Living With Chronic Pain

Trigger Point Pain

Most of us already know what a trigger point is- that muscle knot that feels like a lump or marble under the skin, causing muscle stiffness and pain. We all know the times we tried to twist and wrench our neck around to stretch and wiggle our way into that perfect position that’ll free us from pain. Or asked someone to dig into that nagging sore spot to get us relief. These are trigger points. Pain and stiffness that feels like it’s in the muscles. Sensitive patches of soft tissue, much more tender than the surrounding tissue, in locations where there’s no obvious reason for it.

Trigger points are often described as a persistent pain that usually results in a decreased range of motion of the muscle involved. Often, the muscles used to maintain body posture are affected the most – these include the neck, shoulders, shoulder blade and pelvic girdle. Although the pain is usually related to muscle activity, it may be constant. It is reproducible and does not follow a particular nerve root distribution such as a ruptured disc might. There’s no associated swelling or neurological deficits.

They. Just. Hurt.

Trigger points are muscle “knots” or sensitive spots in the soft tissue that don’t relax on their own and are very sensitive to touch. They can also cause muscle spasms (twitches) or a feeling of tightness or pain in the area of the spasm or radiate to other sites. Too many of them grouped together is known as “myofascial pain syndrome.” Although their true nature is uncertain, it’s thought that a trigger point is a small patch of tightly contracted muscle, a ‘micro-cramp’ of a tiny patch of muscle tissue (as opposed to a whole-muscle spasm like a “charlie horse”). That small patch of muscle chokes off its own blood supply, which irritates it even more causing a vicious cycle. 

These sore spots are as common as pimples, often alarmingly fierce, and they seem to grow like weeds around injuries. There’s no question they’re painful and often a major factor in back pain. Trigger points can be vicious and cause far more discomfort than most people believe is possible. 

Aches and pains are an extremely common medical complaint, and trigger points seem to be a factor in many of them. They are involved in headaches (including migraines), neck, low back pain and more. What makes trigger points clinically important -and fascinating – is their triple threat. They can:

1. Cause pain:  Sometimes muscles just hurt. Trigger points can cause pain directly. Trigger points are a “natural” part of muscle tissue. Just as almost everyone gets pimples, sooner or later, almost everyone gets muscle knots.

2. Complicate pain issues: Trigger points complicate injuries and other painful problems. They show up like party crashers: whatever’s wrong, you can count on them to make it worse, and in many cases they actually begin to overshadow the original problem.

3. Mimic other pain problems. It is easy to mistake trigger point pain for practically anything but a trigger point. For instance, muscle pain is probably more common than repetitive strain injuries (RSIs), because many so-called RSIs may actually be the entire muscle hurts, not a specific point of spasm. A perfect example is shin splints. Or referred pain from temporal mandibular joint disease (TMJ), headaches, tinitus, and many other issues. 

Here are common sites:

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Trigger points can be an irritant or a full blown catastrophe. In some cases, the pain is so intense it can be mistaken for acute, more dangerous concerns like a ruptured disc or kidney stone. It can be so agonizing it forces the body to get bent out of shape from the asymmetrical spasm pulling one side harder than the other. Once the spasm is relieved, symmetry is restored and the pain will diminish.

Next week I’ll discuss the array of treatment options available for helping patients to cope with the spectrum of trigger point pain. 


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