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Written by Ryan Edgar, PT, DPT
Introduction: If you have ever had pain or difficulty moving a part of your body, like your neck or lower back, and it feels as if a rope-like band is restricting the motion, then it is possible that the cause of the limitation is a “Trigger Point” within a muscle. Trigger points are what we most commonly refer to as “muscle knots”. They are a very common cause of pain and are often overlooked as the main source of pain reproduction. Trigger points can be responsible for pinching nerves that supply the extremities, thus, producing numbness and tingling down the leg or arm. Many patients seek pain relief through the traditional approach of anti-inflammatory medications, muscle relaxants, and/or antidepressant medications but find very little relief because trigger points do not respond well to these means.
Anatomy: Trigger points form when small, localized areas of muscle fibers become taut bands which form nodules within a much larger muscle. This can be caused by multiple factors including: overloading a muscle, psychological stress, direct trauma to one area, irritated nerves, or even from other trigger points. A lot of the time, trigger points form as a protective measure for unstable joints due to muscle weakness or loose ligaments. The most common areas for trigger points to form are the muscles along the neck and lower back, however, they can form in any muscle in the body. Trigger points can also lie quietly in muscles and be non-painful until pressed on. These are referred to as “latent” trigger points and although most people don’t notice them, they can cause restricted movement, reduced efficiency, stiffness, and weakness. Most people have a few latent trigger points and may not notice them for years until something re-activates them, whether it be overloading the muscle in some way, illness, or stress.
Symptoms: It is Important to know that trigger points can cause pain in remote parts of the body. For example, if there is a trigger point located in the scalenes, one of the muscles in the neck, it can refer pain to the upper chest or down the arm on the same side as the compromised muscle. The trigger points pull on surrounding tendons and ligaments and cause pain in what seems like the joint or an area where there is no muscle. When the trigger point tightens muscles surrounding a nerve leaving the spine, the result can be numbness or tingling below the nerve being pinched. This means that if the brachial plexus, the nerve bundle supplying the arm, is pinched by trigger points within the upper trapezius muscle near your neck, you may feel numbness and tingling in your shoulder, arm, and/or hand. Unfortunately, there are no commonly available lab tests or imaging studies that can confirm the diagnosis at this time, however, a skilled physical therapist will be able to recognize symptoms and locate the trigger points.
Problems: A common issue that arises when trigger points are present in the neck musculature are cervicogenic headaches, meaning headaches that spawn from the neck. These headaches can be commonly mistaken for migraines. Trigger points found in the neck can refer pain to areas like the forehead, eyes, and even the cheek. A lot of the time this is a result of poor posture while sitting or standing. We spend a lot of our time looking at computers, phones, books, or working at a desk which can force your head into a forward position and your shoulders to hunch. When this happens, the muscles in your neck are held in a tightened position for a prolonged amount of time creating these knots. Trigger points found in the lower back can make bending forward or moving in a specific way very painful, even sending sharp pains down the leg and sometimes into the foot. This can make everyday activities such as lifting groceries or walking difficult and painful. Trigger points can also make it difficult to stay in one position for too long. Driving long distances, standing at work, and sleeping are just some examples of activities that can be disrupted due to the presence of trigger points.
Treatment: Treating each trigger point is relatively simple and physical therapists are here to help. Since trigger points are the contraction mechanism formed by muscle fibers, the treatment of the trigger point involves unlocking that contraction mechanism. This can be achieved in several ways. Trigger point pressure releases involve applying pressure with a finger or other instrument to the trigger point and increasing the pressure as the trigger point "releases" and softens. Many patients experience relief in just their first treatment, but for some it may take a few treatment sessions before pain relief is noticed. It is common for patients to experience soreness one or two days after the treatment but after multiple sessions this soreness usually occurs less frequently. Stretching the involved muscle is another treatment technique that will help to fully distract the muscle allowing for the trigger points to release. Once the trigger point has been released, it is important to move the muscle through its complete range and not let it sit without movement. The rate at which improvements are seen and the effectiveness of the treatment can rely on multiple factors including:
Type of injury that occurred and how long it has been
Overall physical health and level of fitness
Underlying abnormalities/medical conditions
Presence of depression or anxiety
The patient’s compliance to self care
During the first session with your therapist they will provide you with a complete evaluation, including obtaining your medical and pain history. With this information in mind, the physical therapist will assess your pain patterns to determine where the pain may be referring from and locate the trigger points that may be present. Your therapist will then choose an appropriate exercise/stretching program and help you to incorporate it into your life along with alterations of how you perform your daily activities or posture while sitting.
If this sounds like you, or you feel that you may benefit from seeing a physical therapist, contact us at our Canton location 860-352-2463 or email at ryan@magnapt.com.
With the convenience of direct access you can make an appointment today without having to see your doctor first!
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