Trigger Points

Some causes of trigger points are easy to identify, such as accidents, falls, accidents, strains and overuse. Everyone is also guilty of ambitiously exercising when out of shape, lifting unreasonable loads or working too long at a new activity. This all constitutes abuse of muscles.

Avoidable Muscle Abuse

Chronically overloading your muscles in work situations is so common these days that there are many terms to describe it, such as ‘overuse syndrome’, ‘repetitive motion injury’, ‘repetitive strain’ and ‘occupational myalgia’. All these terms mean you have worked a group of muscles beyond what they are capable of and now you’re suffering for it.

Most people need to take a critical look at their work situations which results in muscle overuse and myofascial pain. Trigger points are often easy to deal with but if you don’t change the situation that brought them on they tend to just come straight back. Thoughtless body positioning can cause inefficient movement and poor body mechanics. Maintaining an awkward position too long, habitual muscle tension, disregard of efficient methods and reluctance to take rest breaks are all potential threats to trigger points that you need to be aware of if you hope to end the pain. Most commonly, lack of commitment in making changes to these hazards is the biggest obstacle in fixing your trigger points.  

Along with mindless, repetitive movements there are other less apparent ways to abuse you muscles and create trigger points. Being overweight or unfit can overstress your muscles, the same as carrying an overloaded purse or backpack. Carrying a billfold in the back pocket is a well-known cause of sciatica, which is pain from the sciatic nerve. This creates trigger points in the buttocks, created from pressure coming from the billfold. Muscles in your back, neck and hips can be severely stressed by the posture you hold created by car seats, chairs and other furniture that is designed for aesthetic pleasure rather than support.

Unavoidable Muscle Abuse

Trigger points can be created in muscles when they suffer a direct impact or trauma such as those in car accidents or falls. The sudden wrenching movements that occur during these incidents, where muscles are either overcontracted or overstretched, can also result in trigger point formation. Trigger points are the major source of pain of whiplash, though they often go unsuspected and are not addressed. Trigger points also generally occur when there are fractures, muscle tears, sprains and dislocations. Trigger points are almost an inevitable part of any physical injury and failure to appreciate this can cause unnecessary pain and suffering and can prohibit full recovery from occurring.

Unsuspected Muscle Abuse

According to Travell and Simons, many medical treatments can cause trigger point formation and myofascial pain and often go unrecognised. Trigger points can form from the immobility enforced by braces, slings and casts. When surgery results in long-term pain persisting, trigger points should be suspected to have been formed in muscles that have been cut, stretched or otherwise traumatised. Physicians may persist in trying to treat the site of the pain and not realise it’s referred myofascial pain. This results in them overlooking it and failing to treat the cause.

A routine injection in the gluteal muscle can cause trigger points, particularly in the gluteus minimus muscle and this can result in the patient suffering unbearable sciatica that can last for months.

Steroids injected into joints can bring some relief but are not necessarily the correct treatment when the underlying cause of pain is myofascial. The problem is when the patient thinks they have been cured and they mindlessly go on repeating the activity that caused the problem in the first place. The crucial trigger points continue to go untreated and continue to pull continually on the bones of the joint, ultimately making the problem worse. Even the steroids themselves, if overused, can degrade the connective tissue between bones, the muscles, ligaments and tendons. Surgery may even be needed to repair the damage.  

Pain medications continue to be the treatment of choice because they are great at reducing the awareness of pain. Pain however must be viewed as a warning that something is wrong and needs to be addressed. Many people, wary of unknown side effects, are becoming hesitant to ingest medications or foreign substances. Medical history is littered with stories about the truth of particular prescription medications that comes out too late. It’s for this reason that it’s not irrational to assume that your medication for conditions such as anxiety, depression or even high blood pressure may be causing more illness than it cures.

As an example of this, Travell and Simons tell us about research that suggests that calcium channel blockers for hypertension appear to aggravate and prolong trigger points. In other words your blood pressure medication could be worsening your pain!                                                                                                                                                                                                                                                                  

Some of the many Trigger Points in the body

Trigger Point Symptoms

Sensory symptoms that are created by myofascial trigger points can often take a variety of forms and are not limited to the sensation of pain.

Symptoms of dysfunction, which include muscle stiffness, weakness, oedema, nausea, dizziness and postural distortions, can be very diverse and include a few surprises.

Referred Pain;

Referred pain is the defining symptom of a trigger point. It is often felt as a deep, oppressive ache, although movement can magnify this pain. Referred Myofascial pain can be just as intolerable as any other kind of pain, it does not depend on the size of the muscle – trigger points in the smallest muscles have the ability to cripple you with pain.

Common examples of referred pain:

                  - Tension headaches           - Migraines            - Sinus pain            - Neck Pain
 
                  - Jaw pain                          - Earaches             - Sore Throats        - Running Stitch

Sore legs, sore feet and painful ankles are also examples of referred pain.

Joint pain, such as that in the knuckles, wrists, elbows, shoulders, knees and hips are classic trigger point symptoms, and is the most usual occurrence of myofascial pain syndrome.
                                                                                                                                                                                                                                                               
Back pain always has a myofascial component. Although arthritis, bad disks and displaced vertebrae quickly come to mind when you have a sore back, the cause is most likely just referred pain from myofascial trigger points.

Lower back pain can come from trigger points in surprising places such as your buttocks, stomach muscles, or even knotted up muscles within your calves. This is why to accurately treat back pain, and all pain, myofascial trigger points need to be considered.

Unexplained intra-pelvic pain and pain connected with sexual function can be referred from trigger points within the thighs, lower abdomen or inside the pelvis itself. It is quite usual for these trigger points to refer pain to the ovaries, cervix, uterus, testes, penis, prostate, rectum or bladder.

Janet Travell believed that trigger points could explain the pain associated with a woman’s menstrual cycle, and that self applied massages between cycles could prevent the pain.

Symptoms that may feel internal may actually be coming from trigger points in external muscles of the body. Stomach aches; heartburn, and pain that feels like ulcers can be caused referred pain from external stomach muscles. Other referred symptoms from abdominal trigger points can include;

       - Heart Arrhythmia                      - Nausea                       - Diarrhea             - Loss of appetite             

       - Projectile vomiting                    - Urinary incontinence

Compression of the Vessels and Nerves;

Muscles that have been lengthened and shortened by trigger points can often squeeze nearby nerves, with nerves that pass through the muscle more vulnerable. The compression of the nerve can distort the electrical signals that run along it and cause sensations within the body. Common sensations are; numbness, tingling, burning and hypersensitivity in the surrounding areas of the nerve. It is not uncommon in the legs and arms and is very common in hands and feet.  

The lack of knowledge on these particular worrisome symptoms may cause misdiagnosis as some health care practitioners are unaware about the trigger points that may be causing this sensation, thus leading to unnecessary surgeries.

Trigger Points can often cause a muscle to clamp down on an artery stooping blood flow, causing a distant body parts feel cold.

Trigger points in the calf can slow the blood return from the veins, creating a swollen ankle or foot. The same can occur in neck veins, leading to swollen wrists or hands.

Releasing of a Trigger Point

Autonomic Effect

The autonomic system of the body controls a lot of things, such as the muscles of the digestive system, the blood vessels, the heart, the respiratory system and the skin.

Trigger points within these parts of the body can cause some unbelievable affects such as; redness in the eyes, excessive tearing, droopy eyelids, a runny nose, excess salivation and goose bumps.

Problems With Movement

Trigger points can reduce the range of motion in a muscle by keeping them short and stiff, and can cause spasms in other muscles. It can cause muscles to tire quickly as it prevents them from relaxing, which makes for a slower recovery from constant exertion.

The weakening effect the trigger points have on the muscle can lead to problems with coordination, trouble distinguishing the weight of things, dizziness and imbalance. These effects can lead to a misdiagnosis of a neurological condition.

In these areas trigger points can become extremely tender and reduce you movement. For example, if your neck hurts, you’ll stop trying to turn it. If your arm hurts, you wont lift it as high etc. This is called “splinting” and “guarding” – The body’s natural way to stop from suffering further damage.

Unnatural curves of twists thing the back and spine can come down to untreated trigger points. Trigger points should be one of the first things investigated when diagnosing scoliosis or other abnormalities in the spinal curve.

Chronically bad posture, like that within the head or hips, can often not be correctable until certain trigger points are addressed.  

Problems with Mood

The chronic pain associated with untreated myofascial symptoms can go on for months or even years. This is a well-known cause of depression, especially when you think it is untreatable.  It can be a deadly cycle dealing with sleepless nights and constant pain and a feeling of helplessness. However, trigger point therapy should be a treatment of depression, should chronic pain be the cause.

Chronic Fatigue is another common symptom of myofascial trigger points. As your muscles tend to over contract when you’re in pain, you can tend to tire quite easily and the pain from the trigger points when you sleep, can cease sleep and not let your muscles relax.