When you hear [or say] “I have knots in my back”, you’re really being told about a range of different physiological phenomena. One of these, and possibly the most common, is myofascial trigger points (TrPs). They can show up almost anywhere in your body, and they can seemingly have no known cause. TrPs can also cause a surprising amount of pain and discomfort, and their patterns of pain aren’t generally localized to the area of insult, but often referred to other regions of the body. Trigger Points are tricky beasts that can create surprisingly intense and odd sensations given that the physiology behind them is relatively subtle.
The Predominant Theory On What A TrP Is:
At this point in time, the vast majority of research supports the idea that a Trigger Point involves a small patch of contracted muscle. This has been argued in research for a good 30 years, however the theory has held up to scrutiny all these years. The contraction present in a TrP is distinguishable from other types of muscle contractions because instead of including the entire muscle, it only occurs in a very small region of a muscle.
Some studies have actually demonstrated that at the centre of TrPs, there is a hypersensitive and hyperactive muscle spindle (reference). Overactive muscle spindles support the idea that small patches of muscle tissue are being consistently engaged. As well, they support the idea that a large factor in TrP pathophysiology is stress (this is because chronically activated sympathetic nervous system means greater sensitivity of muscle spindles).
Where The Pain Comes From:
Trigger points have three main ways they could be causing you pain. The likelihood is that all 3 factors are indeed contributing at the same time.
- Nerve irritation caused by the muscle being contracted consistently
- Consistent contraction of the muscle fibers reduces the blood flow to that region of the tissue, creating pain signals
- With less blood flow, there is a greater accumulation of metabolic by-products, which leads to greater local irritation.
What is the pain like?
If you’re wondering if you have Trigger Points, with a generous degree of certainty I can tell you “yes, you do“. And you’ve likely had them many times in your life – in fact the time without them would have been brief and rare at best. They’re a totally natural part of being human – whether moving our bodies or not.
Possibly one of the most difficult things about Trigger Points is that they have no unifying, clearly defined set of symptoms or causes. The pain they cause could be local and be clearly related to an action. Yet with the same frequency, they can create referred pain to other areas of the body and mimic other medical conditions! Headaches, tooth aches, low back pain, shin splints, fatigue, carpal tunnel syndrome, dizziness, sciatica and even tumour symptoms and sensations often associated with acute heart failure have been known to be caused by the presence of Trigger Points.
That note is not meant to replace the appropriate medical evaluation of potentially life-threatening conditions. It’s simply noted here to highlight that the pain could be anything!
To Complicate Things More…
Trigger Points not only result in pain signalling (which again, can be local to- or far away from- the area of sensed pain), they can also reduce the effectiveness of a muscle. Altering muscle firing patterns creates the potential for surrounding structures getting involved in pain signalling. Typically, TrPs reduce the ability of a muscle to contract at the correct time and to the appropriate degree. Changing these things forces more work to be done by surrounding musculature and by muscles that support the same action intended (reference).
What this means is that TrPs can be the result of a pre-existing issue, AND they can also induce their own issues. By layering issue on issue, it can be difficult to understand what insult came first and how to treat it!
As a manual therapist, or as someone who experiences chronic/unexplained pains, this presents us with some unique challenges.
What Can We Do?
- See a variety of manual therapists. Sadly, it is actually quite rare to find a manual therapist who can consistently identify the correct areas and points to massage. Having a variety of therapists (even modalities) in your care-regimen will increase the likelihood that TrPs are being found and “dissolved”.
- Self-Massage. The biggest suggestion with this practice is to understand the idea that TrPs often cause pain from afar. Exploration of neighbouring muscles for Trigger Points is an incredibly valuable practice! You’ll likely find many different sore spots when you explore!
If you’re exploring some self-massage at home, I’m a really big fan of RAD rollers – I find that they are a great density to sink into the tissue (better than a few other ones I’ve tried over the years). Take care in positioning them just right to get the right amount of intensity needed to release a TrP (you should be able to comfortably breathe into the amount of sensation provided). (Find them here).
This is just a glimpse into Trigger Points. There is still a long way to go in understanding and defining TrPs. The information above is designed to help you understand more about them and what they can “show up” as. And I don’t know about you, but all this talk of Trigger Points makes me feel like it’s time for a treatment.
Article last edited: June 26, 2018.
For more reading on Trigger Points, head on over to PainScience.com – there’s a really thorough and well balanced e-book there too: “Trigger Points & Myofascial Pain Syndrome“.