What Causes Trigger Point Pain Perpetuating Factors

The following excerpt was taken from the “Pain Relief with Trigger Point Self-Help” book-on-CD by Valerie DeLaune, Lac.
Visit triggerpointrelief.com to learn more about the book-on-CD.

What Causes and Keeps Trigger Points Going: Perpetuating Factors

"If we treat myofascial pain syndromes without . . . correcting the multiple perpetuating factors, the patient is doomed to endless cycles of treatment and relapse. [Perpetuating factors are] the most neglected part of the management of myofascial pain syndromes . . . The answer to the question, 'How long will the beneficial results of specific myofascial therapy last?', depends largely on what perpetuating factors remain unresolved . . . One may view perpetuating factors also as predisposing factors, since their presence tends to make the muscles more susceptible to the activation of [trigger points] . . . Usually, one stress activates the [trigger point], then other factors perpetuate it. In some patients, these perpetuating factors are so important that their elimination results in complete relief of the pain without any local treatment." ~~ Dr.s Janet Travell and David G. Simons.

Trigger points are a symptom, not a cause. Needling or applying pressure to the trigger points deals with the acute part of the problem, but does not solve the underlying factors. If you get temporary relief from trigger point therapy but symptoms quickly recur, then trigger points are definitely a factor, but perpetuating factors need to be addressed in order to gain more lasting relief. Be sure to check muscles listed in the muscle chapters that can cause "satellite trigger points," since this is one perpetuating cause. For example, if you find trigger points in the gluteus minimus but trigger points quickly recur, check the quadratus lumborum also, because it can refer to the gluteus minimus and cause trigger points to be reactivated there. (Top)

This section will outline some general causes of trigger point activation and how to address the factors, and each muscle section will specifically address issues particularly pertinent to that muscle. Although you can click on the section listing below to go directly to a section, I recommend you read all the perpetuating factors, since you likely have more than one factor that you may not have recognized up to this point.

• Acute or Chronic Viral, Bacterial, or Parasitic Infections
• Allergies and other Environmental Stressors
• Diet
• Emotional Factors
• Good Sport Syndrome
• Injuries
• Mechanical Stresses
• Nutritional Problems
• Organ Dysfunction and Disease
• Sleep Problems
• Spinal Mis-alignments and Other Problems
• Laboratory Tests

Diet

In Chinese Medicine, certain types of pain will be aggravated by certain types of food and drink, and helped by others:

Pain that is sharp and stabbing, worse with stress, and better with activity will be aggravated by coffee and black tea (even decaf!), alcohol, deep fried/greasy/fatty foods, heavy red meats, food preservatives, spicy foods, caffeine, sugar, and marijuana.

Pain that is achy and worse with damp weather will be aggravated by dairy, pork and other rich meats, roasted peanuts, concentrated juices especially orange and tomato, cucumber, crab, eggs, tofu, wheat, bread, yeast, beer, bananas, sugar and sweeteners, and saturated fats. Foods that help resolve dampness and phlegm include barley, corn, lemons, mushrooms, garlic, celery, onions, kohlrabi, clams, lettuce, seaweed, grapes, alfalfa, sardines, pears, grapefruit, peppermint, radish, shrimp, almonds, and walnuts.

Pain that is stabbing and worse with cold weather will be aggravated by cold food and drinks, and helped by warming foods such as ginger, cherry, peaches, sweet potatoes, turnips, black pepper, coconut milk, kohlrabi, nutmeg, shrimp, spearmint, cayenne, chicken, garlic, onions, squash, trout, and walnut. (Top)

Pain that is dull and achy, worse with activity, and better with rest will be aggravated by dairy, tofu, raw foods and undercooked grains, sweets, hard-to-digest foods, and cold or frozen foods and drinks. It will be helped by foods that help to fortify the digestive system such as squash, white rice, ginger, oats, cinnamon, yams, onions, black beans, pine nuts, and small amounts of animal proteins.

Of course, you should avoid any of the listed foods that cause you to have allergic reactions.

You may have more than one type of pain, and something that is good for one type of pain may be bad for another. If it is worse for one type of pain, you should eliminate the item from your diet, even if it helps another type of pain. Eliminating the foods alone may not be enough, if the underlying condition that was caused by the food is still present. For example, if you have been eating damp-producing foods which have lead to dampness in the muscles (as in Fibromyalgia), even if you stop ingesting the food you still have dampness in the muscles that must be eliminated. Plan on avoiding the necessary foods for two months minimum in conjunction with acupuncture and/or herbs and other supplements, in order to determine whether eliminating the food is helpful. Many people will stop ingesting a food or drink for one week, decide it hasn't made a difference, and then re-start their regular diet. Or the food or beverage is so important to them that they'd rather have pain and other medical conditions, than give the substance up. Reaching a conclusion after one week is one way to justify continuing to ingest the substance. (Top)

Excess caffeine increases muscle tension and trigger point irritability, leading to increased pain. Dr.'s Travell and Simons state that "... caffeine has long been known to cause a persistent contracture, or caffeine rigor, of muscle fibers. This rigor is due to enhancement by caffeine of the release of calcium from the sarcoplasmic reticulum and to interference with the rebinding of calcium ions by the sarcoplasmic reticulum." They found that caffeine in excess of 150 mg daily (more than two eight-ounce cups of regular coffee) would lead to caffeine rigor. I suspect for some people it could be even less. In counting your daily intake, be sure to count any caffeine in the drugs you are taking, and remember that espresso and similar drinks will have far greater amounts of caffeine.

Alcohol aggravates trigger points by decreasing serum and tissue folate levels. It increases the body's need for vitamin C, while decreasing the body's ability to absorb it. Tobacco also increases the need for vitamin C. In Chinese Medicine, caffeine and alcohol are said to be very "qi stagnating." Marijuana is very stagnating also, and stays in your system for about three months after smoking it. Stagnation is one cause of pain, therefore using any of the above substances will increase your pain level. (Top)

Mechanical Stresses

Chronic mechanical stresses are one of the most common causes of trigger point activation and perpetuation, and are nearly always correctable. A skeletal asymmetry, including a shorter leg and a small hemipelvis (the part of the pelvis you sit on) can be corrected with shoe lifts and butt lifts. In this book-on-CD, reference to a shorter leg refers to a true leg length inequality where the bones are shorter on one side, rather than the "shorter leg" caused by a spinal mis-alignment, which is a term chiropractors use. A skeletal disproportion, such as a long second toe can be corrected with shoe orthotics, and short upper arms can be corrected with ergonomically correct furniture. Vertebral subluxation and other bones-out-alignment can be adjusted by a chiropractor or osteopathic physician, especially if the muscles are also first relaxed by an acupuncturist or massage therapist.

Mis-fitting furniture is a major cause of muscular pain, particularly in the work place. There are companies that specialize in coming into your work place and correcting your office arrangement, and fitting you for furniture that fits your body. Your employer may balk at the cost, but if they don't change your mis-fitting furniture, they will end up paying for it in lost work time and worker's compensation claims. (Top)

I see a lot of what I call "mouse injuries" -- arm and shoulder pain due to using a computer mouse for extended periods of time without proper arm support. The keyboard should be kept as close to lap level as possible. When not using your computer, your elbows and forearms should rest evenly on either your work surface or armrests of the proper height. Your computer screen should be directly in front of you, and the copy attached to the side of the screen, so that you may look directly forward as much as possible. Your knees should fit under your desk, and the chair needs to be close enough that you can lean against your backrest. A good chair will have a backrest with a slope of 25 to 30-degrees back from the vertical which supports both the lumbar area and the mid-back. The seat should be low enough that your feet rest flat on the floor without compression of the thigh by the front edge of the seat, high enough that not all the pressure is put on the buttocks, and slightly hollowed out to accommodate the buttocks. The armrests must be high enough to provide support for the elbows without having to lean to the side, but not so high as to cause the shoulders to hike up. The upholstery needs to be firm and casters should be avoided. I highly recommend headsets for phones to solve neck and back pain.

A lumbar support helps correct round-shouldered posture. It seems, oddly enough, that most car seats actually curve the wrong way in the lumbar area. Most chiropractic offices carry lumbar supports of varying thickness. I recommend getting one for the car and your favorite seat at home, and investing in a good chair for the office, even if your employer won't. Try to avoid sitting in or on anything without back support, which causes you to sit with your shoulders and upper back slumped forward. When going to sporting events, picnics, or other places you won't have a back support, bring a Crazy Creek Chair™ (or something similar) to provide at least some support. You can get one through most of the major sporting goods suppliers, and they cost about $33, a good investment in your back, and they are very lightweight for carrying. Or consider a lightweight collapsible chair, also available at sporting goods stores.

Sleeping in a sagging bed can cause back and hip problems. (See the section on Sleep Problems).

But properly fitting furniture won't help as much if you are not also conscientious of avoiding poor posture. If you slouch at your desk or on your couch at home, or read in bed, for example, your muscles will suffer.

Be sure to sit while putting clothing on your lower body. Don't wear high heels or cowboy boots. If you have a habit of immobilizing your muscles to protect against pain, you will need to start gently increasing your range of motion as you inactivate trigger points. Don't keep stressing the muscles to see if it still hurts or to demonstrate to your treating professionals where you have to move it to in order to get it to hurt -- if you keep repeating this motion, you will just keep the trigger points activated. If you carry a purse, get a strap long enough that you can wear it diagonally across your body, rather than over one shoulder. If you use a day pack, put the straps over both shoulders. Without realizing it, you are hiking up one shoulder at least a little to keep the straps from slipping off no matter how light your purse or pack may be. Notice whether you hold your shoulders up or are tightening muscles such as your butt, arms, or abdomen when you are under stress. You will need to re-train yourself to break this habit.

If you are clenching your jaw or grinding your teeth, see a Dentist for help. The soft plastic bite splints found over-the-counter in pharmacies are too soft and do not help temporomandibular joint dysfunction. You need to be fitted by your dentist for a hard, slippery acrylic night guard.

Constricting clothing can lead to muscular problems. My rule of thumb is, if the clothing item leaves an elastic mark or indentation in the skin, it is too tight and is cutting off proper circulation. Check your bras, socks, ties, and belts to see if they are too tight.

(only two of these sections have been included in the excerpt - the full text can be obtained by visiting (www.triggerpointrelief.com)

Valerie DeLaune, LAc. Is a Licensed Acupuncturist, Diplomate in Acupuncture, Master of Acupuncture, Certified Neuromuscular Massage Therapist and Certified Massage Therapist in Juneau, Alaska. Valerie says, "My intention is to aid patients in their self-healing. I assist patients by teaching them self-help techniques that will empower them to make positive changes in their lives and their health." Visit her website at www.triggerpointrelief.com.