Understanding Trigger Points: From Causes to Therapeutic Intervention
Trigger points, often referred to as muscle knots, are discrete, focal, hyperirritable spots found in a taut band of skeletal muscle. These spots are palpable nodules and when compressed, can elicit a unique response known as a jump sign, local tenderness, local twitch response, and referred pain which usually responds with a pain pattern distant from the spot12.
Trigger points are not just an everyday ache or pain, but are specific areas of tension in the muscle fibres, which can cause significant pain and discomfort.
Key Takeaways:
- Trigger points are hyperirritable spots in muscles that cause referred pain.
- They are often the result of acute or repetitive trauma, poor posture, lack of exercise, and chronic stress conditions among others.
- Two types of trigger points exist: active and latent, where active trigger points cause pain constantly or during movement, while latent ones cause pain when compressed3.
- Trigger point therapy, including techniques like dry needling and active release technique, can be effective in alleviating the pain caused by these trigger points.
Understanding Trigger Points
Trigger points can be thought of as “knots” in the muscle fibres. These knots form when a muscle is either overused or injured. The fibres within the muscle tense up and form a nodule. This nodule, or trigger point, can cause pain in the area around the nodule, or refer pain to other areas of the body.
The pain caused by trigger points is distinct from other types of muscular pain, making them a significant concern for individuals experiencing chronic or persistent muscle pain.
Types of Trigger Points
Active Trigger Points: These trigger points cause pain constantly or when the muscle is moved. They significantly reduce the flexibility of the muscle, causing discomfort and limiting movement3.
Latent Trigger Points: Unlike active trigger points, latent ones only cause pain when they are compressed. Although they might not cause active discomfort, they can still limit movement and cause stiffness in the muscle.
Anatomy and Etiology of Trigger Points
Trigger points primarily develop in the myofascia, mainly in the centre of a muscle belly where the motor endplate enters. These nodules, which are palpable and about 2-10mm in size, can occur at different places in any skeletal muscles of the body.
It’s noteworthy that everyone has trigger points in their body, and they can even be present in babies and children. However, their presence does not necessarily result in the formation of a pain syndrome unless certain conditions are met2.
Causes of Trigger Points Formation
Ageing
Injury: Sustained by a fall, stress, or birth trauma.
Lack of Exercise: Often seen in those who are inactive, contributing to muscle tension and the development of trigger points.
Bad Posture: Such as upper and lower crossed pattern, swayback
posture, telephone posture, and cross-legged sitting.
Muscle Overuse: And respective micro-trauma, like weightlifting.
Chronic Stress Condition: Including anxiety, depression, and psychological stress trauma.
Vitamin Deficiencies: Such as vitamin C, D, B; folic acid; iron.
Sleep Disturbance
Joint Problems and Hypermobility
Techniques to Alleviate Pain from Trigger Points
Trigger point therapy is aimed at alleviating the pain caused by these hyperirritable spots in muscles. Techniques such as dry needling, active release technique, and trigger point injections are commonly used.
These therapies can significantly reduce the pain and increase the range of motion in the affected muscle
Dry Needling
Dry needling involves inserting a thin needle into the trigger point to relieve the tension in the muscle. This technique can be quite effective in reducing the discomfort caused by trigger points, especially when performed by trained professionals.
Benefits of Dry Needling:
- Immediate relief from pain.
- Increased range of motion in the affected muscle.
- Reduced muscle tension.
To learn more about dry needling and its effectiveness in treating trigger points, feel free to read our informative post on Dry Needling: The Answer to Trigger Point Pain.
Active Release Technique (ART)
Active Release Technique is a type of soft tissue treatment that focuses on relieving tissue tension via the removal of fibrosis/adhesions which can develop in tissues as a result of overload due to repetitive use. This technique can be particularly beneficial for athletes or individuals with chronic muscle tension.
Benefits of ART:
- Improved flexibility and movement.
- Reduced chronic pain.
- Enhanced athletic performance.
Trigger Point Therapy for Athletes (coming soon)
Myofascial Pain Syndrome
Myofascial Pain Syndrome (MPS) is a condition associated with trigger points. It refers to regional pain of soft tissue origin, which arises from trigger points and is associated with muscle tenderness.
The pain from MPS is distinct and can be identified through certain clinical criteria such as a tender spot in a taut band of skeletal muscle, patient pain recognition, predicted pain referral pattern, and local twitch response5.
Myofascial Pain Syndrome (MPS) and Trigger Points
Myofascial Pain Syndrome is a common chronic pain condition that is significantly associated with trigger points. The relationship between MPS and trigger points is well-established, with the former being a consequential ailment of the hyperirritable spots present in the skeletal muscle fascia. MPS is characterised by regional muscle pain, tenderness, and the presence of trigger points.
Clinical Evaluation of Trigger Points in MPS
Healthcare professionals use several clinical criteria to identify trigger points in individuals suffering from MPS. The four main criteria include:
Tender Spot: In a taut band of skeletal muscle.
Patient Pain Recognition: The pain recognized by the patient is associated with a trigger point.
Predicted Pain Referral Pattern: Pain that follows a specific pattern, distinct from other types of muscular pain.
Local Twitch Response: A transient visible or palpable contraction of the muscle when the trigger point is stimulated4.
Treatment Approaches for MPS
Treatment for Myofascial Pain Syndrome often revolves around managing the trigger points to alleviate the pain and improve the range of motion in the affected muscles. The commonly used treatment modalities include:
- Dry Needling: This technique involves inserting a thin needle into the trigger point to relieve the tension in the muscle, which in turn reduces pain and improves function.
- Manual Trigger Point Release: Healthcare professionals, such as chiropractors, may use their hands to apply pressure to the trigger point to relieve tension.
- Trigger Point Injections: Injecting a local anaesthetic, saline, or other substances directly into the trigger point to alleviate pain.
These treatment modalities aim at deactivating the trigger points and consequently alleviating the symptoms of MPS. A multidisciplinary approach that includes physical therapy, stress management, and patient education often yields the best results.
Trigger Point Therapy Techniques (coming soon)
Frequently Asked Questions
What Causes Trigger Points?
Trigger points may form due to a variety of factors including muscle injury, overuse, stress, tension, lack of exercise, poor posture, or an awkward sleeping position6.
How Are Trigger Points Diagnosed?
Diagnosis of trigger points is typically done through a physical examination where the healthcare professional searches for tender spots in taut bands of muscle.
The presence of referred pain, local twitch response, and a jump sign are strong indicators of trigger points2.
Can Trigger Points Go Away on Their Own?
In some cases, trigger points may resolve on their own with rest and avoidance of muscle overuse. However, many trigger points may require intervention such as manual therapy or trigger point injections to alleviate the pain and prevent further muscle tension.
How Are Trigger Points Treated?
Treatment for trigger points can include manual trigger point release, dry needling, trigger point injections, stretching exercises, and massage therapy. It is advisable to consult with a healthcare professional for a personalised treatment plan.
Understanding the Effectiveness of Trigger Point Therapy (coming soon)
External Resources for Further Reading
In a bid to understand and manage trigger points effectively, a thorough comprehension of their anatomy, etiology, clinical evaluation, and treatment is crucial. The knowledge of how trigger points influence pain and the subsequent management through various therapeutic interventions forms the cornerstone of addressing myofascial pain syndrome and improving the quality of life for individuals affected by this condition.
Ready to take control of your muscle health? At Ian The Chiro, we’re committed to empowering our patients with the knowledge and care they need to overcome muscle pain. Reach out now to make an appointment and take the first step towards a more comfortable and active life.
