Trigger Points–questions & answers about myofascial pain and trigger point therapy

What does the term “myofascial pain” mean?

It means pain caused by trigger points in skeletal muscles or in the fascia surrounding the muscles. The pain can be caused by one trigger point or by several, and often, multiple muscles are involved.

Trigger points exist within taut bands of muscle tissue. Trigger points can be either active or latent. When they are active, they cause pain. When they are latent, they are not causing pain, but they can become active in the future. Myofascial pain is very common, but it is not well-understood by most medical doctors. Many cases of pain that linger or remain undiagnosed by doctors involve trigger points.

What Are Trigger Points?

They can best be described as hyper-irritable nodules existing in taut bands of muscle fibers or in the fascia surrounding muscles.

What causes trigger points?

Traumatic injuries, repetitive stress or trauma, misuse of the body such as poor posture or poor movement patterns.

The pain of trigger points can be exacerbated by emotional stress, resting or sleeping with muscles in a shortened position, and by exposure to cold.

How do trigger points cause pain?

Exactly how is not completely understood. It is known that they can create pain locally, in the immediate area where they are found. Most interestingly, they can refer pain to other parts of the body. If one treats only the area of pain, the trigger point will not be eliminated. In the medical literature about myofascial pain, there are reliable maps of pain referral patterns for hundreds of common trigger points.

How do we get rid of trigger points?

A common method is to insert a needle into the trigger point. I naturally use acupuncture needles. They are very thin and relatively non-invasive. I palpate in the area of the trigger point until I find it, I trap the taut muscle band between my fingers, and then I gently insert the needle. Generally, the muscle will twitch. This is a sign that the trigger point has been deactivated. Deactivating the trigger point reduces muscle tightness and relieves the pain.

Do the needles hurt?

Traditional acupuncture rarely hurts. Trigger point needling technique is a little more aggressive, but it is really not much different from what is experienced during regular acupuncture.

I have arthritis. Is the pain I feel due to a deteriorated joint or to trigger points?

Possible both, and sometimes exclusively by trigger points. Arthritis patients commonly have structural changes in the joints such as erosion of cartilage, spurs and joint space narrowing, but these do not always cause pain. Many arthritis patients who do have pain became pain-free after their trigger points are deactivated.

How do acupuncture and trigger-point therapy work together?

Both work very well together to eliminate pain. Traditional acupuncture helps pain in the following ways:

  • It blocks pain signals so they do not reach the brain.
  • It reduces the perception of pain in the brain.
  • It stimulates the production of endorphins, the body’s natural pain killers.
  • It releases trigger points that are located within the immediate area in which pain is found. Part of the treatment strategy in most schools of acupuncture involves needling in the area of pain. Often there will be trigger points in this area, and the needling will deactivate them. But please read the paragraph below.

Trigger point therapy adds another dimension to traditional acupuncture. As mentioned earlier, many trigger points refer pain to other areas of the body, areas outside of their immediate location. If we only needle the area of pain, we will not eliminate the source of pain. A knowledge of trigger points gives us the ability to find pain-causing points that are off the map of traditional acupuncture. This knowledge is gained by studying the literature on myofascial pain and putting the knowledge into practice.

My method of treatment

When I perform acupuncture for myofascial pain, I always treat trigger points, whether they are located within the area of pain or outside of it. I also use traditional acupuncture points to reduce the perception of pain. I choose distal points on the acupuncture meridians that flow through the painful area. In Chinese medicine, pain results from a block in the flow of vital energy, called “chi” in Chinese. When we restore the normal flow of chi, pain is diminished, and distal meridian points are the best way to do this.

Trigger point therapy was developed in the western world of orthopedic medicine, originally by Janet Travell, M.D. Acupuncture was developed in the eastern world, originating in China. When I treat pain, I try to use the best of the west and the east. And why not?

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