Myofascial Trigger Points

Most Common Cause of Chronic Pain and Limited Range of Motion

Aug 26, 2009 Maija Haavisto

Myofascial trigger points are a very common problem that can lead to severe pain and other puzzling symptoms, which are often misdiagnosed.

Put simply, myofascial trigger points are painful, hyper-irritable areas in muscles that cause pain, stiffness, limited range of motion and sometimes other symptoms. They can refer pain to other parts of the body - sometimes very far from their original location. As a result they are often misdiagnosed.

Trigger points are always created in certain places in a muscle and always refer pain to the same areas. However, because there are hundreds of muscles in the body, there are hundreds of possible locations for trigger points. Also, trigger points in one muscle tend to create trigger points in other nearby muscles.

Myofascial trigger points are classified as either active or latent (inactive). Latent ones do not cause pain, but can still reduce range of motion. An active trigger point is easy to recognize by pressing on it, because it feels very painful. Often it is also palpable as a small "knot".

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, whether it involves physical labour or prolonged sitting or standing. Poor posture promotes trigger points, but the reverse is also true.

A single strained movement can also cause trigger points, such as may happen in sports, falling or trying to prevent falling. Carrying or lifting heavy objects frequently promotes trigger points - which also goes for pregnancy. Surgery and dental operations are also common causes. 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 anemia and some other nutritional deficiencies, viral infection, hypothyroidism, adrenal insufficiency and hypoglycemia. 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, headaches (of all types) and other kinds of pain, such as eye pain, mouth pain, earache and pain in the genitals. The pain is often severe and does not respond well to painkillers. Especially NSAIDs and acetaminophen (paracetamol) tend to be useless.

The pain is frequently misdiagnosed as a serious condition, such as arthritis, bursitis, carpal tunnel syndrome, dental woes or degenerative spinal changes. Even when these conditions are present, trigger points often add to the pain. Trigger points may explain children's growing pains and some of the pain and balance problems associated with old age.

While myofascial pain is different from fibromyalgia, these conditions often coexist. Trigger points can cause the pain or contribute to it in interstitial cystitis and temporomandibular joint pain (TMJ/TMD).

Most physical injuries are also complicated by trigger points, which explains why such conditions as whiplash often persist for years, even when the original injury should have healed. Untreated, trigger points can cause problems for years or even decades.

Other Symptoms and Misdiagnosis

Myofascial trigger points also affect circulation and the function of the autonomous nervous system, which can lead to such symptoms as blurry vision, nasal congestion, restless legs syndrome, tinnitus, muscle weakness and atrophy, problems swallowing, urinary frequency and incontinence, intermittent claudication, numbness, dizziness, cold extremities and dyspnea (trouble breathing).

Trigger points in the torso can promote digestive symptoms like stomach ache, bloating, heartburn, diarrhea, constipation, nausea and even vomiting. Pelvic trigger points can be behind sexual dysfunction such as impotence and pain during and after intercourse, the latter in both sexes. They often contribute to dysmenorrhea (painful periods).

Many massage therapists and dentists know about trigger points, but physicians only rarely do. Because of this symptoms caused by trigger points are usually attributed to other conditions. This can lead to misdiagnosis of a serious condition such as appendicitis or a heart attack and/or even unnecessary surgery.

Treatment of Myofascial Trigger Points

Trigger points do not generally respond well to medication and stretching can make them worse, but luckily they can be treated with e.g. self-applied massage at the trigger point.

References

Davies Clair. The Trigger Point Therapy Workbook: Your Self-Treatment Guide for Pain Relief (Second Edition). 2004.

Vázquez-Delgado E, Cascos-Romero J, Gay-Escoda C. Myofascial Pain Syndrome associated with Trigger Points: a literature review (I). Med Oral Patol Oral Cir Bucal. In press 2009.

Ettlin T, Schuster C, Stoffel R, et al. A distinct pattern of myofascial findings in patients after whiplash injury. Arch Phys Med Rehabil. 2008 Jul;89(7):1290-3.

The copyright of the article Myofascial Trigger Points in General Medicine is owned by Maija Haavisto. Permission to republish Myofascial Trigger Points in print or online must be granted by the author in writing.

Knee trigger points can be mistaken for arthritis

What do you think about this article?

---

NOTE: Because you are not a Suite101 member, your comment will be moderated before it is viewable.

post your comment

What is 5+9?