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Trigger Points: A common cause of musculoskeletal pain

Trigger points are common causes of musculoskeletal pain. They are often overlooked, misdiagnosed, and undertreated.

What is a trigger point?

A trigger point is also known as a muscle knot. It is a hyperirritable and hypersensitive spot in a muscle. Compressing, stretching, or overloading the muscle elicits pain. Pain can radiate to other parts of the body. This is called referred pain. Severe trigger points can cause pain at rest.

How do trigger points form?

There are many causes of trigger points. These include trauma, injury, poor posture, repetitive movements, or chronic tension. Other risk factors include sedentary lifestyle, stress, sleep deprivation, nutritional deficiencies, and infections.

All of these result in hypercontracted muscle fibers. These damaged muscle fibers release neurotransmitters which hyperstimulate pain receptors.

Trigger points also cause decreased blood flow to the affected muscle knot. Reduced blood flow causes an imbalance in muscle chemistry.

Hypercontraction and decreased blood flow prevents the body from relaxing the muscle. The muscle stays in a contracted state. This restricts range of motion, causes stiffness, and results in weakness.

What are trigger point symptoms?

Trigger points manifest themselves as a deep aching or burning pain. Some people feel tightening of the muscle and endorse a pressing pain. The pain is chronic and disturbs sleep. It affects day to day activities and has a large negative impact on emotions.

How do you diagnose trigger points?

There is no blood test or imaging study used to diagnose trigger points. It is a clinical diagnosis made by a thorough physical exam. Usually there is a taut, palpable band in a muscle. This band can be exquisitely tender.

How are trigger points treated?

Treatment options focus on relieving tension within the muscle knot. The following are common ways to treat trigger points.

  • Deep tissue massage (from a tennis ball, theracane, massage gun, etc.)

  • Heat (10-15 minutes at a time, up to 4 times a day)

  • Stretching and strengthening

  • Ultrasound phonophoresis (usually at a physical therapy office)

  • Antidepressant medications to address chemical imbalance

  • Trigger point injections / therapeutic needling

  • Extracorporeal shockwave therapy

Which one is best?

Trigger point injection is also known as therapeutic needling. There is an abundance of scientific literature to support therapeutic needling.

Inserting a thin needle into the dysfunctional muscle breaks down the muscle knot. It causes the contracted muscle fibers to stretch and release pain relieving chemicals. Repeated needling stimulates a local contraction known as a twitch response. This is usually a sign of successful needling.

Disruption of the muscle knot restores normal blood flow. Restoration of blood flow fixes the chemical imbalance. The body breaks down the damaged muscle fibers and replaces it with new fibers.

Here's a thought exercise:

Consider the following analogy to better understand trigger points and therapeutic needling.

Imagine a long rope.

Now imagine a bunch of knots tied into the rope.

The knots are contraction knots known as trigger points.

Notice the rope is now shorter than before.

Shorter muscles restrict range of motion, cause stiffness, and result in muscle weakness.

Now imagine we use a tool to unknot and untangle the rope.

Once untangled, the rope can straighten out to its normal length.

Therapeutic needling breaks up muscle knots.

This promotes muscle relaxation and reduces pain.

Visit this website to find out where common trigger points are.

Stretches and Exercises

Here are some stretches and exercises for trigger points in common areas of the body.


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