Trigger points: Symptoms, Causes & Treatment

How to get rid of trigger points (knots)?

What are Trigger points?

Trigger points are localized spots of tenderness in the muscles in the taut band of muscles fibers. Trigger points are discrete, focal, hyperirritable spots located in a taut band of skeletal muscle. They produce pain locally and in a referred pattern and often accompany chronic musculoskeletal disorders [1].

Normal Healing cycle

The normal healing cycle is divided into three stages: inflammation stage, proliferation stage, and maturation stage.

  1. The first one is the inflammation stage. This stage is followed by redness, increased pain, increased temperature, and swelling. This stage is important as swelling protects the surrounding area from damage, disposal of pathogens is caused by increased temperature and white blood cells are indicated to start the healing cycle.
  2. The second stage is the proliferation stage, in this stage scar tissues are formed on the affected area. It is very essential for the healing cycle as the cycle cannot continue without the formation of scar tissues. This stage is followed by fascia restrictions and muscle spasms [1].
  3. The third and last one is the maturation stage, in this new skin replaces the scar tissues on the affected area and completes the healing cycle [2].

Causes of trigger points

The causes of trigger points are as follows:

  1. Trigger points often arise from sustained repetitive activities, like lifting heavy objects at work or working on a computer all day.
  2. Trigger points can also be caused by physical trauma which occurs when the force or object strikes the body, often causing a concussion, deep cuts, and broken bones.
  3. Trigger points can also be caused due to bad posture and bad body mechanics during sleeping and other activities [2].
  4. Moreover, trigger points are also caused by the inflammatory/ infectious process by which the protects the body from the pathogen [3].

Trigger points Vs Fibrosis (scar tissues)

It is said somewhere that the knots throughout the body are Trigger points but it is also said that the knots throughout the body are scar tissues. But the reality is that there is a combination of trigger points and scar tissues. Through studies and experiences, it is said that fibrosis is more predominant than trigger points [3].

Symptoms of Trigger points

Symptoms of Trigger points can be:

  1. Muscle spasm can occur which is the sudden involuntary movement in any muscle of the body.
  2. The patient can suffer the decreased joint range of motion means one will not be able to move his joints properly.
  3. There can also be a pain in joints due to trigger points.
  4. The patient can suffer from a lack of flexibility in joints or muscles due to trigger points.
  5. There can also be decreased muscle strength by trigger points [3].

Which patients have Trigger points?

Trigger points can occur to patients having joint pain, shoulder pain, neck pain, shoulder bursitis, tendonitis, and arthritis can have trigger points. It is also part of the healing cycle during a muscle spasm [4].

Current treatment for trigger points

Some current treatments are which are used to treat trigger points are:

  1. Massage is the current treatment for trigger points as it may help to loosen the knots but no evidence shows that massage therapy is much effective for trigger points for long terms.
  2. Another current treatment for trigger points is dry needling. In this, a fine needle or acupuncture needle is inserted into the skin and muscle. But it is said that dry needling is effective in reducing the pain of the lower quarter trigger points and for short terms and some findings also suggest that dry needling has no positive response on depression, quality of life, function, range of motion, or strength.
  3. One more current treatment for trigger points is Trigger point injections. Trigger point injections may treat chronic muscle pain related to myofascial trigger points. The treatment involves injecting medication directly into myofascial trigger points which will reduce the pain but it may not be an insignificant benefit.
  4. Another current treatment for trigger points is Kinesio and cross taping. Kinesio is not effective to release trigger points [4].

The best solution for a trigger point release

The best solution to release trigger points is the instruments that are designed by the therapist to treat trigger points. Because it is impossible to treat it only by hand.

Trigger points are discrete, focal, hyperirritable spots located in a taut band of skeletal muscle. Trigger points produce pain locally and in a referred pattern and often accompany chronic musculoskeletal disorders. Trigger points are treated by professional therapists and physiotherapists with special instruments designed by the therapist.

ASTR tools used to release trigger points, fascia restrictions and scar tissue which is more effective treatment to address the root cause of the problem. It is very common to have trigger points, scar tissue and fascia restrictions occurring at the same time. Effective treatment has to address all these issues at same time

Conclusion

Trigger points are discrete, focal, hyperirritable spots located in a taut band of skeletal muscle. Trigger points produce pain locally and in a referred pattern and often accompany chronic musculoskeletal disorders. Trigger points are treated by ASTR tools

References 

  1. Do TP, Heldarskard GF, Kolding LT, Hvedstrup J, Schytz HW. Myofascial trigger points in migraine and tension-type headache. The journal of headache and pain. 2018 Dec;19(1):1-7. https://pubmed.ncbi.nlm.nih.gov/30203398/
  2. Money S. Pathophysiology of trigger points in myofascial pain syndrome. Journal of pain & palliative care pharmacotherapy. 2017 Apr 3;31(2):158-9. https://pubmed.ncbi.nlm.nih.gov/28379050/
  3. Moraska AF, Schmiege SJ, Mann JD, Burtyn N, Krutsch JP. Responsiveness of myofascial trigger points to single and multiple trigger point release massages–a randomized, placebo controlled trial. American journal of physical medicine & rehabilitation. 2017 Sep;96(9):639. https://pubmed.ncbi.nlm.nih.gov/28248690/
  4. Shah JP, Thaker N, Heimur J, Aredo JV, Sikdar S, Gerber L. Myofascial trigger points then and now: a historical and scientific perspective. PM&R. 2015 Jul 1;7(7):746-61. https://pubmed.ncbi.nlm.nih.gov/25724849/
  5. Barbero M, Schneebeli A, Koetsier E, Maino P. Myofascial pain syndrome and trigger points: evaluation and treatment in patients with musculoskeletal pain. Current opinion in supportive and palliative care. 2019 Sep 1;13(3):270-6. https://pubmed.ncbi.nlm.nih.gov/31313700/