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Despite the extensive material available on the subject, myofascial trigger points (aka TPs) are still not well understood in conventional medicine. It’s vital to understand this phenomenon because this issue is one of the most significant causes, not only of lower back pain, but chronic pain in general. The term myofascial is derived from myo which means muscle, and
fascia
which is the connective tissue that envelopes muscles, tendons, and joint capsules. In their 2-volume work, Myofascial Pain and Dysfunction, Drs. Janet Travell and David Simons offer this definition of TPs: 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. While pain is common sensation caused by TPs, other sensations can be illicited as well. Tingling, numbness, thermal sensations (hot/cold), achiness, or the feeling that the area “just isn’t right” are all possible symptoms. Trigger Point Referral vs. Nerve Root Referral It’s important to distinguish between these two distinct problems. Nerve root referral is caused by the compression or entrapment of a nerve by bone, cartilage, or soft tissues. For example, the
sciatic nerve
which travels from the lumbar spine through the buttocks and down the leg, can become either 1) compressed by a spinal disc or 2) entrapped by the piriformis muscle. In both cases, pressure on the nerve is the direct cause of pain, tingling, or numbness. Trigger point referral, on the other hand, is a neurological phenomenon is which the muscle sends a message to the central nervous system, and then that message travels out to another part of the body, causing sensation. For example, if I have TPs in my lower back, they might send a signal to my nervous system. The nervous system would then send a signal to my buttocks and I would feel pain there. The pain 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. Primary Causes These points develop within skeletal muscles and fascia for any of the following reasons: • Sudden trauma to musculoskeletal tissues (muscles, ligaments, tendons, bursae) • Injury to intervertebral discs • 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) Are These Points Causing My Pain? In order to know whether or not TPs are a factor in your lower back pain or other pain, it’s necessary to be evaluated by a health practitioner qualified to treat this problem, such as a
Neuromuscular Therapist
or other manual therapist. Your physician may or may not have experience with treating this phenomenon. An osteopathic physician is more likely to be more helpful with this issue than a general M.D.
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