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"The Pain is not always where the Pain Is":
Understanding & Treating Myofascial Trigger Points

Have you ever had a headache but wondered where the pain was really coming from? Maybe the neck, but not sure? Or had pain down the leg and were afraid you had a bulging disk in your low back? Certainly any persistent pain should be evaluated by a healthcare professional to rule out significant pathology. But it may be a relief to know that many persistent muscle pain problems can be attributed to what is called myofascial trigger points. "Myo" essentially refers to muscle and "fascial" relates to the fascia or connective tissue that surrounds muscles and other structures in the body. The term trigger points refers to specific locations in the body that when activated, trigger the experience of pain. In many cases the pain is actually felt at a different location than the trigger point itself.

Many people simply use the word "muscle knot" to describe the characteristic nodule or taut band found in trigger points. Some of the most common places for muscle knots are in the neck and upper back, but they can be located almost anywhere in the body. On occasion, pain is experienced in the actual location of the trigger point as in example C; but typically pain is referred to another area of the body as shown in example A. Here, pain is experienced in the upper arm, but is originating in a muscle overlying the shoulder blade. When this type of referred pattern is present, it often leads us to focus our attention where we feel the pain, but we may completely miss the source of the problem.

What Conditions Can Be Attributed to Myofascial Trigger Points?

Myofascial trigger points not only generate pain, but they can also lead to muscle weakness and decreased range of motion. Trigger points are a contributing factor in many of the common conditions we hear about. Sciatica (leg pain) can often be traced to trigger points in the gluteal muscles and hip rotators. Patients with the diagnosis of plantar fasciitis frequently have trigger points in their calf muscles. Trigger points in the neck muscles can play a role in generating facial and TMJ pain as well as headaches. In a recent study, 93 percent of migraine patients were found to have trigger points in the neck muscles, compared to only 29 percent in the control group. Despite this significant difference, health professionals often overlook trigger points as a complicating factor in the symptom picture.

What Causes Trigger Points?

So if trigger points cause pain, what causes trigger points? More often than not, they are associated with some form of overload on the muscles. They are commonly seen in people with repetitive strain injuries and can also occur with eccentric loading (when muscles are lengthening while contracting, such as back muscles during forward bending). A prolonged period of stress with accompanying muscle tension can also increase the likelihood of developing trigger points. Even seemingly mild postural imbalances can overload muscles, putting them at risk. Additionally, it has been noted that metabolic disturbances can play a role in the development of trigger points. They may also be associated with internal organ disease. Trigger points in the abdominal muscles of women, for example, are 90 percent predictive of endometriosis.

How is Myofascial Pain Syndrome Treated at Integrative Therapies?

Luckily, if trigger points are detected and found to be a source of pain, they can usually be successfully treated by a number of interventions. One common treatment is clinical massage and manual therapy provided by licensed bodyworkers, neuromuscular clinicians and physical therapists. Treatments geared toward postural balancing and movement re-education can be helpful, as well as a variety of physical therapy modalities such as microcurrent stimulation, cold laser therapy and biofeedback. Therapeutic exercise, including stretching and stabilization or selective muscle strengthening, may be needed to deactivate trigger points and to prevent their recurrence. Acupuncture and a technique called dry needling have also been found to be very effective in some cases. When a person has tried a number of options but is still experiencing residual symptoms, trigger point injections administered by our skilled physician may offer significant relief.

Above all, when it comes to pain, it is very important to treat not just the symptom, but to address the underlying causes and perpetuating factors. Your treatment team can help you figure out where your pain is coming from, how to treat it, and give you guidance in self-care strategies to keep your pain at bay.


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