Trigger points are small, tender knots that can form in muscles or fascia (covering of the muscles). The myofascial pain syndrome is common painful muscle disorder caused by myofascial trigger points. The pain generated from these small knots is felt locally and in a referred pattern. They usually are associated with a chronic musculoskeletal disorder. The common theory of trigger points formation is either acute trauma (sports injuries) or repetitive micro-trauma which causes stress on muscle fibers and fascia and leads to the formation of trigger points. Micro-trauma could be caused by poor posture habits, lack of exercises, sleep problems and joint problems. For example, holding the phone between the ear and shoulder to free arms, or improper body mechanics during sitting or lifting, carrying activities can induce stress and microtrauma in muscle.
The common locations of trigger points are the neck, shoulders, upper trapezius (upper back and shoulder blade area), and pelvis. The pain produced in muscles also affects the joints and my cause reduced range of motion. They can cause a tension headache or neck spasms if the neck and head regions are affected.
The diagnosis is made by clinical exam. It can reveal a hard, tender, hypersensitive nodule and upon palpation, symptoms can be reproduced. Trigger points can be differentiated from tender points on the exam because palpation produces pain locally as well as referred pain which is felt in a remote area from the trigger point. While tender points palpation elicits the local pain which is felt at the site of palpation only.
Treatment starts with eliminating the predisposing factors like poor body postures and mechanics. Medication like muscle relaxants for pain can be used. The treatment options are manipulative therapy, ultrasound, spray and stretch technique, dry needling, physical therapy to improve body mechanics and injection.
Trigger point injections can be done right in the office. The mixture of lidocaine (numbing medication) and corticosteroid (cortisone) is injected directly into the tight nodule. Trigger point injections are one of the most effective ways to treat trigger points and provide symptomatic relief.
