Treating Trigger PointsPrint
Treating Trigger Points
What PTs don't know about trigger points can hurt their patients.
By Valerie DeLaune, LAC
Any of the muscles in the human body can develop trigger points and cause referred pain and dysfunction. Symptoms can range from intolerable, agonizing pain to painless restriction of movement and distortion of posture.
Trigger points may refer pain in local areas and to other areas of the body. Approximately half the time, trigger points aren't located in the same place as the symp¬toms. For example, trigger points in the upper portion of the trapezius muscle can cause headache pain in the temples, base of the skull, angle of the jaw, and possibly above the ear and over the eye.
If you aren't familiar with referral patterns, you can't treat pain adequately because you won't know which potential muscles are harboring the offending trigger points.
Tracking Weakness and Muscle Fatigue
Trigger points cause weakness and loss of coordination of involved muscles, along with an inability of the muscles to tolerate use. Many practitioners take this as a sign that the patient needs to strengthen weak muscles. But if the trigger points aren't inactivated first, conditioning exercises may encourage surrounding muscles to do the work instead of the muscle containing the trigger point, which further weakens and deconditions the muscle containing trigger points.
Muscles containing trigger points fatigue more easily and don't return to a relaxed state as quickly. In addition, trigger points may cause other muscles to tighten and become weak and fatigued in the areas of the referred pain. They also cause tightening of an area as a response to pain.
Determining Other Symptoms
Trigger points can cause symptoms not normally associated with muscular problems, such as swell¬ing, ringing in the ears, loss of balance, dizziness, urinary frequency, buckling knees, abnormal sweat¬ing and eye tearing. For example, the sternocleidomastoid muscle can cause dizziness, nausea, sinus conges¬tion, eyelid twitching, hearing problems, eye problems and a chronic sore throat. Most practitioners probably wouldn't think these symptoms could be caused by a trigger point in a muscle.
A trigger point can be in either an active or a latent phase, depending on the irritation. If the trigger point is active, it refers pain or other sensations and limits range of motion. If the trigger point is latent, it may cause only a decreased range of motion and weakness, but not pain.
Trigger points can form where nerve endings that cause muscle to contract attach to the muscle fiber, generally in the middle of the muscle fiber. These areas are central myofascial trigger points. Trigger points can form at the muscle's attachments; these are attachment trigger points.
A primary, or key, trigger point can cause a satellite trigger point to develop in a different muscle. It may form because it lies within the referral zone of the primary trigger point. The muscle with the satellite trigger point may be overloaded because it's substituting for the muscle with the primary trigger point, or it may be countering the tension in the muscle with the primary trigger point.
How Trigger Points Form
Trigger points can form after a sudden trauma or injury, or they develop gradually. Common initiating and perpetuating factors are mechanical stresses, injuries, nutritional problems, emotional factors, sleep problems, acute or chronic infections, and organ dysfunction and disease. It's crucial to identify and correct perpetuating factors for lasting pain relief.
Look for knots, tight bands and tenderness in the muscle. When a trigger point is present, 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 aren't available for use because they're already contracted, which is why you can't strengthen a muscle that contains trigger points. If trigger points are left untreated, the myofibril may break in the middle, causing it to retract to each end, leaving an empty shell in the middle and causing permanent damage.1
When pressed, trigger points are usually tender. The sustained contraction of the fibril can lead to the release of sensitizing neurochemicals, which produce pain that's felt when the trigger point is pressed. The areas at the ends of the muscle fibers--at the bone or where the muscle attaches to a tendon--also become tender as the attachments are stressed by the contraction in the center of the fiber.1
Part of the current hypothesis about the mechanism responsible for the formation of trigger points is the energy crisis component theory. The sarcoplasmic reticulum is responsible for storing and releasing ionized calcium. The type of nerve ending that causes the muscle fiber to con¬tract is called a motor end plate. This nerve ending releases acetylcholine, a neurotransmitter that tells the sarcoplasmic reticulum to release calcium, and then the muscle fiber contracts.
When it's operating normally, the nerve ending stops releasing acetylcholine and the calcium pump in the sarcoplasmic reticulum returns calcium back to that area. If a trauma occurs or there's an increase in the motor end plate's release of acetylcholine, an excessive amount of calcium can be released by the sarcoplasmic reticulum, causing a maximal contracture of a segment of muscle, leading to a maximal demand for energy and impairment of local circulation. If circulation is impeded, the calcium pump doesn't get the fuel and oxygen it needs to pump calcium back into the sarcoplasmic reticulum, so the muscle fiber continues to contract.
The longer pain goes untreated, the greater the number of neurons that get involved. When more muscles are affected, more pain is caused in new areas and more neurons get involved. As the problem gets bigger, there's a greater likelihood that the pain will become a chronic problem. This vicious cycle continues until there's outside intervention, such as needling or pressing on the trigger point.
The sooner you treat trigger points, the less likely pain will become a permanent problem.
1.Simon, D.G., Travell, J., & Simons, L.S. (1999). Myofascial pain and dysfunction: The trigger point manual: Volume. 1. The Upper Half of Body. Baltimore, MD: Lippincott Williams & Wilkins.
About the Author
Valerie DeLaune, LAC, is the author of Pain Relief with Trigger Point Self-Help and Trigger Point Therapy for Headaches and Migraines. She can be reached at firstname.lastname@example.org. You can Visit her website at http://www.triggerpointrelief.com..