Tight muscle knots that cause localized and radiating pain are called trigger points, and the name couldn’t be more apt. These painful areas trigger a variety of painful symptoms and can lead to a chronic condition called myofascial pain syndrome.
Here, Dr. Stanley Mathew, our triple-board-certified pain medicine specialist at American Rehabilitation Medicine in Cedar Rapids and Dubuque, Iowa, explains the mystery behind trigger points and the best treatment options.
The anatomy of a trigger point
Your muscles — which make up about 28-54% of your body, depending on your age, gender, and physical fitness level — contain fibrous muscle cells surrounded by connective tissue called fascia. These fibers connect to one another end-to-end like a chain. Your body releases various chemicals that cause your muscle fibers to contract and relax so they can function when you want them to.
Trigger points occur when those fibrous bands become taut and develop an irritated spot that remains contracted, forming a nodule or knot. This, in turn, stretches out the fascia, and the result is a painful trigger point.
When you try to use a muscle that has a trigger point, it may not respond as you intend because the muscle fibers are already locked into a contraction, or they may be weakened, strained, and fatigued.
Types of trigger points
There are two primary types of trigger points: active and latent.
Active trigger points may be painful even when you’re not using the affected muscle; latent trigger points only hurt when you apply pressure and often cause muscle weakness or restriction.
Trigger points trigger different types of pain
Depending on which type of trigger point you have, where it’s located, and how severe it is, you may experience different kinds of pain.
Jump sign is a type of pain that makes you jump, jerk, wince, or yelp when someone touches your trigger point. It’s startlingly intense and may seem out of proportion to the amount of pressure applied.
Referred pain occurs when you feel pain somewhere other than the site of your trigger point. For example, you may have a trigger point in your trapezius muscle, but you feel the pain in your head. A trigger point in your shoulder blade may present as pain in your chest, arm, or shoulder.
Local twitch response is a quick contraction triggered by firm pressure in a snapping fashion near the trigger point. There is usually a visual dimpling of the skin as the muscle fibers below contract.
What triggers a trigger point?
The exact causes of trigger points is still up for debate within the medical community, but we do know the things that predispose you to developing them.
Any accident or event that injures your muscles can lead to trigger points, including a car crash, childbirth, sports injury, or a fall.
Repetitive stress injuries
Any time you overuse a particular muscle group, it causes micro trauma to the area. It’s particularly common in sports such as tennis and golf, as well as in throwing sports, like baseball. But it can also happen if you type all day, hold a phone between your head and shoulder, or work on an assembly line.
Tissue trauma caused during surgery may result in a trigger point, and the scar tissue that develops as you heal may also cause one.
If you have bad posture — sitting cross-legged, sitting or standing swaybacked, hunching, etc. — your muscles are under constant unsupported pressure that may result in trigger points.
If you don’t get enough vitamin C, folic acid, iron, vitamin D, or vitamin B in your diet, you may develop trigger points.
If you don’t get quality sleep, it puts a strain on all your body’s systems, including your muscles, and they may let you know there’s a problem by developing trigger points. Ironically, trigger points can also be the culprit in your lack of sleep, so it’s important to correct the problem before it spirals out of control.
Lack of exercise
Leading a sedentary lifestyle can tank your overall health and can also cause trigger points.
The way you feel mentally and emotionally manifests in your physical state. Depression and anxiety in particular are known for their direct correlation with physical pain, including trigger points. If you’re under constant stress, you may also develop painful trigger points.
Treatments for trigger points
Dr. Mathew offers three types of trigger point injections to ease your pain and resolve your trigger points:
- Corticosteroids reduce inflammation
- Botox® disrupts chemical signals that contract your muscles
- Dry needling (no medication) relaxes the muscle and incites healing
If you have a trigger point or myofascial pain syndrome, get the expert care you need from Dr. Mathew and our team of pain management specialists here at American Rehabilitation Medicine. Request an appointment online or call us today!