Article reviewed and approved by Dr. Ibtissama Boukas, physician specializing in family medicine
A trigger point is a painful point reproduced on palpation of a muscle. These tender points can be found anywhere in the body, and are one of the most common causes of chronic musculoskeletal pain.
This article explains what a trigger point is (causes, symptoms, diagnosis), and offers several solutions aimed at treating and preventing their appearance.
A trigger point is a sensitive and palpable point in a muscle or fascia. This pain generally appears on palpation of the affected muscle, or on muscle contraction of the same muscle. The discomfort can be felt locally, or even away from the painful point.
There are no noticeable physical changes caused by the trigger point (such as swelling, redness, etc.). Likewise, the referred pain does not follow a nerve path that would indicate peripheral nerve damage. Rather, referred pain appears to follow a characteristic trigger point pattern.
One theory suggests a poor supply of oxygen and nutrients to the muscle, causing pathological contraction. This sustained contraction thus leads to poor circulation in the affected area due to the compression of the blood vessels, thus slowing healing and causing long-term chronic pain.
Trigger points can occur in different parts of the body, and all muscles can theoretically be affected. The most affected muscles are those that maintain posture (cervical muscles, shoulders, pelvis, etc.). More specifically, the most affected muscles are:
- the sternocleidomastoid
- the trapeze
- the levator scapula
- the infraspinatus
- the rhomboids
- the breastplate
- the squares of the loins
- glutes (small, medium large)
- the tensor fascia lata
We all have trigger points in the body, but their presence does not necessarily cause pain all the time (this is called a latent trigger point). Despite the absence of pain, a latent trigger point can still restrict certain movements and lead to muscle weakness.
When symptomatic, trigger points are usually associated with myofascial syndrome or fibromyalgia. There may also be psychosomatic disorders that could explain their appearance. Their consequences vary, and can sometimes go so far as to limit the activities of daily living.
In general, trigger points occur due to:
- Acute injury or trauma
- repetitive movements
- The stress
- Physical inactivity
- A non-optimal posture
- A sleep disorder
- Vitamin deficiencies
- joint problems
Signs and symptoms
A patient with a trigger point most often consults for progressive onset pain that becomes more and more incapacitating. In the head and neck area, symptoms may manifest as headaches (type tension headache), tinnitus, jaw pain (temporomandibular joint), visual disturbances, or torticollis.
In addition, patients may complain of body aches and morning stiffness. To these symptoms can be added:
- Muscle weakness in the affected muscles
- Impaired motor control of affected muscles
- Decreased range of motion
- Postural abnormalities
- Compensatory phenomena
Above all, it must be understood that no medical imaging test or blood test can diagnose a trigger point. Since the diagnosis is mainly based on palpation, it is not unanimous from a scientific point of view.
The objective of the consultation with the healthcare professional is to identify the cause or medical condition associated with the presence of trigger points.
In addition, it will be necessary to find elements of his daily life which could explain the presence of trigger points. It can be a lack of exercise (sedentary), muscle overload, poor sleep hygiene, stress, etc. Although the pain is generally related to the activity of the damaged muscle, it can also be constant (that is to say, be present at all times).
The physical examination will then make it possible to palpate the exact location of the trigger point. The professional will try to identify nodules in the muscles, sometimes associated with a change in temperature. Palpation of the nodule will cause tenderness either locally, or further away from the painful point (often, following the characteristic pattern of the corresponding trigger point).
It should be noted that the reproduction of the symptoms must be consistent with the pain felt on a daily basis to affirm that the trigger point is indeed the responsible factor.
In addition to the palpatory examination, there will be an evaluation of posture, range of motion involving the affected muscles, as well as a neurological examination to rule out a more serious cause.
Once the presence of trigger points and their potential cause have been identified, it is time to find solutions aimed at relieving the symptoms. Treatment modalities to relieve and prevent trigger points include:
Certain painkillers or anti-inflammatories are regularly prescribed to relieve pain caused by trigger points. When they do not work, more powerful drugs can be considered:
- Muscle relaxants
Trigger Point Infiltration
If the doctor believes that a trigger point is responsible for the pain felt by his patient, he could offer him a cortisone infiltration (or other solution) at this level. We call them trigger point infiltrations (or myofascial infiltration), and they are used mainly in the presence of myofascial syndrome.
It should be noted, however, that research shows inconsistent and often temporary results.
Physical therapy can be effective in treating the cause and consequences of a trigger point. Modalities used in physical therapy (physiotherapy) include:
- Education on lifestyle habits related to the appearance of trigger points (sleep, stress, physical activity, etc.)
- Heat and ice (video explanations)
- Postural rehabilitation
- Adapted exercises and stretches
- Myofascial release
- Neuroproprioceptive taping
- Drainage lymphatique
Some of the various forms of alternative therapies that can relieve pain from trigger points include:
- Occlusion training (Blood flow restriction therapy or BFR)
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