misdiagnosed due to the fact that there is no clinically relevant test for trigger points, and the symptoms are often distant from the point of origin. For example a patient may be suspected to have heart disease because of chest pain when in fact the pain was referred from a trigger point in the neck or chest. Or some people have been diagnosed with a disc herniation in their neck because of pain referred into their fingers. Examples such as these and many other situations occur all the time as trigger points can form in pretty much any muscle.
So how do you prevent and treat these trigger points? You can help prevent them by following a few different steps. The best way is to engage in a stretching and strengthening program to ensure that your muscles are strong and limber. It is especially important to target stretching in those muscles which tend to get tight and strengthen those muscles which are prone to becoming weak. If done on a regular basis, this will go a long way in preventing trigger points and their symptoms. Furthermore by increasing muscle fitness (strength, endurance and flexibility) muscles are just less prone to injury. This exercise program should emphasize proper posture, proper balance of strength between opposing muscles and postural awareness as problems in any of these areas are common contributors to trigger point development. You should also be aware of activities that have contributed to the development of previous trigger points, and either try avoiding those activities or modifying them. For example spending hours looking down at a laptop computer screen (as seen with students) can cause trigger points resulting in neck pain and headaches. A suggestion would be for the student to try using a separate keyboard and prop the laptop up higher when working at a desk. This simple ergonomic change promotes better neck posture and along with further precautions including periodic mini-breaks and strengthening the core muscles of the neck will prevent symptoms without reducing productivity.
If you do suspect you have muscle pain or headaches due to trigger points, there are a number of treatments available. And the good news is that trigger points are often very responsive to care. First though you will need someone experienced to be able to find them. Usually when they are present, they occur in more than one muscle. Examination of muscles takes practice of palpation skills as well as knowledge of the common referral patterns of pain. So the examination would not only include the area you feel pain but other related areas. Furthermore it is my experience that the joints associated with the area of complaint and the areas of the trigger points need to be addressed. Treatment could then include a combination of techniques which may consist of stretching of the taut bands, massage to the muscles, mobilization or adjustment of the joints, physical therapies and instructions for self care, exercise and most importantly prevention.
- Travell J and Simmons D, “Myofascial Pain and Dysfunction: The Trigger Point Manual,” Williams & Wilkins, Baltimore, 1983.
Back to the top.
<<Previous post ...... Next post>>