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Trigger points are focal spots in skeletal muscles that cause local pain and referred pain in other parts of the body. They are palpable nodules that develop in the myofascia, mainly in the centre of a muscle belly, and can be found in any skeletal muscle. These muscle knots can develop anywhere in the body but are commonly found in the back and neck. They are caused by acute trauma or repetitive microtrauma, such as occupational or recreational activities that produce repetitive stress on specific muscles or muscle groups. Various modalities, such as injection and manipulative therapy, can be used to inactivate trigger points and provide relief from symptoms.
| Characteristics | Values |
|---|---|
| Location | Centre of a muscle belly where the motor endplate enters |
| Size | 2-10mm |
| Development | Acute trauma, repetitive microtrauma, lack of exercise, prolonged poor posture, vitamin deficiencies, sleep disturbances, joint problems, occupational or recreational activities with repetitive stress on a specific muscle or muscle group |
| Symptoms | Pain, referred pain, tenderness, motor dysfunction, autonomic phenomena, muscle weakness, movement restriction, muscle imbalance, altered motor recruitment, changes in range of motion, headaches, migraines, tinnitus, toothaches, earaches, temporomandibular joint problems, postural abnormalities |
| Treatment | Spray and Stretch technique, ultrasonography, manipulative therapy, injection (most effective) |
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What You'll Learn
Myofascial trigger points
Trigger points may develop as a protective measure against unstable joints, acute trauma, or repetitive microtrauma. Lack of exercise, prolonged poor posture, vitamin deficiencies, sleep disturbances, and joint problems may all predispose the development of micro-trauma. Occupational or recreational activities that produce repetitive stress on a specific muscle or muscle group commonly cause chronic stress in muscle fibres, leading to trigger points.
Trigger points can be classified as active or latent. An active trigger point causes pain at rest and is tender to palpation with a referred pain pattern that is similar to the patient's pain complaint. A latent trigger point does not cause spontaneous pain but may restrict movement or cause muscle weakness.
Trigger point injection has been shown to be one of the most effective treatment modalities to inactivate trigger points and provide prompt relief of symptoms. Invasive treatments for myofascial trigger points include injections with local anaesthetics, corticosteroids, or botulism toxin or dry needling.
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Taut bands of muscle fibres
A taut band is a structural muscle abnormality, or a contracted section of muscle. They are associated with conditions like fibromyalgia and myofascial pain syndrome (MPS). Taut bands can develop due to fatigue, chronic overuse, tissue trauma, movement impairment (postural dysfunction), and certain diseases.
Trigger points are hyperirritable spots located within a taut band of skeletal muscle. They are palpable nodules within the tight muscle, typically 2-10mm in size. They produce pain locally and in a referred pattern, often accompanying chronic musculoskeletal disorders. Trigger points can be differentiated from tender points, which are associated with pain at the site of palpation only.
To palpate taut bands, gently strum the muscle fibres perpendicular to their direction, feeling for differences in tension between adjacent fibres. Taut bands often feel like an overly tight "guitar string" within the muscle, extending from origin to insertion.
Mild taut bands may resolve with rest and improved movement patterns, but persistent bands often require manual intervention, corrective exercise, or other therapeutic techniques. Treatment options for taut bands include compression techniques, needling, and trigger point therapies.
It has been hypothesized that the formation of taut bands and trigger points is caused by overactivated beta motor units and rigour (silent contracture) of their muscle fibres. This overactivity of the beta units is thought to be caused by continuous afferent reflex drive from inflamed muscle spindles full of contraction, inflammatory and pain metabolites.
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Treatment of trigger points
Trigger points are discrete, focal, hyperirritable spots located in a taut band of skeletal muscle. They produce pain locally and in a referred pattern and often accompany chronic musculoskeletal disorders. Acute trauma or repetitive microtrauma may lead to the development of stress on muscle fibres and the formation of trigger points.
Trigger points can be treated in a variety of ways, including:
Injection
Trigger-point injection has been shown to be one of the most effective treatment modalities to inactivate trigger points and provide prompt relief of symptoms. Various clinical trials have supported the use of injections, although conclusions are limited by low participant numbers, the potential for a placebo effect, and a lack of post-treatment follow-up.
Massage
Massaging the trigger points can help break up the knots and release tension in the muscles. Massage is a modality in which direct pressure is applied in a slow, controlled fashion over the trigger point.
Physical Therapy
Gentle stretching exercises can reduce the pain in the affected area. Applying heat can also help reduce muscle tension and pain.
Medication
Doctors may prescribe medication to help relieve the pain associated with myofascial pain syndrome. These can include pain relievers such as Advil, Motrin, or Aleve, or antidepressants if stress and anxiety are the root cause of the pain.
Spray and Stretch Technique
This technique involves stretching the skin over a trigger point and applying a topical anesthetic spray, such as ethyl chloride. The anesthetic introduces a sudden sensory stimulus that distracts the patient from the discomfort within the trigger point-affected muscle.
Other Techniques
Other techniques for treating trigger points include ultrasonography, manipulative therapy, dry needling, acupuncture, and osteopathic manual medicine.
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Trigger points in the back
Trigger points are focal, hyperirritable spots in a taut band of skeletal muscle. They are palpable nodules, often referred to as "knots", that can be felt through the skin. These spots are painful when compressed and can cause referred pain, tenderness, motor dysfunction, and other issues. Trigger points are typically associated with other injuries and/or pathologies. They can be caused by acute trauma or repetitive microtrauma, such as occupational or recreational activities that produce repetitive stress on specific muscles. Examples include sitting in chairs with poor back support or moving boxes using improper body mechanics. Trigger points can also develop from stress, overuse of a muscle, structural imbalance, or improper stretching before physical activity.
There are several treatment options available for trigger points in the back. Rest and relaxation are often recommended as a first step. If this is ineffective, physical therapy or massage therapy may be helpful. Trigger point injections are another effective treatment option that can provide prompt relief of symptoms. These injections are safe, simple, and quick procedures that can help discover the cause of neck and back pain, eliminate it, and prevent its recurrence. Other adjunctive treatments such as cupping, dry needling, and kinesiotaping are also gaining popularity and may be used in conjunction with exercise and other manual therapy interventions.
Manual therapy techniques can be applied directly to the trigger point or used to address the root cause and surrounding areas. Spinal manipulation, such as manipulation of the thoracic spine, cervical spine, and cervicothoracic junction, is one technique that may be indicated for back trigger points. Trigger Point Release, such as ischemic compression, can also help decrease pain locally. This can be performed by a physical therapist or self-taught. Self-mobilization techniques such as thoracic extension mobilizations, foam rolling, and self-ischemic compression with a lacrosse ball can be used in conjunction with manual therapy to improve outcomes.
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Trigger point science
Trigger points are focal, hyperirritable spots in skeletal muscle. They are palpable nodules within the tight muscle, which can be 2-10mm in size. They are associated with taut bands of muscle fibres, which can be painful on palpation. Trigger points are classified as active or latent. An active trigger point causes pain at rest, whereas a latent trigger point does not cause spontaneous pain but may restrict movement.
The term "trigger point" was coined in 1942 by Dr. Janet Travell. The Integrated Trigger Point Hypothesis (ITPH) is the current working hypothesis to explain the formation, sensitization, and manifestation of trigger points. This hypothesis suggests that when sarcomeres and motor endplates become overactive, pathological changes occur at the cellular level. This leads to a local inflammatory response, loss of oxygen and nutrient supply, endogenous shortening of muscle fibres, and increased metabolic demand on local tissues.
There are several proposed mechanisms for the development of trigger points, but scientific evidence is lacking. The radiculopathic theory explains the relationship between problems with nerve roots and the creation of trigger points. The polymodal theory suggests that polymodal receptors throughout the body can turn into trigger points under constant pathological stimuli. Acute trauma or repetitive microtrauma may also lead to the development of trigger points.
Trigger points are often associated with chronic musculoskeletal disorders and can result in regional, persistent pain and decreased range of motion in the affected muscles. They can manifest as tension headaches, tinnitus, temporomandibular joint pain, decreased range of motion in the legs, and low back pain.
Various treatments are used to inactivate trigger points, including the Spray and Stretch technique, ultrasonography, manipulative therapy, and injection. Trigger-point injection has been shown to be one of the most effective treatments for providing prompt relief of symptoms.
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Frequently asked questions
Trigger points are hyperirritable spots in the skeletal muscle. They are associated with palpable nodules in taut bands of muscle fibres. They are commonly known as muscle \"knots\" and can be very painful and sensitive to touch.
Trigger points can be caused by acute trauma or repetitive micro-trauma, leading to stress on muscle fibres. Lack of exercise, prolonged poor posture, vitamin deficiencies, sleep disturbances, and joint problems may all predispose the development of micro-trauma.
Trigger point injections (TPI) are a common treatment method. TPIs involve injecting pain-relieving medication into the targeted location to address areas of fascia tension. Other treatment methods include Spray and Stretch technique, ultrasonography, manipulative therapy, and physical therapy.
