Trigger points

June 1, 2020

 

Trigger points are hyperirritable spots located in a taut band of muscle. They produce pain locally and also can cause radiating symptoms. Actute or repetitive trauma can lead to stress on the muscle fibers forming a trigger point. These spots may even cause a decrease in range of motion. It can effect body posture, mostly in the neck, shoulders, and pelvis. Trigger points can cause headaches, tinnitus, TMJ pain, and lower back pain.

 

Trigger points can occur for varies reasons: age, fall injury, poor posture, lack of exercise, muscle overuse, vitamin deficiencies, sleep disturbances, joint problems, and chronic stress. It is still not fully understood what exactly causes them to form, but rest assured, we all have them! Depending on how they affect you, there are things you can do to provide relief.

 

For quick pain relief, Tylenol and NSAIDs may help. In worse cases, a doctor may prescribe muscle relaxants, antidepressants, NSAIDs, or anti-anxiety drugs. A doctor may also offer a trigger point injection by inserting a small needle into the active trigger point. The tigger point is made inactive and pain is usually relieved. 

 

The best management for trigger points is with physical therapy and exercise. Whatever caused the trigger point to become active, there must be a correction. Postural training and education is crucial. Stretching, massages, and foam rolling will help loosen hyperactive, tight muscles. Stretching exercises will help correct to any under active, weak muscles. Taping techniques can help also for pain relief. Different modalities including electrical stimulation, hot/cold packs, and laser treatment can also help reduce pain.

 

Other helpful interventions that may help can include dry needling, acupuncture, laster therapy and prolotherapy.

 

Refer to the list below for common trigger point locations:

 

 

 

II. Trigger Points: Head and Neck
  1. Paraspinous Neck Muscles

    1. Refer pain to occiput

    2. Symptoms include retro-orbital Headache

    3. Muscle Components

      1. Splenius cervicis muscle

      2. Semispinalis cervicis muscle

      3. Rotatores cervicis muscles

      4. Multifidus muscle

  2. Upper Trapezius

    1. Refer pain to neck and temporal forehead

  3. Sternocleidomastoid

    1. Associated with Otalgia and possibly Vertigo

    2. Associated with increased Lacrimation and Coryza

  4. Clavicle Musculature

    1. Referred pain across forehead and behind ear

  5. Sternal Musculature

    1. Referred pain into occiput, cheek and periorbital

    2. Mimics Sinusitis

  6. Splenius Capitis (cervical paraspinous muscle)

    1. Referred Retro-orbital or temporal-orbital pain

    2. Symptoms include vertex Headache

  7. Peri-auricular muscles

    1. Referred pain to teeth and jaw

    2. Muscle Components

      1. Temporalis Muscle

      2. Masseter Muscle

      3. Medial Pterygoid Muscle

      4. Lateral Pterygoid Muscle

III. Trigger Points: Shoulder, Thorax, and Arm
  1. Anterior Serratus Muscle (lateral to Breast)

    1. Referred pain to lateral chest and Scapula border

    2. Related to decreased chest expansion

    3. May result in perceived Dyspnea

  2. Pectoralis Major Muscle and Pectoralis Minor Muscle

    1. Referred pain to Breast and ulnar arm

  3. Levator Scapulae Muscle (lateral Neck)

    1. Referred pain to base of neck

    2. Associated with neck stiffness

    3. Follows cervical Whiplash injury

    4. Associated with Mood Disorders

  4. Infraspinatus Muscle (lower Scapula)

    1. Referred pain to Shoulder joint and down upper arm

    2. Mimics Cervical Radiculopathy

  5. Supraspinatus Muscle (upper Scapula)

    1. Referred pain to middle deltoid and elbow

    2. Mimics Cervical Radiculopathy

IV. Trigger Points: Back and Buttock
  1. Quadratus Lumborum Muscle (above iliac crest)

    1. Referred pain to low back

  2. Iliocostalis Muscle (lateral paraspinous muscle)

    1. Referred pain to lower quadrant of Abdomen

    2. Referred pain to buttock

  3. Gluteus Maximus Muscle

    1. Referred pain to Sacrum and inferior buttock

V. Trigger Points: Thigh, Leg and Foot
  1. Quadriceps Femoris (anterior thigh quad muscles)

    1. Rectus femoris referred to Patella and distal thigh

    2. Vastus intermedius referred to upper thigh

    3. Vastus medialis referred to medial knee

  2. Biceps Femoris (Hamstring Muscles)

    1. Referred pain to calf

  3. Gastrocnemius (superficial posterior calf)

    1. Referred pain to calf and foot instep

  4. Soleus (deep posterior calf)

    1. Referred pain to heel and to sacroiliac joint

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