Myofascial Pain and Dysfunction: The Trigger Point
Within the medical profession a condition frequently overlooked is Myofascial Pain and Dysfunction. This condition has many different descriptive terms but the most common one is Myofascial Trigger Point, or simply a muscle “Trigger Point.” For a Chiropractor it is a commonly seen condition, and at my clinic in Victoria B.C. Canada I see people with this painful issue regularly.
So what is it? Without using too much medical terminology, a trigger point is muscle that is very stiff in one or more areas; or it could also be an extremely painful muscle in one or more spots of the body. This condition has long been recognized by manual clinicians such as Chiropractors, Massage Therapists, Physical Therapists, Naturopaths, and others. The condition can become a distressing part of nearly everyone’s life at one time or another. Within physical medicine and rehabilitation the condition requires skilful detective work in areas that are often neglected or dismissed as unimportant. It truly is a jigsaw puzzle that requires a clear understanding of each patient while remembering that no two people are alike. To identify the cause is the key challenge for the doctor and patient.
By definition, a Trigger Point is a hyper-irritable spot, usually within a taut band of skeletal muscle or in the muscle’s fascia (thin coating or covering sheath) that is painful to compression and that can give rise to characteristic referred pain (pain in other locations), and severe tenderness. It usually has the feeling of a “knot” in a muscle. “Myofasciitis” is another diagnostic term which means muscle pain, tenderness, and the dysfunction attributed to the inflammation from trigger points.
Trigger points can be long-standing and painless, (“latent” trigger points), or they can suddenly appear (“active” trigger points). If you happen to be the unfortunate person who has an active trigger point it usually means agonizing, incapacitating pain. The pain can be so bad that people who have experienced a heart attack, broken bones, or kidney stones will say trigger point pain is just as severe. In my clinic I have treated scores of people who are in agony from trigger points. While they are not really as dangerous as some other conditions, trigger points can certainly hinder your quality of life.
The “WHY” File: Why does this happen? The mechanism of causation remains controversial. The evidence suggests that it begins with muscular strain, becoming a site for sensitized nerves, increased metabolism and reduced circulation. It can be caused by trauma, tension, inflammation, overuse, overload, poor posture, stress, repetitive strain, poor sleep, emotional stress, or other medical conditions, such as nerve entrapment, thyroid dysfunction, vitamin insufficiencies, and metabolic dysfunctions. Some experts believe trigger points arise as a protective measure against unstable joints. The reason for the prevalence of this condition is overstressing and /or irritation of the muscles of the body, either physically, chemically, or emotionally.
More about Myofascial Pain and Dysfunction:
- Middle-aged women are very vulnerable to trigger points but individuals of either sex and at any age can develop this condition.
- Dysfunction may affect any muscle in the body, but most commonly occurs in the muscles of the upper back, neck, shoulder, shoulder blades, chest, and lower back.
- Commonly feels like stiffnes or tightness or can be severe sharp pain, often in a band or nodule within the muscle.
- Trigger points can strike suddenly, often for apparently unknown reasons.
- They can also resolve quickly, especially with proper management.
Treatment and Options: The most effective way to care for trigger points is through manual techniques. At my clinic in downtown Victoria, B.C., we utilize a method involving cryotherapy (ice) application with precise stretching of the muscle in a manner which facilitates healing. Medical specialists may incorporate trigger point injections if the problem is not responsive. Massage therapy is very effective in the management of latent and active trigger points. Acupuncture can also help with this condition especially if the pain is severe. Other high technology options exist as well such as therapeutic laser and acoustic wave therapy, and research is still growing.
Prevention tips: It is essential to have awareness of your daily habits, posture, and body positioning in your occupation and in all physical activities. Regular stretching, Yoga, Pilates, and exercise ball sessions are good prevention choices. A customized care plan and spinal stabilization program (which I implement with many of my patients) can be very effective. Preventative natural healthcare is also recommended.
Yours for health,
Eric Backhouse, D.C.