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“The Pain from Someplace Else”

Myofascial Pain and Trigger Point Therapy

3 Hours Continuing Education

Carolyn McMakin, M.A.,D.C.

Private Practice
Portland, Oregon


  1. 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.
  2. Trigger 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).
  3. Trigger 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 trigger points.
  4. Active myofascial trigger points vary in irritability from hour to hour and from day to day.
  5. Trigger 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 factors.
  6. The 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 pain.
  7. Myofascial 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 things. Trigger 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 pain.
  8. Myofascial 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 extended period.
  9. Myofascial 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.
  10. 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 to develop.

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