Let’s Talk Trigger Points

Dr. Matthew Gianforte

Trigger points are a common cause of musculoskeletal pain including headache, neck pain, and low back pain. Trigger points are “knots” of hard, tight muscle tissue. They often occur in number around injuries. These small patches of tight muscle fibers can cause pain, complicate pain, and mimic other pain problems. Therefore releasing them through trigger point therapy injections can be a very useful addition to exercise and chiropractic care routines. The team at LifeWorks Integrative Health is experienced and specialized in Trigger Point Injections.  

The Developing Science

The science behind trigger points and trigger point therapy is still developing. It has had a slower progression into mainstream medicine primarily because it does not have a medical specialty from which it can gain the research funding. Trigger points develop within muscles and there is no medical specialty around muscle tissues. Practitioners who work in areas of chronic pain are a group outside of physical therapists and chiropractors who take notice of trigger points since many chronic pain diseases are actually connected to myofascial pain syndrome which primarily relieved by trigger point therapy. Even chronic pain conditions like fibromyalgia can sometimes turn out to be Myofascial Pain Syndrome (MPS) and effectively treated with Trigger Point Therapy. Many situations of severe and strange pain that do not fit into traditional diagnostic criteria or patterns are known to have been relieved through trigger point therapy.

An important body of research on trigger points and muscle related pain continues to grow and chronic pain specialists in particular are taking note. The development of trigger points is dependent on multifaceted interactions within the spinal cord. When signals from nociceptors (also known as pain receptors) occur, this sends to a signal to the spinal cord and brain there is pain. What is designed as an alert system for your body to adjust, adapt or find safety, often becomes a chronic nagging and severe pain because the nature of much of the pain American’s experience is from repetitive improper movements. The spine can also send referred pain signals which means you may feel pain in areas where muscle fibers are not actually tightened or bundled, but that share nerve connections. This is why you may feel pain down your arm when a shoulder trigger point is pressed.

What Is Myofascial Pain Syndrome?

This a chronic pain condition that is characterized by the persistence of muscle pain. Signs and symptoms are:

  • Deep, aching pain in a muscle
  • Pain that persists or worsens
  • A tender knot in a muscle
  • Difficulty sleeping due to pain

Muscle injury and stress causing tight muscle or frequent contracting muscles are the primary causes of MPS. Chronic, repetitive improper movements and poor muscle balance contribute to the development of MPS since many of the normal working, sitting, and daily muscle use positions people use add stress and strain to muscles. This includes postures like excessive sitting, poor posture, shoulder/neck strain, driving, computer work, and use of handheld devices/tablets.

MPS and trigger points are not limited to only affecting muscle tissue. The tightening and hardening of muscle fibers that make a trigger point and create pain have a chemical and metabolic component to them. The body’s systems are integrated at all levels to the point that these tight bundles contain what some consider oxidative or noxious chemicals in the body. Research has confirmed elevated levels of eleven inflammatory compounds in and around trigger points including acetylcholine, noradrenaline, and serotonin that create an oxidative or inflammatory environment. This is considered a metabolic crisis surrounding the trigger point where inflammatory chemicals are release by the body as a response to the pain signaling from the nociceptors. This biochemical reaction in the body as a response to pain contributes to inflammation in the whole body and may contribute to immune dysfunction.

Treatment With Trigger Point Therapy

Trigger Point Therapy is the use of injections of generally saline, or a localized pain relief like Lidocaine break apart the muscle bundle creating the pain and provide pain relief. This relief is often instant and when accompanied with exercise, stretching, and rehab to keep the muscles lose a very effective treatment for many people. Stretching routines may also seem like a small part of a rehab regimen for pain that isn’t that important to follow through on, but it can compliment trigger point therapy in a way that can completely change the outcome of trigger point therapy. Pain relief doctors who typically manage pain with medications alone are starting to recommend and respond to the research around trigger point therapy because alternative pain management tools are needed due to the overuse of pain medications. The epidemic of pain medication use in the United States requires multiple medical disciplines to come together to find the right solution for the pain rather than jump from one pain cover up to another. This medication method often leaves the patient in worse condition than when they started taking medications for their pain, and still in pain.

Truly addressing pain must include understanding why the pain is there, taking the steps to correct the underlying imbalances to stop/resolve the pain, and at the same time taking any quick action that is safe and effective to relieve the immediate pain. The multidisciplinary team at LifeWorks includes practitioners experienced in trigger point therapy, chiropractic, rehab and functional medicine. This type of comprehensive team understands the need for immediate relief while keeping the longer, bigger, more complete picture in mind so that your pain continue to improve and resolves over time. Trigger point therapy is part of pain solutions, not just pain management.

While the science, standards of diagnosis and treatment, as well as wide-spread use of trigger point therapy is still developing, the benefits of effective outcomes are available now from practitioners who are paving the way in understanding more about this useful tool in pain management.  Don’t settle for pain meds, unnecessary surgeries, and diminished quality of life when trigger point therapy may offer effective, easy, and even quick relief of your pain.

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