Muscle is the largest organ in the human body. It typicallly accounts for almost 50% of the body's weight. There are approximately four hundred muscles in the human body and any one of them can develop trigger points, potentially causing referred pain and dysfunction. Symptoms can range from intolerable, agonizing pain to painless restriction of movement and distortion of posture. Muscles consist of many muscle cells, or fibers, bundled together and surrounded by conective tissue. Each fiber contains numerous myofibrils. Most skeletal muscles contain approximately one thousand to two thousand myofibrils, and each myofibril consists of a chain of sarcomeres connected end-to-end. Muscular contractions take place in the sarcomere. When a trigger point is present, numerous sarcomeres are contracted into a small thickened area and the rest of the sarcomeres in the myofibril are stretched thin. Several of these contractures in the same area are probably what we feel as a "knot" or "tight band" in the muscle. These muscle fibers are not available for use because they are already contracted, which is why you cannot condition or strengthen a muscle that contains trigger points.
When pressed, trigger points are usually very tender. The sustained contraction of the fibril probably leads to the release of sensitizing neurochemicals which are body substances that affect the nervous system. This produces the pain that is felt when the trigger point is pressed. Pain intensity levels can vary depending on the amount of stress placed on the muscles. The intensity of pain can also vary in response to flare-ups of any of the other perpetuating factors, such as emotional factors, illnesses, and insomnia. Healthy muscles usually do not contain knots or tight bands, are not tender to pressure, and, when not in use, feel soft and pliable to the touch, not like the hard and dense muscles found in people with chronic pain.
Trigger points may refer pain both in the local area and/or other areas of the body. Approximately half the time, trigger points are not located in the same place where you feel symptoms. This means that if you work on the areas where you feel pain, you probably will not get relief. Unless you know what location to search in for the trigger points causing your pain, you probably will not get relief. For instance, trigger points in the upper portion of the trapezious muscle which is between the neck and the shoulder, can cause headache pain in the temples, the base of the skull, in the angle of the jaw, and possibly above the ear and over the eye. Referred tingling, numbness, or burning sensations are more likely due to trigger poiints constricting around or putting pressure on a nerve. For example, the sciatic nerve runs either under or through the piriformis muscle in the gluteal area, and trigger points in the piriformis muscle can compress the sciatic nerve, causing a pseudosciatic pain that mimics true sciatica (Travell and Simons, 1983).
Muscles containing trigger points are fatigued more easily and do not return to a relaxed state as quickly when use of the muscle ceases. In addition, trigger points may cause other muscles to tighten and become weak and fatigued in the areas where you experience the referred pain, and also cause a generalized tightening of an area as a response to pain. Trigger points tend to form where the nerve ending that causes the muscle to contract attaches to the muscle fiber, generally in the middle of the muscle fiber. Trigger points also tend to form at the muscle's attachments. When people first develop some kind of pain problem, they usually wait to see if it will go away. Sometimes it does, and sometimes it does not. The problem with "waiting to see" is that when trigger points are left untreated, muscles can be damaged, and eventually changes to the central nervous system can lead to a vicious cycle of pain. This central nervous system invvolvement probably explains why some experience chronic headache and pain.
Something starts to hurt, so you tense the area up. Then it hurts more, so the muscle tightens up more, perpetuating and esclating the cycle of pain. Any intervention that helps treat trigger points and eliminate perpetuating factors can help break the cycle. This could include trigger point self-treatment, stretching, heat and/or ice, chiropractic or osteopathic treatments, massage, ultrasound, homeopathy, biofeedback, trigger point injections, counseling, and even analgesics. Massage and self-treatment of trigger points will allow muscle cells to start uptaking oxygen and nutrients and eliminating metabolic wastes again, the proper cell metabolism process. Also, by pressing on the trigger points and making it hurt a little bit more than it is already hurting, it causes your body to release pain-masking chemicals such as endorphins, thereby breaking the pain cycle.
Valerie DeLaume, L.Ac., a licensed acupuncturist and certified neuromuscular therapist, reports that it is her experience that people who do self-treatments at home in addition to receiving weekly professional treatments improve at least five times faster than those who only receive professional treatments. After the second or third treatment, based on the person's medical condition, how their muscles feel to her, their dilegence about self-treatment and working on perpetuating factors, and how much they have improved, she can usually give them a pretty good idea of how many treatments they may need. Ask the practitioner after the first few weeks how long and how often she wishes to see you. Some of the most complex cases will get worse before they get better. Often progress is evident first on the mobility level.
If one is unable to receive relief from self-help techniques, it may be that something other than trigger points is causing or contributing to your headaches or TMJ pain and you should see a doctor for X-rays and other diagnostic tests. Referred symptoms due to trigger points can mimic other, more serious conditions or occur concurrently with them. See a doctor immediately to rule out serious conditions if you have pain in your head with any of the following symptoms:
-Your pain has a sudden onset or starts after a head injury.
-Your pain lasts for more than a few days.
-The intensity of pain is greater than your previous headaches, or the symptoms are different. Changes can be an indication of a different, more serious cause.
-Your headaches start after the age fifty.
-Your headaches are accompanied by a stiff neck, fever, seizures, convulsions, blurred vision or other vision changes, eye pain, ear pain, dizziness, mental confusion, disorientation, lack or alertness, speech difficulties, drowsiness, or muscle numbness, tingling, or weakness.
-Your headaches are triggered by coughing, bending, or lying down.
-Your headaches cause severe nausea or vomiting.
Hopefully you doctor will rule out any serious conditions. If you have a diagnosis of headache, migraine, or TMJ pain, chances are you can relieve much or all of your pain with a combination of self-treatment of trigger points and treating and eliminating perpetuating factors. Regardless of the diagnosis from the medical doctor or dentist, you will always do well to identify and eliminate all the underlying causes to the extent possible, and treat the trigger points.
Some massage therapists are trained in trigger point therapy. Acupuncturists may also be. If you are already receiving treatment from one of these ask them about it, or see if they can give you a reference.
Valerie DeLaune has a master's degree in acupuncture from the Northwest Institute of Acupuncture and Oriental Medicine and holds professional certificates from the Heartwood Institute and the Brenneke School of Massage. She has authored books and articles on trigger points and acupuncture topics and although she is currently living in Juneau, AK, she may be reached for more information at www.triggerpointrelief.com.
Her recent book "Trigger Point Therapy for Headaches and Migraines: Your self-treatment workbook for pain relief" was published in 2008 by New Harbinger Publications, Inc.. It is recommended as a comprehensive resource for understanding the cause, location, self-treatment, and has suggestions for the elimination of perpetuating factors, regarding trigger points in the relation to different kinds of headaches, TMJ pain, facial and neck pain, and limited range of motion in the neck and jaw. The workbook is complete with useful photographs and understandable language.