Trigger Points: How can something so small cause so much pain?

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Patients often ask me what trigger points are and how did I get them?  Think of trigger points as muscle “knots” which are sensitive spots in the muscle. They not  only hurt when you press on them, but they can cause pain in another part of the body when pressed, called referred pain. Many people seem to develop these small sore spots around the back of the neck, top and back shoulders, and between the shoulder blades.  I see these frequently in those who spend their days sitting in front of a computer. Trigger points are also very common in the low back area just off the back  center. 

 

Trigger points often form around an injured area.  It doesn’t have to be a major injury.  Small muscle or fascia tears can occur from repetitive motions. If you form many trigger points it can be referred to as myofascial pain syndrome.  These common spots happen very frequently and are often alarmingly fierce, and they seem to grow like weeds around injured areas. They may be a  major factor in back and neck pain, as a cause, a complication, or a bit of both. They can mimic many different more serious conditions such as pinched nerves, joint arthritis, and other forms of neck and back pain.
 

How do they develop?

Trigger  points develop as a result of muscle injuries, strains, sprains, and trauma which can be minor and from repetitive use and from even poor posture. When muscle fibers, fascia, ligaments, or tendons become  weakened, overstretched, or inflamed, tiny tears may occur. As the  tissue heals, it contracts, becoming twisted and knotted with scar tissue. These knotted fibers restrict the fresh blood supply needed by the muscle cells.  In addition, there is often a shortening of the  muscle fibers to protect itself from further injury. When pressed, the  area “triggers” and contracts causing the pain.
 

How do you locate them?

Trigger points are often found within a hard, rope-like or knotted band of muscle. You will know when you have found one as it will be very sensitive to the touch. Muscles involved in past surgeries tend to have painful trigger points as do muscles located around the joints.

What is puzzling about trigger points, is despite being felt within a tight band of tissue, trigger points don’t show up under ultrasound or MRI and there is only normal looking tissue if a biopsy is taken.
 

How do trigger points affect your body?

Trigger points can affect movement by keeping muscles short and stiff, which reduces range of motion. They can maintain spasms in other muscles. They prevent muscles from relaxing, causing them to  tire quickly, recover slowly from exertion, and contract excessively when they work. They can also keep muscles out of balance to the extent that they partially disarticulate joints, causing them to catch or pop  when you move. This could potentially lead to premature arthritis and  premature cartilage wear in the affected joints as the joints move abnormally. 

 

How about in the neck area?  

In the neck area, trigger points can lead to stiffness and pain when trying to turn your neck as well as muscle spasms. As I stated in the first paragraph, I see this often in patients who work at the desk in front of a computer. By the time I see patients in my clinic, they often require more than  just trigger point care. I often need to treat the neck or cervical joint problems as well. But this is a treatable condition.  Schedule an appointment with Southwest Pain Management to learn more. Regain the  function of your neck and reduce your neck pain.

What about trigger points in your low back area?  

In  the low back, trigger points often interfere with standing and walking.  Again, by the time I see patients in my clinic, often, the lumbar or low back spine joints are also involved. We can help with both.

 

How are trigger points treated?

Some massage therapists may be able to do myofascial release which is a way to relax the trigger points. Oral muscle relaxants can help with muscle spasms.  Here at Southwest Pain Management, we also needle the trigger points.  We find them, mark them, then needle them while injecting a bit of local anesthetic for comfort.  It is well tolerated by patients even awake but we offer In Office Anesthesia to those who want it. This breaks them up and significant relief comes after a few days.  To avoid them from recurring, it is important to change the reason for them forming in the first place. That may mean correction to posture or doing limited and modified activity in the area affected while performing proper stretching exercises. Combined with regular needling of the trigger points every 1-2 months may be enough to reduce or eliminate your source of pain.

Why do we needle the trigger points?  

Because it works!  It desensitizes the trigger points over time to longer be “triggered”. 

 Study: Trigger point dry needling for the treatment of myofascial pain syndrome:  current perspectives within a pain neuroscience paradigm, April 2019. 

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