“The Pain from Someplace Else”
Myofascial Pain and Trigger Point
3 Hours Continuing Education
Carolyn McMakin, M.A.,D.C.
- Trigger points cause
referred Pain: Myofascial pain is referred from trigger points in specific
patterns characteristic of each muscle. The pain is rarely located
at the TP responsible for it! The pain is usually described as dull
and achy, sometimes as deep, and varies in intensity from minor, to severe,
to incapacitating. It may occur at rest, with motion, or with stretching.
It can usually be elicited with compression of the trigger point. Referred
pain does not follow segmental, sclerotomal, myotomal, or dermotomal patterns,
or the known patterns for referral from visceral structures.
The severity and extent of the referred pain depends on the irritability
of the trigger point, not on the size of the muscle. Small obscure
muscles can be more trouble than the large familiar muscles - in part,
because no one thinks to check them.
points are activated directly by acute overload, overwork, fatigue, direct
trauma, and chilling. Patients can often trace the onset of their
pain to a single trauma, specific event, or movement, which often had occurred
months or years before. Then can also be caused by excessive repetitive
or sustained contractions (overuse, overload fatigue).
points are activated indirectly by other trigger points, visceral disease,
and arthritic joints. Secondary trigger points can develop in
the referred pain areas from visceral complaints such as ulcers, renal
colic, myocardial infarction, gall stones, etc. They can also develop
in adjacent, antagonistic, or synergistic muscles, overloaded by the strain
of compensation for the shortened, weakened muscle containing the primary
- Active myofascial
trigger points vary in irritability from hour to hour and from day to day.
point irritability may be increased from a latent to an active level by
many factors. The amount of stress needed depends on the degree
of conditioning of the muscle and the number and severity of perpetuating
signs and symptoms of myofascial trigger point activity long outlast the
precipitating event. Active TP’s cause the muscle to develop
habits of guarding that limit movement. Chronic muscular pain, stiffness,
and dysfunction result. With rest and the absence of perpetuating
factors TP’s can revert from an active to a latent state. The pain
disappears but the patient can experience recurrences when activities reactivate
the TP. There is usually a pattern of recurrent episodes of the same
trigger points often cause phenomenon other than pain. Autonomic
concomitants in the pain reference zone include localized vasoconstriction,
sweating, lacrimation, coryza, salivation, and pilomotor activity. Proprioceptive
disturbances caused by trigger points include imbalance, dizziness,
tinnitus, and distorted perception of the weight of objects lifted in the
hands. Muscle strength becomes unreliable and patients tend to drop
points in the soleus can cause depressed ankle jerk.
Knee buckling caused by inhibition of the quadriceps can be due to
TP’s in the vastus medialis. These symptoms can occur instead of
pain, or in addition to pain. Trigger
points can cause dysfunction in muscles at a distance. Inactivation
of trigger points in the lower extremity can result in a 30 - 40% increase
in intercisal (mouth) opening when the restriction in jaw motion is caused
by trigger points in the muscles of mastication. Treatment of trigger points
in the muscles of mastication can relieve or reduce cervical or lumbar
trigger points cause stiffness and weakness of the involved muscle.
Myofascial stiffness of the muscle is most marked after a period of inactivity
especially after a night’s sleep or after sitting in one position for an
trigger points are always bilateral, even when only one side is symptomatic.
The worst trigger points on the symptomatic side will always be present
on the opposite side as latent trigger points. If they are not treated
they can recreate the trigger points on the symptomatic side.
- B-6 deficiency
is a predictor of development of myofascial pain. After trauma
if patient is deficient in B-6, magnesium, or Vitamin C, MFTP more likely