If you are suffering from pain that has eluded diagnosis, myofascial trigger points are an essential phenomenon to understand. This phenomenon is by far the most prevalent and yet least understood cause of mysterious pain in the body.
Despite the extensive material available on the subject, this phenomenon is not well understood in conventional medicine. Medical schools still devote very little attention to the muscular system, and trigger points are a muscular phenomenon.
We owe our understanding about myofascial trigger points to the groundbreaking two-volume work, Myofascial Pain and Dysfunction: The Trigger Point Manual, by Dr. Janet Travell & Dr. David Simons.
Drs. Travell and Simons define a trigger point as follows…
A hyperirritable spot, usually within a taut band of skeletal muscle or in the muscle’s fascia, that is painful on compression and that can give rise to characteristic referred pain.
The key part of this definition is the last phrase:
“…can give rise to characteristic referred pain.”
What distinguishes a trigger point from other tender points is that it creates a referred sensation — pain, tingling, numbness, aching, or thermal sensations like hot or cold.
This referred sensation can either radiate out from the point, or it can refer to another part of the body.
If a point is simply tender but does not refer, we call it an ischemic point (a region of poor blood flow). Too often health professionals toss around the term “trigger point” to refer to any tender point in the body. But this just creates confusion in identifying true trigger points.
A trigger point referral IS NOT caused by compression, “pinching,” or pressure on a nerve of any kind. That describes a nerve root referral in which pain is caused due to the compression or entrapment of a nerve by bone, cartilage, or soft tissues.
Two examples of a nerve root referral can be illustrated with the sciatic nerve which travels from the lumbar spine through the buttocks and down the leg. The sciatic nerve can be…
1) Compressed by a bulging or herniated spinal disc resulting in nerve root compression
2) Entrapped by the piriformis muscle resulting in muscle entrapment
In both cases, pressure on one part of the nerve sends sensation — pain, tingling, or numbness — to another part of the nerve. The region of sensation is called the referral zone.
A trigger point referral, on the other hand, is a muscle-based phenomenon. When muscles become ischemic (low blood flow) as a consequence of strain or chronic contraction, a strange neurological phenomenon can occur…
The muscle can begin to send a signal to the central nervous system. Then from the central nervous system that signal can travel out to another part of the body causing sensation.
For example, if I have a trigger point in a muscle in my lower back it could send a signal to my central nervous system which would then send a signal to my buttocks and I would feel pain there.
The pain, then, would not be caused by a nerve being pinched or compressed in my lower back, but rather by the trigger point creating a feedback loop of signals: from my lower back to my nervous system to my buttocks.
Myofascial trigger points can develop within skeletal muscles and fascia for a wide variety of reasons:
• Sudden trauma to musculoskeletal tissues (muscles, ligaments, tendons, bursae)
• Injury to intervertebral discs
• General fatigue (Fibromyalgia is a perpetuating factor for Trigger Points. Some evidence suggests Chronic Fatigue Syndrome may produce TPs as well)
• Repetitive motions; excessive exercise; muscle strain due to over activity
• Systemic conditions (eg, gall bladder inflammation, heart attack, appendicitis, stomach irritation)
• Lack of activity (eg, a broken arm in a sling)
• Nutritional deficiencies
• Hormonal changes (eg, TP development during PMS or menopause)
• Nervous tension or stress
• Chilling of areas of the body (eg, sitting under an air conditioning duct; sleeping in front of an air conditioner)
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