Myofascial trigger points are an extremely common cause of chronic pain. In a recent study conducted by a pain management center, it was discovered that there was a myofascial component to pain in 95% of the study participants.
Myofascial refers to muscle tissue (myo) and the three-dimensional web of connective tissue (fascia) that stretches between it throughout the body.
As a result of injury, repetitive strain, poor posture, stress etc. trigger points can form in the myofascial structure.
Trigger points are tight, painful knots of constricted muscle that pull the surrounding muscle and fascia tight.
They can cause pain and stiffness throughout the body. Sometimes a trigger point in one muscle will cause pain in a seemingly unconnected part of the body.
This is called referred pain. An example would be when a trigger point in the top of your shoulder causes pain in your neck or forehead.
People who suffer from chronic myofascial pain, or myofascial pain syndrome, should be aware that relief is available through trained therapists and personal exercise.
This article is intended give you a better understanding of what trigger points are, how they affect you, and what you can do to manage the pain they cause.
The Knot is Tied
On average, muscles make up 36 to 42% of a person’s entire body weight. As has been mentioned before, they are all connected by a web of tissue called fascia, which runs through your body in three layers, from the top of your head to the bottom of your feet.
In its normal, healthy state, fascia is flexible and relaxed, moving with your muscles somewhat like a loose knit.
When a trigger point forms within a muscle, it bunches the muscle and pulls the fascia taut, making it less pliable creating stiffness, pressure and tension in various areas of the body.
This in turn can cause other muscles to react and other trigger points to form, even pinching nerves, which results in more severe pain.
Trigger points can form after a single injury or trauma or over time from continued stress, sometimes called micro-trauma. Examples of activities, lifestyles or traumas that can lead to trigger points include,
- Injury: car accident, bike wreck, sports injury, falling down the stairs, etc.
- Poor posture: sitting for long periods of time, leaning over a desk, long bouts of inactivity (for example if bedridden for some time)
- Repetitive overuse of certain muscles: typing, gardening, manipulating tools, etc.
- Heavy lifting over a long period of time
- Poor sleeping habits: not enough truly restful sleep
- Stronger muscles being forced to compensate for weak ones (in case of limp or other trigger points, etc.)
- Joint disorders
- Vitamin deficiencies
Goaded by trauma, large or small, a muscle may contract into a tight, tender “knot.” There are two types of trigger points, active and latent.
The active trigger point is very noticeable. It exhibits itself in a dull ache, sharp or burning pain, stiffness and weakness of the muscle in which it is located.
You can often locate the active trigger point with your finger and pressing it will cause pain to radiate into the surrounding muscles.
A latent trigger point may not be noticeable until it is shocked into painful activity, but it can have unpleasant side effects even before you notice it.
Unless pressed, they are unlikely to cause pain, but they can still cause stiffness and weakness in the muscle and may place stress on surrounding muscles, causing secondary trigger points to develop.
Few people have only one trigger point. The more areas of pain you experience, and the longer you have dealt with myofascial pain, the more likely you are to have several points that will need attention.
A Life is Changed
Living with chronic pain that limits your movement can make it difficult to function normally and enjoy daily activities.
Yet many people give little attention to myofascial pain as something that can be cured. They have grown used to living within its limitations and just dealing with it at its worst.
This does not have to be the case for you. Medical understanding of trigger points, how they affect your body, and how they can be released has continued to expand over recent years.
Many physicians, therapists, chiropractors and trainers are now being trained to “untie” muscle knots and help their patients enjoy a life relatively free from physical limitations of this kind.
Lessons in Release
It is important to understand that myofascial pain does not respond to anti-inflammatory drugs, muscle relaxants, or strengthening programs.
Attempting to strengthen a muscle weakened by a trigger point without first dealing with the trigger point will only increase tension and pain in that area.
NSAIDs provide only a very temporary relief of pain and do not address its cause at all.
Until the contracted knot within the muscle—and all the resultant stress and contractions in surrounding muscle and fascia—has been released, the pain will continue to return and debilitate.
Professionals trained in myofascial therapy will be able to locate tender trigger points and use pressure, massages and stretches to “untie” muscle knots and release the muscle from its locked contraction.
Depending on how long the problem has existed, and how many primary and secondary trigger points have developed, this may be a somewhat complicated therapy that will need to take place in ½ to 1 hour sessions over several weeks or months.
A skilled specialist will choose the therapy that will best address your trigger points, tightness and pain and will work with you to release and relax the muscles and get them back to working as they should.
Continued therapy is often necessary as well, especially if your trigger points form because of a daily activity connected to your job or hobby—a lifestyle factor that cannot be done away with.
Your therapist should be able to advise you on how to decrease muscle trauma while involved in these activities and to some extent, how to treat it yourself with massages, exercises, heating or cooling pads, etc.
Pain relief may begin immediately, or it may take some time for you to notice and be able to enjoy the difference.
Once again, “untying knots” that have been there for long periods of time and undoing the other negative effects they have had on your body may be somewhat complicated and will take time.
While undergoing treatment of myofascial trigger points, you may find the pain temporarily moves to another part of your body as the muscles relax and return to their proper functions.
This is all a normal part of recovery from chronic pain within a complex system of muscle and connective tissue.
You may also experience relief from a pain you were not even seeking treatment for as patterns of pain can be overlapped, and with myofascial pain syndrome, a trigger point in one part of your body may have been causing pain in other seemingly unrelated parts.
Kissing Pain Goodbye
In order to achieve the best results from pain-relieving therapy and take your life back, you will have to be personally involved in the process. Showing up for physical therapy is only the first step.
A positive attitude, communication with your specialist, and patience are all crucial elements if you are to complete the healing process and keep yourself from sliding back to tension and pain.
Proper exercises and stretches that you can do on your own will speed the healing process and help you maintain fitness and flexibility once the original trigger points are dealt with.
Keeping up with the correct exercises, eating a proper diet with great nutrition, and doing away with factors causing muscle tension (when possible) will call for self-discipline, but will greatly increase the quality of your life and decrease probability of returning trigger points and pain.
You should also give attention to your overall health, making sure you get the proper amount of sleep, activity and relaxation and properly caring for any perpetuating conditions (medical, etc.) you may be dealing with.
Remember, pain is a symptom. Proper therapy and care endeavors to discover its source and make the necessary corrections to put everything right. This is especially true with myofascial pain syndrome trigger points.
Robert Gerwin, MD summed up this condition with these words:
“Myofascial pain syndromes are muscle pain syndromes that… lead to the development of the characteristic taut or hard band in muscle that is tender and that refers pain to distant sites.
MPS can be regional or generalized… [and] may persist long after the initiating event or condition has passed, but it is nonetheless a muscle disease that can be satisfactorily treated.”
If you are dealing with myofascial pain syndrome, it is hoped that you will take heart from the information included in this article and take steps to seek treatment and begin the process of untying your muscle knots and kissing this chronic pain goodbye.