Trigger points
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
Paraspinous Neck Muscles
Refer pain to occiput
Symptoms include retro-orbital Headache
Muscle Components
Splenius cervicis muscle
Semispinalis cervicis muscle
Rotatores cervicis muscles
Multifidus muscle
Upper Trapezius
Refer pain to neck and temporal forehead
Sternocleidomastoid
Associated with Otalgia and possibly Vertigo
Associated with increased Lacrimation and Coryza
Clavicle Musculature
Referred pain across forehead and behind ear
Sternal Musculature
Referred pain into occiput, cheek and periorbital
Mimics Sinusitis
Splenius Capitis (cervical paraspinous muscle)
Referred Retro-orbital or temporal-orbital pain
Symptoms include vertex Headache
Peri-auricular muscles
Referred pain to teeth and jaw
Muscle Components
Temporalis Muscle
Masseter Muscle
Medial Pterygoid Muscle
Lateral Pterygoid Muscle
III. Trigger Points: Shoulder, Thorax, and Arm
Anterior Serratus Muscle (lateral to Breast)
Referred pain to lateral chest and Scapula border
Related to decreased chest expansion
May result in perceived Dyspnea
Pectoralis Major Muscle and Pectoralis Minor Muscle
Referred pain to Breast and ulnar arm
Levator Scapulae Muscle (lateral Neck)
Referred pain to base of neck
Associated with neck stiffness
Follows cervical Whiplash injury
Associated with Mood Disorders
Infraspinatus Muscle (lower Scapula)
Referred pain to Shoulder joint and down upper arm
Mimics Cervical Radiculopathy
Supraspinatus Muscle (upper Scapula)
Referred pain to middle deltoid and elbow
Mimics Cervical Radiculopathy
IV. Trigger Points: Back and Buttock
Quadratus Lumborum Muscle (above iliac crest)
Referred pain to low back
Iliocostalis Muscle (lateral paraspinous muscle)
Referred pain to lower quadrant of Abdomen
Referred pain to buttock
Gluteus Maximus Muscle
Referred pain to Sacrum and inferior buttock
V. Trigger Points: Thigh, Leg and Foot
Quadriceps Femoris (anterior thigh quad muscles)
Rectus femoris referred to Patella and distal thigh
Vastus intermedius referred to upper thigh
Vastus medialis referred to medial knee
Biceps Femoris (Hamstring Muscles)
Referred pain to calf
Gastrocnemius (superficial posterior calf)
Referred pain to calf and foot instep
Soleus (deep posterior calf)
Referred pain to heel and to sacroiliac joint