Trigger points may be active or latent. Active trigger points cause pain while the muscles and body are at rest. Latent trigger points do not cause pain without applied pressure but restrict movement or cause muscle weakness. Local twitch responses may also result. These responses refer to a visible or palpable contraction or dimpling of the muscle and skin.
About 23 million people in the U.S. have one or more chronic musculoskeletal system disorders with trigger point symptoms. Additionally, they live their life with everyday symptoms which affect their muscles and pain levels. Overall, musculoskeletal system disorders are the main cause of disability in working-age people and other age groups today.
- Pain and Dysfunction Within Muscles
- Tight Tender Spots
- Sharp Intense Pain or Dull Aches
- Referred Pain
- Decreased Range of Motion
- Regional Persistent Pain
Physically, trigger points can be found as they are a hypersensitive bundle of muscle fibers that are harder than the surrounding muscle tissues. These hyperirritable points can be found in taut bands of muscle. Trigger points can send referred pain to another site remote from the original trigger point.
People who have fibromyalgia or myofascial pain syndrome often have tender points as well. Tender points cause pain in the location of the injury. Conversely, Trigger points have referred pain which affects a remote site. Tender points do not cause referred pain but often cause a total body increase in pain sensitivity.
Trigger Point Causes
- Repetitive Use or Overuse of a Muscle
- Auto Accident Injuries
- Structural Imbalances
- Improper Stretching
- Lack of Stretching Prior to Physical Activity
Trigger points develop in areas of the body where you have muscle spasms, decreased circulation, increased muscle contraction and nerve sensitivity. Due to these conditions contractions and knots occur within the muscle. Knots in your muscles develop when overstimulated muscle fibers are unable to release from their contracted state. In this contracted state, blood flow decreases and oxygen supply diminishes resulting in a build-up of metabolic waste. This build-up causes pain to radiate through your muscles.
Acute trauma or repetitive microtrauma may lead to the development of trigger points within the muscle fibers. Additional symptoms include a tension headache, tinnitus (ringing in the ears), jaw pain, and decreased range of motion in the legs and lower back.
Microtrauma may result from a lack of exercise, poor posture, vitamin deficiencies, sleep disturbances, and joint problems.
Activities that cause repetitive stress on a specific muscle or muscle group commonly cause chronic stress in muscle fibers. Common conditions include tennis elbow, golf shoulder, and surgical scars.
Treatments include acupuncture, massage, ultrasonography, application of heat or ice, electrical nerve stimulation, as well as trigger-point injections. Massage techniques utilize cycles of isolated pressure to release muscle constrictions and provide pain alleviation. Receiving massage treatment on a regular basis can help you manage pain and stress from chronic conditions. Physical therapy may treat trigger points better in the acute stage of formation. Additionally, physicians often prescribe muscle relaxers and sleeping aids for these conditions.
Trigger Point Injections
For an injection, your physician will locate your trigger point and sanitize the area. The trigger point will then be pinched to isolate it. Your physician’s fingers will stabilize the trigger point to prevent it from rolling away from the needle prior to the injection.
After completing the injection, your physician will test for other trigger points in the same area. If additional points are found in the palpation exam, they will also be injected. Pressure will then be applied to the injection area to promote homeostasis. An adhesive bandage will be applied to the injection site and the procedure will be complete.
Deterrents for Injections
- Bleeding disorders
- Ingestion of blood thinner medication such as aspirin three days prior to the injection
- Presence of an infection
- Allergy to anesthetic agents
- Acute muscle trauma
- Extreme fear of needles
You can expect to feel sore after the procedure. However, your soreness should subside within 3-4 days. You should remain active by having your muscles go through their full range of motion. But, you should avoid strenuous activities during the initial recovery period (3-4 days). If your procedure was ineffective, it is not recommended to have more than 2-3 injections in the same muscle.