Trigger Points Are a Real Pain
Trigger points are so common in my treatment room. They affect everyone from athletes to office workers to laborers. Read on to learn all about trigger points, how you get them, and what to do about them.
What is a Trigger Point?
A trigger point is a localized tight area in a muscle that refers pain to another location in a predictable pattern. The trigger point may be irritated or painful on its own (active), or you may not notice it until pressure is applied (latent).
Why Do Trigger Points Form?
Trigger points occur for many reasons. They can form quickly following an injury such as during a car crash, a fall, or during contact sports. They can develop over time due to repetitive use such as in the shoulder of a painter or the neck or low back of someone who sits all day for work. They can result from chronic stress or vitamin deficiency and can be secondary to joints moving too much or too little.
For the nerds like me who like more details: The best current explanation for how trigger points form is that, for unclear reasons, the motor nerve tells the muscle cell to continually contract. This results in localized inflammation, poor oxygen and nutrient supply, increased energy needs, abnormal movement, and pain.
Notice the self-sustaining cycle: formation of trigger point <- -> pain & altered muscle patterns.
How Can I Get Rid of Them?
First, other more serious conditions should be ruled out, and if the trigger point is due to an injury, that needs to be evaluated before beginning a treatment program to prevent further tissue damage.
Most trigger points respond very well to a combination of strengthening & stretching the muscle. As mentioned above, trigger points elicit a predictable pattern of referred pain. For example, certain trigger points in the upper back can cause headaches; others cause pain down the arm. Additionally, a single muscle can contain multiple trigger points. The location of your pain, along with other information, helps pinpoint which muscle is affected, and that's the information you need to determine what type of stretching and strengthening will heal it.
The simplest way to relieve trigger point pain is to combine massage with focused exercise, or stubborn ones may benefit from acupuncture or dry needling; these treat the cause. Oral pain medication is often used to relieve referred pain (i.e. headaches), and pain relievers or steroids can also be injected directly into the trigger point. Medication doesn't treat the trigger point; it just masks the pain.
The Most Common Trigger Points I See in Practice
Number 1, by far, is found in the upper trapezius, shown here by the circled x, and the referral pain pattern is shown in red. You can identify this trigger point by squeezing the muscle belly at the base of your neck. If this produces pain in the shaded area, congratulations, you have self-diagnosed this trigger point! Remember, the trigger point itself may or may not be painful when left alone, but it will be tender when you squeeze.
If you notice this headache pattern, treat the trigger point by applying pressure or squeezing for 5-10 seconds. Release quickly and repeat once or twice. Breathe slowly throughout the treatment; follow up with a glass of water.
The next image shows another common cause of headaches. These trigger points are found in the small suboccipital muscles that connect the base of your skull to your first 2 spinal bones. If you experience tension at the base of your skull or pain in the red-shaded area, try this: lie on your back with the base of your skull at the edge of your bed. That's it! Relax for 1-5 minutes and let gravity release the tension in these muscles. You can shift so that the pivot point moves a little closer to or farther from your skull for best results.
These are often latent trigger points, so you probably won't feel pain in the muscle itself. However, they can get VERY tight and be extremely tender or almost numb when palpated. These trigger points can result from shallow breathing, excessive coughing, carrying a heavy bag over one shoulder, prolonged or frequent posture with the head and/or shoulders forward, stomach sleeping, and more.
Here's a stretch to try: Place the back of your hand (the one on the same side as the pain) on your low back and look over your opposite shoulder. Play around with your head position (more or less rotation, more or less extension), and drop your shoulder a little until you feel a good stretch. Keep your breaths deep and relaxed; hold the position for 10-20 seconds. Rest and repeat if needed. Drink some water. 😁
I work on a *lot* of rhomboids in my practice. Achy or burning pain between your shoulder blade and your spine? Try this: Pin a tennis ball between the wall and the painful spot in your back. Roll up, down, and side to side, or simply press into the trigger point for 10-20 seconds. Then...? You guessed it...drink some water.
Glute trigger points
I'm not going to include pictures or instructions for this one. Trigger points in your 3 gluteal muscles can refer pain into your low back, pelvis, buttocks, hip, or down the back & side of your leg. I mention them here because so many people have inactive glutes, which leads to mystery pain and pain medication, and, in the worst case scenario, surgery for something that could have been easily healed. My suggestion? Just start where you're at. Take the stairs, do some squats or glute bridges, and take a walk around the building during your lunch break.
In my chiropractic practice, I always incorporate muscle stretching & strengthening into my care plans, because muscles and joints simply do not function independently. We do some work during the treatment time, and I usually give simple home exercises to help you heal faster, increase spinal stability, and stay healthier.
I hope you found some useful tips in this post. If you need additional help, please reach out to my office at 816-416-9920 to schedule an appointment with me in downtown Kansas City.