Treating painful trigger points

Trigger points are painful,
hyper-irritable 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, 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 workplace 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, the most
common method, applies 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

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.


Working at a desk all day can lead to trigger points in the upper shoulders and back.
Photo: File