Trigger Point

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Areas in the body where trigger points are more commonly found may include:. You can get trigger points anywhere in your body, and if they occur excessively, you may experience chronic pain and myofascial pain syndrome. Imagine having a small cut on your finger. One cut, one finger. It may hurt a bit, especially if something bumps the tiny cut or if you move your finger in just the right way. But the cut is nothing serious, and it is merely a temporary nuisance.

Now imagine your entire hand and all your fingers have tiny cuts on them. These cuts are so numerous that they hurt, and hurt badly. And since the cuts are so numerous, every motion and some resting positions causes pain. This is myofascial pain syndrome. You have so many tiny muscle and fascial trigger points that your body's muscles are constantly in a painful state.

Trigger Point Therapy – That Is How We Treat Pain

Myofascial pain syndrome can be difficult to treat; the pain is so widespread and so mysterious that it can be difficult to know where to start treatment. Research indicates that no one really knows what the exact tissue is that makes you feel trigger points. It is also unknown why some people feel pain when touching muscle knots and some people do not. Today's science cannot explain why some trigger points hurt and some trigger points are simply muscle knots.

It is theorized that trigger points, the tight bands of muscle and fascia tissue, become so tense that the limit blood flow to muscle tissue. This creates a metabolic crisis in the muscle tissue; there are pain and tightness which requires oxygen and nutrients to help heal, but those nutrients are unable to get to the muscle due to decreased circulation because of the tightness.

The pain-decreased circulation-pain cycle begins, and this cycle can be difficult to interrupt. There are two types of trigger points that physical therapists treat: active and passive trigger points. Passive trigger points simply hurt at their exact location. If you have a painful muscle knot in your hamstring and someone presses on it, the pain will be felt right where the pressure is on the knot. An active trigger point refers to pain to another part of the body. If someone presses on an active trigger point in your shoulder, you may feel pain in your shoulder along with symptoms in your chest or arm.

Regardless of the type of trigger point you have or the fact that we do not fully understand what is happening when trigger points form, you may benefit from physical therapy to help manage your problem. If you seek out care from a physical therapist for trigger point therapy, do not go with the goal of eliminating your trigger points. Rather, focus on learning strategies to help manage painful trigger points.

Myofascial release techniques and trigger point therapy may be helpful for your muscle knots and trigger points. Myofascial release is thought to help properly align the fascia surrounding your muscles. This can help improve circulation and normal movement of your muscles. Trigger point therapy is performed by having your PT press and hold on top of the trigger points in your muscles.

This temporarily cuts off circulation to the tissue.

How to Do a Trigger Point Injection

This cutting off of circulation increases a chemical called nitric oxide in the tissue. Nitric oxide signals your body to open up microcapillaries, thus bringing in more blood flow and breaking the pain-spasm-pain cycle. One of the best things you can do for your trigger points is to learn to self-manage your condition. This may include performing self-massage trigger point techniques. These may include:. Research indicates that there is not one single best treatment for muscle knots.

One thing is for certain-engaging in an active treatment program of postural correction and exercise is superior to passive treatments for trigger points. Check-in with your physical therapist for a complete evaluation of your condition to learn about self-care strategies to manage your trigger points.

Trigger Point Pain

It can also cause sweating, tearing of eyes, goosebumps and dizziness. The affected dense, shortened muscles, laden with taut bands may even compress and entrap nerves, leading to another secondary set of symptoms. If unaddressed or ineffectively treated, eventually, other muscles around the dysfunctional one may be required to "take up the slack", becoming stressed and developing secondary trigger points. It is not unusual for chronic pain patients to have multiple, overlapping referred pain patterns, making diagnosis and treatment more complex.

It is easy to see why this widespread pain is often mistaken for Fibromyalgia - a related but separate diagnosis. Trigger points can also lie quietly in muscles, sometimes for years.

Wrong document context!

This type of trigger point is called latent. Latent trigger points are very common. Unless you press on the trigger point and feel the tenderness, you probably don't know they are there. Most people have at least a few. Latent trigger points may persist for years after apparent recovery from injury.


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Latent trigger points cause:. Since a trigger point is an abnormal biochemical and mechanical area in contracted muscle tissue, the number and exact location on each person can vary. All muscle tissue is potentially prone to developing trigger points. Sometimes people have one trigger point but more often they have many. Prolonged referral of pain and weakness from a one trigger point to another area of the body will generally cause other trigger points to develop in that area. These, in turn, if left untreated, can activate and also refer pain, creating multiple pain patterns.

The more areas that have pain and the longer you have had the pain, the more trigger points you are likely to have. It is rare for someone with pain to only have one or two muscles with trigger points. A skilled practitioner who has been trained to recognize the symptoms of myofascial pain and palpate muscles for myofascial trigger points can assess whether myofascial trigger points are present. There are no commonly available lab tests or imaging studies that can confirm the diagnosis at this time.

Myofascial trigger points can be seen on special MRI scans and special ultrasound but these are currently only used in research. If an MPS becomes chronic, it tends to generalize, but it does not become fibromyalgia. Gerwin, MD. Treating each trigger point is relatively simple. Treating the whole myofascial pain syndrome so that pain fully goes away is a more complicated process.

Other techniques often used include Spray and Stretch which is a technique that uses a vapo-coolant spray very cold because it evaporates the second it touches your skin to distract the muscle into allowing a more complete stretch thereby helping to release the trigger point.

References

Once trigger points are released the muscle needs to be moved throughout its full range. Simple limbering movements done by the patient at home are important in the retraining of the muscle. Many patients experience relief from pain during the first treatment. For others several treatments are needed before their pain starts to diminish. It is common for patients to experience some soreness for one to two days after treatment.

This usually resolves after the first few treatments.

You may experience fatigue as the chronically held musculature is allowed to relax and return to a normal tone, however some patients experience an increase in energy. As the work-load of the musculature shifts and returns to abnormal balance, pain patterns may change. This is a temporary and normal stage of recovery from chronic pain.

It is not uncommon for people to experience relief from symptoms they were not seeking treatment for, such as chronic hand and forearm pain clearing up after being treated for a stiff neck. Returning to normal activities without pain is most often accelerated by adherence to the self-care program given to you by your therapist. Minimizing stress, pacing your activities and avoidance of overexertion as well as focusing on what you can do instead of your limitations are of prime importance.

Good communication, patience and a positive attitude are essential. Your rate of improvement depends on many conditions:. Along with hands-on treatment to release myofascial trigger points, your therapist should:. The goals are set cooperatively with you at the initial session and are periodically reassessed.

Supplemental Content

Your input, insight and creativity are highly encouraged. Members Home. References to medical articles Devin Starlanyl. January References. February References. March References. April References. May References. July References. September References.

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