The two most important characteristics of trigger points that you will notice are tender “knots” or tight bands in the muscles, and referred pain. You may also notice weakness, lack of range of motion, or other symptoms you would not normally associate with muscular problems.
Tenderness, Knots, and Tight Bands in the Muscle
When pressed, trigger points are usually very tender. This is because the sustained contraction of the myofibril leads to the release of sensitizing neurotransmitters via a cascade effect.
The sustained contraction elevates metabolites such as potassium ions and lactic acid, which leads to elevated levels of inflammatory agents such as bradykinin and histamine, which activates pain nerve fibers, which then leads to the excretion of pain transmitters, such as substance P.
Pain intensity levels can vary depending on the amount of stress placed on the muscles. The intensity of pain can also vary in response to a multitude of perpetuating factors, and in the presence of central nervous system sensitization. The areas at the ends of the muscle fibers also become tender, either at the bone or where the muscle attaches to a tendon.
Knots and Tight Bands
Healthy muscles usually do not contain knots or tight bands and are not tender to applied pressure. When not in use, they feel soft and pliable to the touch, unlike the hard and dense muscles found in people with chronic pain.
People often tell me their muscles feel hard and dense because they work out and do strengthening exercises, but in reality healthy muscles feel soft and pliable when not being used, even if you work out.
Muscles with trigger points may also be relaxed, so do not assume you do not have trigger points just because the muscle is not hard and dense.
Trigger points may refer pain both in the area in which the trigger point is located, and/or to other areas of the body. These are called referral patterns.
Over 60% of commonly found trigger points are not located within their area of referred pain. The most common referral patterns have been well documented and diagramed, and are well understood by trigger point therapists.
Unless you know where to search for trigger points, and you only work on the areas where you feel pain, you probably will not get relief.
For example, trigger points in the iliopsoas muscle (deep in your abdomen) can cause pain in your lumbar area. If you do not check the iliopsoas muscle for trigger points and only work on the quadratus lumborum muscle in the lumbar area, you will not get relief.
Weakness and Muscle Fatigue
Trigger points can cause weakness and loss of coordination, along with an inability to use the muscle.
Many people take this as a sign that they need to strengthen the weak muscles, but you cannot condition (strengthen) a muscle that contains trigger points—these muscle fibers are not available for use because they are already contracted.
If trigger points are not inactivated, conditioning exercises will likely encourage the surrounding muscles to do the work instead of the muscle containing the trigger point, further weakening and de-conditioning the muscle containing trigger points.
Muscles containing trigger points are fatigued more easily and do not return to a relaxed state as quickly when you stop using the muscle.
Trigger points may cause other muscles to tighten up and become weak and fatigued in the areas where you experience the referred pain. They will also often cause a generalized tightening of an area as a response to pain.
Trigger points can cause symptoms that most people would not normally associate with muscular problems. For example, trigger points in the abdominal muscles can cause urinary frequency and bladder spasms, bed-wetting, diarrhea, frequent belching and gas, nausea, loss of appetite, heartburn, food intolerance, vomiting, and testicular pain, in addition to causing referred pain in the abdominal, mid back, and lumbar areas.
Trigger points may also cause stiff joints, generalized weakness or fatigue, twitching, trembling, and areas of numbness or other odd sensations. It probably would not occur to you (or your health care provider) that these symptoms could be caused by a trigger point in a muscle!
Sensitization of the Opposite Side of the Body
For any long-term pain, it is not unusual for it to eventually affect both sides of the body. For example, if the right lumbar area is painful, there may be tender points in the left lumbar area. Often the opposite side is actually more tender with pressure.
This is because whatever is affecting one side is likely affecting the other. Poor body mechanics, poor footwear, overuse injuries, chronic degenerative or inflammatory conditions, chronic disease, or central sensitization.
For this reason, I almost always treat both sides on patients. You may find that you have trigger points only on one side for any given muscle, but always check both sides before making that assumption.
The above is an edited extract from pain relief with Trigger Point Self Help by Valerie DeLaune. Valerie is a licensed acupuncturist and certified neuromuscular therapist who teaches trigger point workshops nationally.
This trigger point therapy blog is intended to be used for information purposes only and is not intended to be used for medical diagnosis or treatment or to substitute for a medical diagnosis and/or treatment rendered or prescribed by a physician or competent healthcare professional. This information is designed as educational material, but should not be taken as a recommendation for treatment of any particular person or patient. Always consult your physician if you think you need treatment or if you feel unwell.
Share this post