Pain
generators of things like headache, pelvic muscle and organ dysfunction, spinal
disease, joint dysfunction, TMJ, and much more can often be attributed to the presence
of myofascial trigger points in over-stressed or injured muscles. So what are
they, how are they classified, and why are the stages of a trigger point (TrP)
important?
WHAT
IS A MYOFASCIAL TRIGGER POINT?
A myofascial trigger point (MTrP) is a “self-sustaining” hyper-irritable area of muscle fiber in a taut band of muscle that is felt as a nodule or bump. This aggravated spot causes gradual shortening of the muscle involved and interferes with normal muscle function. Myofascial TrPs can also put pressure on the surrounding nerves, lymph and blood vessels, causing other symptoms in addition to pain.
Common
abbreviations:
MTrP
= myofascial trigger point
TrP
= trigger point
Trigger
points can usually be felt unless the muscle is too tight, they are buried
under other large muscles or they are located behind bone. They radiate pain in
a consistent pattern according to their location in the muscle affected and hidden TrPs are often located by
their pain referral pattern. Additionally, TrP/s can be well away from the pain referral zone.
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National Association of Myofascial Trigger Point Therapists handy
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It’s
important to know what a trigger point feels like, so get familiar with your
body. Feel around to see if you find any lumps or bumps that reproduce your
pain. In average size muscles, TrPs are about the size of a pea and there can certainly be more than one. If a muscle is too tight, massage may be necessary to relax the muscle so we can isolate
the TrP. Muscles around the face are very tiny. In this case, they may feel
like a tight string, while larger muscles feel like a tight rope.
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Acute myofascial pain from trigger points differs from chronic myofascial pain. You can read more in our book, Integrative Therapies forFibromyalgia, Chronic Fatigue Syndrome, and Myofascial Pain and in an article I wrote for HealthCentral, What YouShould Know About Chronic Myofascial Pain.
____________________________________________________________________________
Trigger
points that are adequately stimulated by compression or needle insertion exhibit a visible local twitch response. However, Perreault T, Dunning J, and Butts R, 2017, report "several studies show that eliciting a local twitch response does not correlate with changes in pain and disability, and multiple systematic reviews have failed to conclude whether the twitch response is relevant to the to the outcome of TrP dry needling."
Note: The size of the muscle involved, whether it is an active primary or active secondary TrP is not relative to pain intensity. Sometimes, TrPs in small muscles can cause more pain than those found in larger muscles. Such is the case of TrPs in the piriformis muscle, which is a small deep muscle in the buttocks that cradles the sciatic nerve. Trigger points in the piriformis muscle mimic sciatica pain which is created by compression of the sciatic nerve as it exits the spine. The treatments are very different.
CLASSIFICATIONS OF TRIGGER POINTS
The
three familiar classifications of TrPs are primary, secondary, and/or satellite.
Knowing the classification of a TrP is important to the person providing
treatment, including us.
Primary TrP
A
primary TrP is the one that starts the painful event. A primary TrP can be active or latent. (More coming on what that means.)
Secondary TrP
A secondary trigger point is
born when compensatory muscles, on the same side of the body, the opposite side,
or even in the same group, also become overloaded in an attempt to temporarily help muscles that are affected by primary TrPs.
EXAMPLE
As we sit at a computer our neck bends as our head drifts forward from its weight. Before long we find ourselves rubbing the back of our neck. Our uncorrected posture has put undue stress on muscles that are trying to lift our head to a neutral anatomical position. We are in pain because muscle fibers have abnormally shortened in an effort to keep our face from smashing into the keyboard. You can imagine how much work is placed on ancillary muscles that have also been pulled out of their normal functioning position. For me, not continually adjusting my posture or taking frequent breaks will trigger a migraine attack because of the presence of occipital neuralgia and the pressure on my occipital nerve. That leads to a predictable cascade of events. My nose begins to run on the right side, my eyelid droops, my right eye crosses, and more.
After note: Muscles on the front, back, and sides of our neck not only
hold up our head, they also contribute to other muscles that support function
of things like our jaw, shoulders, scapula, and so on. The opportunity for
secondary TrPs to develop is extensive.
Secondary TrPs can also be active or latent.
Secondary TrPs can also be active or latent.
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Trigger point charts you can download
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Satellite TrP
A
satellite trigger point is a type of secondary TrP that is located in the referral zone of the primary
trigger point.
STAGES OF TRIGGER POINTS
Active Trigger
Point
Active
TrPs hurt without being touched, radiate pain, restrict motion, and can cause
other symptoms depending on the surrounding nerves, lymph system, and blood
vessels. They call for our attention.
Latent Trigger
Point
A
latent trigger is a dormant TrP that causes pain only when it is compressed or
manipulated. Latent TrPs do all the same things as active TrPs and cause
stiffness and weakness that persist for years after apparent recovery. They can
go unnoticed only to be reactivated from a seemingly minor overstretching, repetitive
use, overuse, or injury. In some people, a harmless event can cause dormant
TrPs to light up like a firecracker instigating a cascade of events including
referral of pain, and other symptoms.
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My interview with myofascial trigger point specialist, Frank Gresham
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CONCLUSION
Myofascial
trigger points restrict muscle movement and cause weakness that can persist for
years after apparent recovery, so don't be lured into thinking you can only
treat active TrPs. A latent primary TrP can
remain dormant wreaking havoc on our musculoskeletal system and unless it is
also treated, it will remain in the same state. This means secondary TrPs will
redevelop and present in the active stage (causing pain without pressing on it),
leaving us to think treatment doesn’t work. Have patience, it's difficult
to define a primary from a secondary trigger point, even for experts and especially when multiple muscles are dysfunctional. But, with
the help of a professional trained in myofascial medicine, such as physician,
physical therapist, chiropractor and/or myofascial
therapist, we can conquer these unruly pieces of muscle fiber that cause us
so much pain.
Update: Now Available - Myofascial Pain Syndrome
(In header of The Pained Ink Slayer)
(In header of The Pained Ink Slayer)
Additional
Reading:
What is a Myofascial TriggerPoint And Its Relationship To Pain?
6 Reasons Why Trigger Point Injections Aren’t Helping Your Fibromyalgia
6 Reasons Why Trigger Point Injections Aren’t Helping Your Fibromyalgia
In healing,
Celeste Cooper, RN / Author, Freelancer, Advocate
Think adversity?-See opportunity!
~ • ~ • ~ • ~ • ~ • ~
Learn more about
Celeste’s books here. Subscribe
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