Treating painful trigger point areas

Trigger
points are painful, hyperirritable areas in muscles that cause pain, stiffness,
limited range of motion and sometimes other symptoms.

The
one characteristic that defines them from just tender points in muscle is that
trigger points can “trigger” pain in other places in the body. 

This
referred pain can sometimes be surprisingly distant from the trigger point. As
a result trigger points can be responsible for many misdiagnosed
conditions. 

A
trigger point should not be confused with scar tissue. Trigger points develop
in muscle, tend to develop in specific spots in those muscles, and refer pain
in predictable patterns. They are thought to be areas of muscular damage,
contraction, restricted blood flow, and toxin accumulation.  

Fascinatingly,
many of these predictable points for trigger point formation are also
acupuncture points. There are roughly 600 muscles in the body, and so there are
hundreds of possible locations for trigger points. 

To
further complicate the trigger point picture, not all trigger points are
“active”. Some are inactive (latent) and do not cause pain. 

However,
the knotting of the muscle is still able to reduce range of motion and affect
joint movements. These latent points can become active if aggravated. Athletes
who notice asymmetry in their flexibility or movement patterns will often be
suffering from latent trigger points.

What causes trigger points?

Repetitive
movements and prolonged use of the same muscles are common causes of trigger
points. However, a sedentary lifestyle is also a risk factor. As a result,
pretty much any job can cause trigger points. 

Someone
who sits at a desk is not safe from work-place injury; they can look forward to
developing trigger points in their upper shoulders and back. Poor posture will
further promote the formation of trigger points. 

Since
trigger points can restrict flexibility proper posture can be difficult. A
vicious cycle of poor posture and trigger points is created!

A
single strained movement can also cause trigger points. Emotional stress often
leads to muscle tension and thus trigger points. Cold temperatures often
aggravate the problem.

Certain
illnesses and metabolic conditions make one more prone to myofascial trigger
points. These include anaemia and some other nutritional deficiencies, viral
infection, hypothyroidism, adrenal insufficiency and hypoglycaemia. Genetic
predisposition can be a factor for some people. Some medications like lithium
and calcium channel blockers may also be to blame.

Chronic Pain from Trigger Points

Besides
pain in the muscles, myofascial trigger points can cause joint pain, and
headaches. The pain can be severe and may not respond well to painkillers. 

The
pain from trigger points can be confused with other conditions such as
arthritis, bursitis, carpal tunnel syndrome, or pinched nerves. Even when these
conditions are present, trigger points often add to the pain.

Trigger
points may even explain children’s “growing pains”.

Recovery
from physical injuries can be complicated by the gradual formation of trigger
points.  Whiplash is a classic example of
a trauma that causes the formation of trigger points leading to a pain syndrome
that can last for years past when the injury should have healed.

Treatment of myofascial trigger
points

There
are several conservative means to treat trigger points. For those individuals
who fail to respond to the conservative treatment, there are drug injection therapies
as well.

Three
of the most popular conservative methods include finger point pressure, dry needling/acupuncture,
and low level laser therapy.

Finger
point pressure is the most common method is to apply pressure to the trigger
point using the finger or thumb. Most people instinctively will apply pressure
to a trigger point themselves. Although uncomfortable, this can be a very
effective way of treating trigger points.  

Pressure
is applied until the trigger point starts to release and the muscle relaxes.
This is followed by massage. Self-applied treatment can also be achieved using
a small rubber ball to lean against.

Dry
needling uses very fine acupuncture needles that are inserted into the centre
of the trigger point. Commonly, the muscle fibres will be seen to twitch, and
you may feel a deep ache either at the trigger point or in the area of referred
pain. Most patients find the dry needling to be a more comfortable and
effective option than finger pressure.

Low
level laser therapy is a new and effective treatment of trigger points.  A therapy laser is applied to the trigger
point for a specific amount of time. The laser encourages cell regeneration and
tissue repair. 

Dr. Jemal Khan is a chiropractor
based in the Cayman Islands.

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