Trigger Points

What is a trigger point?

Trigger points are described as supersensitive spots in muscle that often feel like nodules in taut bands of muscle fibres. Trigger points can be a common cause of pain. Compression of a trigger point may show local tenderness, referred pain or a local twitch or response. Unexplained pain frequently radiates from these points of local tenderness to broader areas.

What does trigger point referred pain feel like?

The referred pain caused by trigger points is usually steady, dull and aching and often deep. It may occur at rest or only on movement. It varies from being a low-grade discomfort to being severe and incapacitating.

Apart from pain, trigger points may cause numbness, tingling, weakness or lack of normal range of movement. Trigger points can also cause earaches, dizziness, sinus congestion, nausea, heartburn and false heart pain. They may also result in depression if pain has been chronic.

Why do we develop trigger points?

Usually it happens when there is some kind of stress on the muscle. This may be from a sudden overload in a traumatic injury like a fall, a car accident or lifting something improperly. Or, it may happen over a long period of time for example from chronic postural stresses such as sitting at a computer.

Most of us have movement patterns which are not as efficient as they could be. We tend to overuse certain muscles and under use others.

Trigger points can also be caused or perpetuated by a problem with the nerves that supply the muscle. This often happens near the spine where the nerves exit from the spinal column. There may be a degenerated or herniated disc or some arthritis in the joints of the spine.

If the spinal nerves become compressed or irritated, the muscle that the nerves supply become more irritable and likely to develop trigger points, which will compress the nerve further. This leads to a “vicious cycle” of pain and dysfunction. For this reason we usually treat the spine, even for extremity pain. If you have pain in your shoulder, elbow or hand there is probably also a problem in your neck. If you have hip, knee or foot pain you will usually benefit from treatment of your lower back.

Because of the muscle tension, there may be some pressure and irritation on the nerve fibres and blood vessels in the area. This causes pain and tenderness in the area and the decreased circulation causes and “energy crisis” at the trigger point.

What common conditions are thought to be due to referred pain from trigger points?

Trigger points are known to cause or contribute to headaches, neck and jaw pain, the symptoms of carpal tunnel syndrome and tennis elbow and many kinds of joint pain mistakenly ascribed to arthritis, tendonitis, and bursitis or ligament injury.

How are trigger points treated?

Physiotherapists tend to use superficial dry needling/acupuncture or specific trigger point massage to elicit trigger points. The purpose of the treatment is to eliminate pain and to re-educate the muscles into pain-free habits. After several treatments the swelling and stiffness of neuromuscular pain is reduced, range of motion is increased, tension is relieved and circulation, flexibility and coordination are improved.