Trigger Points

What Are Trigger Points? In my daily clinical practice, the vast majority of patients have tight and achy muscles that cause pain and restrict the movement of their joints. Muscles are complex structures within the human body that play a fundamental role in movement, stability, and support. They work through a coordinated process of contraction and relaxation, facilitated by the interaction of specialised proteins within muscle fibres. When muscles or joints become injured or during times of high stress, the muscles become tight and can go into an involuntary contracted state called a trigger point, and eventually into a muscle spasm1. In healthy situations, when muscles contract, they pull across the joint and act as primary movers of that joint. However, when muscles begin to involuntarily contract, they can restrict the movement of the joints because the muscles are not acting appropriately1.

Muscle trigger points, also known as myofascial trigger points, are highly sensitive areas within a muscle that can cause localized or referred pain, where the patient experiences their pain in a more remote area of the body. A good example of the phenomenon is the gluteus or piriformis muscles in the hip that can refer pain down the person’s leg simulating sciatica or a trapped nerve in the lower back. Trigger points can occur in any muscle and are associated with neck pain, low back pain, knee pain, shoulder pain and even jaw pain5–8. These points are typically tender to the touch and may produce pain or discomfort when pressure is applied. Trigger points are defined as:

A focus of hyperirritability in a muscle1.

Elbow Pain

Trigger points can develop for a variety of reasons, including:

  1. Muscle Overuse or Strain: Repetitive movements or activities that place excessive strain on a muscle can lead to the development of trigger points. This often occurs in individuals who engage in activities that require repetitive motions, such as typing, lifting heavy objects, or playing musical instruments.
  2. Muscle Imbalance: Imbalances in muscle strength or flexibility can contribute to the formation of trigger points. When certain muscles become overactive or tight while others remain underactive or weak, it can create tension and stress within the muscle tissue, leading to the development of trigger points.
  3. Poor Posture: Maintaining poor posture for extended periods can place undue stress on certain muscles, leading to the development of trigger points. For example, sitting at a desk with rounded shoulders or slouching can cause muscle imbalances and trigger point formation in the neck, shoulders, and upper back.
  4. Injury or Trauma: Traumatic injuries, such as sprains, strains, or direct blows to the muscle, can cause localized inflammation and muscle spasms, which may contribute to the development of trigger points.
  5. Emotional Stress: Emotional stress and tension can also contribute to the development of trigger points. Stressful situations can cause muscles to tense up and contract involuntarily, leading to the formation of trigger points over time.

The symptoms associated with trigger points can vary depending on their location and severity. Common signs and symptoms of trigger points include:

  • Localized tenderness or pain within a specific muscle or muscle group
  • Pain that radiates or refers to other areas of the body.
  • Muscle stiffness or tightness
  • Decreased range of motion
  • Sensations such as tingling, numbness, or weakness in nearby areas

Referred Px

Trigger points can be effectively treated through various therapeutic techniques, including:

  1. Manual Therapy: Hands-on techniques such as massage therapy, myofascial release, and trigger point therapy can help release tension and restore normal muscle function.
  2. Stretching and Exercise: Gentle stretching and targeted exercises can help improve flexibility, strengthen weak muscles, and alleviate tension in trigger point areas.
  3. Dry Needling: A technique that involves inserting thin needles into trigger points to stimulate a healing response and relieve muscle tension.
  4. Heat and Cold Therapy: Applying heat packs or cold compresses to trigger point areas can help reduce pain and inflammation, promoting relaxation and healing.
  5. Stress Management: Incorporating stress-reduction techniques such as meditation, deep breathing exercises, and relaxation techniques can help alleviate emotional stress and tension, reducing the likelihood of trigger point formation.
  6. Spinal Manipulative Therapy: Spinal manipulation has been shown to bombard the central nervous system with stimulus from the dysfunctional spinal joints and muscular mechanoreceptors. The mechanoreceptors bombard the brain with information regarding the position and function of the spinal joints and muscles, which leads to normalising the brains processing and integration with the returning motor information from the brain. As this process of spinal manipulation is repeated, the processing of sensory information restores the returning control signals from the brain, leading to increased muscular activity and improved joint positioning2–4. We have discussed this in detail in our previous blog “How Does Chiropractic Work?”
  7. Ischemic Compression: This is a similar approach to the dry needling mentioned above, but instead of inserting a needle, the therapist uses a finger tip or thump to apply a sustained pressure on the trigger point. This leads to a temporary reduction in blood supply to the muscle, resulting in muscle fatigue and relaxation. Another proposed mechanism for the effect of sustained pressure on the trigger point is bombardment of pain signal to the brain that leads to a reflexive inhibition of the muscle, causing it to relax. This is a similar effect of spinal manipulation which we have discussed in our previous blog “How Does Chiropractic Work?”.

Stretching

By addressing the underlying causes of trigger points and implementing appropriate treatment strategies, individuals can experience relief from pain and discomfort while improving overall muscle function and mobility. It’s important to consult with a healthcare professional or qualified therapist for an accurate diagnosis and personalized treatment plan tailored to your specific needs.

Here at Spriggs Chiropractic, we utilise a range of techniques to reduce tigger points in injured muscles. Give us a call on 01635 43238 to find out if our treatment techniques can work on your aches and pains!

If you would like to learn more about trigger points, there is an interesting discussion at Physiopedia.

By Mark Spriggs, DC, MChiro, MSc, PGcert, FRCC

References:

  1. Ge HY, Arendt-Nielsen L. Latent myofascial trigger points. Curr Pain Headache Rep. 2011;15(5):386-392. doi:10.1007/s11916-011-0210-6
  2. Haavik H, Kumari N, Holt K, et al. The Contemporary Model of Vertebral Column Joint Dysfunction and Impact of High-Velocity, Low-Amplitude Controlled Vertebral Thrusts on Neuromuscular Function. Vol 121.; 2021. doi:10.1007/s00421-021-04727-z
  3. Lelic D, Niazi IK, Holt K, et al. Manipulation of dysfunctional spinal joints affects sensorimotor integration in the prefrontal cortex: A brain source localization study. Neural Plast. 2016;2016. doi:10.1155/2016/3704964
  4. Robinault L, Holobar A, Crémoux S, et al. The effects of spinal manipulation on motor unit behavior. Brain Sci. 2021;11(1):1-19. doi:10.3390/brainsci11010105
  5. Itoh K, Katsumi Y, Kitakoji H. Trigger Point Acupuncture Treatment of Chronic Low Back Pain in Elderly Patients – a Blinded Rct. https://doi.org/101136/aim224170. 2004;22(4):170-177. doi:10.1136/AIM.22.4.170
  6. Itoh K, Asai S, Ohyabu H, Imai K, Kitakoji H. Effects of Trigger Point Acupuncture Treatment on Temporomandibular Disorders: A Preliminary Randomized Clinical Trial. J Acupunct Meridian Stud. 2012;5(2):57-62. doi:10.1016/J.JAMS.2012.01.013
  7. Itoh K, Hirota S, Katsumi Y, Ochi H, Kitakoji H. Trigger Point Acupuncture for Treatment of Knee Osteoarthritis – a Preliminary Rct for a Pragmatic Trial. https://doi.org/101136/aim26117. 2008;26(1):17-26. doi:10.1136/AIM.26.1.17
  8. Itoh K, Katsumi Y, Hirota S, Kitakoji H. Randomised trial of trigger point acupuncture compared with other acupuncture for treatment of chronic neck pain. Complement Ther Med. 2007;15(3):172-179. doi:10.1016/J.CTIM.2006.05.003
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