Trigger points are defined as a small area with hypersensitivity and hyperirritability that, when pressed, causes local pain or local pain that also travels to distant locations. A trigger point is an area with altered metabolism that shortens the muscle causing weakness and dysfunction. Most trigger points are in the muscles, but not all of them. Trigger points are probably the most common finding we will talk about. Symptoms of pain with trigger points seem to peak in mid-life around ages 30 to 50, while dysfunction or stiffness and decreased mobility affect the senior population. Symptoms of trigger points are pain, numbness, headache, restricted, and/or tight joints. The pain can start in one area and travel to another.
Muscles make up the largest part of the body, accounting for about forty percent. Pain from trigger points is far more common than pain from joints or nerves. Many, many studies have documented effects of trigger points. Trigger points have the ability to refer pain. Referred pain is a pain that starts or is caused in one area, but the individual feels it in another. Sometimes the referral pain can be very far from the original trigger point. The trigger point can be in any tissue including muscle, ligament, and joint capsules. We will mostly focus on muscle trigger points. A trigger point in a muscle is an area of altered metabolism that tightens or contracts. This causes a shortening of the muscle. Shortening of the muscle weakens it and decreases mobility in the joint it serves. If this persists long enough, the joint capsule and ligament also shorten causing a chronic dysfunction, pain, and stiffness. When a nerve or artery runs through the muscle, this chronic shortening can cause irritation, producing numbness and neurological signs. This is common in the neck, as the nerves and blood vessels go down the arm as they dissect the cervical musculature.
A trigger point feels like a nodule or muscle band below the skin. As you compress this knot, it is painful. The pain may travel or refer to another area. The trigger point that causes a referral is usually a sign that the trigger point is more active or sensitive. Causes of trigger points are poor posture or sleeping habits that put the muscle in a shortened and/or stressful position.
Joints that are not functioning properly can cause or activate trigger points. A normal joint will feed information back to the muscle to tell the muscle where it is in space or position. This is called proprioception. If this information is abnormal because of stiff joints or abnormal motion in joints, trigger points will eventually occur in the muscles.
Just dealing with the trigger point and not the joint will lead to frustration, as you will get only temporary or short-term relief. Injury to a joint or trauma to the muscle can cause trigger points. When a joint is injured, the muscles go into spasm around the joint to protect it from moving and injuring it more. The spasm causes shortening which will lead to trigger points. Differences in leg length or shoulder height between sides will cause greater stress in certain muscles leading to shortening and contractures – and trigger points. A short leg can cause the shoulders to be unlevel, causing stress in the muscles through the shoulders and neck. Many of these trigger points refer pain to the head causing headaches. Vitamin deficiencies, especially of the B vitamins and vitamin C have been recorded in chronic trigger point cases. This is a very common finding. Vitamin deficiencies should be assessed in those not responding to trigger point therapy.
Individuals with thyroid deficiencies seem to have an increased risk in developing trigger points. This has been shown in several studies. Borderline hypothyroid is common in America. Patients with chronic trigger points who are unresponsive and have cold intolerance should be evaluated for hypothyroid.
Mood and psychological behavior can cause or aggravate trigger points. Stress, anxiety, depression, and inattention can be expressed in your muscles with contractures and shortenings that cause trigger points. Relaxation therapy including Yoga, meditation, and Thai-Chi can help relax the muscles. Individuals can learn to let the stress out of their muscles, benefiting individuals with trigger points. Yoga allows stretching of the muscles. This is very useful in trigger points and is the most – or one of the most – beneficial ways to get relief from trigger points. Treatment consists of first finding out what is causing the trigger points. If you just treat the trigger point and not the cause, the trigger point will probably return. Most trigger points will even go away by themselves if you find the cause and treat it. If the problem is longstanding or chronic, you may have to treat the trigger point, also.
There are several treatments available for trigger points. Stretching the muscles should always be done either by itself or in conjunction with other therapies for trigger points. Remember that the trigger point is an area of contracture and it shortens the muscle. By stretching the muscle, we can literally pull the contracture apart and allow an increase in blood flow to the area. Stretches should be done regularly. In chronic cases where the cause of trigger points can’t be fixed, stretching the muscle will offer some symptom relief. This will also prevent the trigger point from getting worse.
Pressure or compression to the trigger point will help reduce the trigger point. This causes fluids to be pumped in and out of the area. It also seems to break up the trigger point. Our massage therapists are familiar with trigger point location and referral. Massage can help get a jump-start on breaking up trigger points.
Electrical stimulation has the effects of decreasing pain and breaking up the trigger point. This is an effective way of treating trigger points. This therapy should be followed with stretching of the muscle.
Injection of procaine or analgesia can offer relief from trigger point symptoms. It is believed that it helps dissipates the metabolites, allowing the trigger point to break up. This is an invasive technique that is reserved for the last resort.
Again, stretching of the muscles is important to maintaining improvement in trigger points. Yoga helps trigger points by stretching the body and its muscles. Specific Yoga stretches can be given to isolate specific trigger points. Yoga offers the added benefit of relaxation therapy also.