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Myofascial Trigger Points and Their Effects on the Muscles

Written on November 20th, 2024 for my anatomy class. Since I'm starting a blog with my writings, I thought I'd give you all a taste of what to expect in terms of my writing style. Enjoy!

Introduction

In the early 1970s at the age of 11, Erika began experiencing intense pain in her neck and shoulders that became so severe that it rendered her bed bound. Her mother took her to all the top doctors in New York City. Everything from her spine alignment to a variety of other tests showed that everything was completely normal. Her doctors had diagnosed it as “too much stress” being the cause of her pain. She was given several prescriptions that ranged from anti-inflammatories to muscle relaxants that would not work and gave her awful side effects with no diagnosis or treatment plan to help her move forward. Even physical therapy, acupuncture and chiropractic treatments still had no effect on her pain.

One sleepless night, her insomniac grandmother discovered a book that would grant Erika a lot more insight and answers. Myotherapy: Pain Erasure by Bonnie Prudden gave Erika something to relate to and led her to make an appointment with a professional trigger therapist. Fortunately, this is exactly what Erika needed. At the age of twenty in 1983, she had no pain after suffering for nine years. This journey inspired her to become a trigger point therapist herself and for the past thirty-two years, she has dedicated herself to assisting people with myofascial trigger pain (“Erika” n.d). 

This paper will explore what myofascial trigger points are, how they happen, its effects on the muscles, are diagnosed, and can be treated.

What are Myofascial Trigger Points?

Myofascial trigger points are defined as hyperirritable spots, usually within a taut band of skeletal muscle or in the muscle fascia that is painful on compression and causes motor dysfunction, issues with the autonomic nervous system, and characteristic referred pain. This means that if there is pressure placed on the trigger point, pain can be felt in other parts of the body that vary in location, sensation, and intensity. They are formed directly in the muscle fiber (Lavelle et al., 2007). While the development of myofascial trigger points is still unknown, a hypothesis known as “the energy crisis hypothesis” is the most accepted idea of how these trigger points form. The energy crisis hypothesis consists of muscle overuse that results in reduced blood flow to the area. The muscles are unable to relax properly. The strain on this muscle is what forms the myofascial trigger points (Minerb & Vulfsons, 2018).  Three different types of trigger points exist. There are active trigger points, latent trigger points and satellite trigger points. Active trigger points elicit pain and can be actively painful. Latent trigger points have the same characteristics as active trigger points but are dormant and cause no pain until pressure is applied. A lot of people do not realize they have latent trigger points until the area is examined.  Satellite trigger points are located in areas of muscle tension that originate from the primary trigger point. For example, if there is a trigger point in the rhomboids major, and there is referred pain in the top of the shoulder blade, pressure is applied on the top of the shoulder blade that results in pain in another part of the body. This means there is also a trigger point in that area, causing a satellite trigger point. (Salvo, 2023)

Areas, Symptoms, and Treatment

While Myofascial Trigger points can be found anywhere in the body where there is a muscle, it is most commonly found in the trapezius, levator scapula, rhomboids, deltoids, glutes, quadratus lumborum, and erector spinae. Symptoms commonly include grimacing, wincing or a vocalized response that seems to be an overreaction in proportion to the pressure being applied. Jumping back, tensing up, or jerking away is also an indicator (Salvo, 2023). Low back pain, decreased range of motion, tension headache, and tinnitus are also possible indicators of myofascial trigger points (Alvarez & Rockwell, 2002).

There are several criteria to look for when diagnosing myofascial trigger points. The main indicators are a tight area of the muscle, a hypersensitive spot, and referred pain. According to Cesar Fernandez-de-las-Penas and Jan Dommerholt (2017), the reliability of the diagnosis when physically examined by a clinician includes the experience of the clinician, and the muscles that are being examined. However, it is constantly questioned whether referred pain is reliable as criteria in diagnosis. In the study mentioned above, it notes that deeper muscles such as the quadratus lumborum have a poorer reliability in diagnosing than superficial muscles such as the trapezius when it comes to physical examination. The questioning behind this comes from the fact that the spinal cord and nerves are what spread the sensation of pain throughout the body, and the study also states that most experts report that they are not seeing a predefined pattern of the referred pain for a specific muscle. Currently, there are no laboratory tests or imaging techniques that can help diagnose trigger points. But the use of muscle biopsy and ultrasonography is currently being explored (Alvarez & Rockwell, 2002). Patients can consider multiple options when looking at how to treat myofascial trigger points. Drug therapy using medicine such as anti-inflammatory drugs, antidepressants, central muscle relaxants or opioids are commonly used when choosing this treatment. It’s recommended for doctors to prescribe the lowest dose possible for the shortest course treatment to reduce drug related adverse effects and to ensure safe and responsible drug use. Patients who experience pain caused by myofascial trigger points often experience anxiety and depression along with their pain. Doctors prescribe antidepressants to help alleviate their psychological problems that the pain contributes to. Needle punching methods such as acupuncture and moxibustion are options as well. Physical rehabilitation therapy such as extracorporeal shock wave therapy and stretching are also available to patients experiencing myofascial trigger points. Extracorporeal shock wave therapy uses focused shockwaves to locate the trigger point to treat it directly (Cao et al., 2021).

Risk Factors

Several risk factors include microtrauma defined as prolonged poor posture, sleep disturbances, joint issues, and lack of exercise. Activities that contribute to repetitive stress on a certain muscle or muscle group often cause chronic stress in the muscle fibers and lead to the development of trigger points. Some examples include holding a phone between the ear and shoulder to free up the arms, sitting in chairs with weak back support, and improper body mechanics. Sports injuries such as golf shoulder or tennis elbow can also result in trigger points (Alvarez & Rockwell, 2002).

Conclusion 

The pain and adverse effects of myofascial trigger points paint a clear picture as to why it’s important to lead a healthy and balanced lifestyle. This includes plenty of exercise, reducing repetitive stress to the muscles, maintaining correct posture, and a healthy sleep schedule. These lifestyle changes among others can help patients in managing these trigger points. If trigger points still develop despite the precautions taken, there is direct treatment available.

References

Erika (no date) Erika, Myofascial Pain Treatment Center, LLC

Demers Lavelle, E., Lavelle, W., Smith, H. S., Department of Anesthesiology (2007). Myofascial trigger points. In Anesthesiology Clin (pp. 841–851).  

Minerbi, A., & Vulfsons, S. (2018). Challenging the Cinderella Hypothesis: A New Model for the Role of the Motor Unit Recruitment Pattern in the Pathogenesis of Myofascial Pain Syndrome in Postural Muscles. Rambam Maimonides Medical Journal, 9(3), e0021. https://doi.org/10.5041/rmmj.10336

Alvarez, D. J., & Rockwell, P. G. (2002, February 15). Trigger Points: Diagnosis and Management. AAFP. https://www.aafp.org/pubs/afp/issues/2002/0215/p653.html

Cao, Q., Peng, B., Wang, L., Huang, Y., Jia, D., Jiang, H., Lv, Y., Liu, X., Liu, R., Li, Y., Song, T., Shen, W., Yu, L., Zheng, Y., Liu, Y., & Huang, D. (2021). Expert consensus on the diagnosis and treatment of myofascial pain syndrome. World Journal of Clinical Cases, 9(9), 2077–2089. https://doi.org/10.12998/wjcc.v9.i9.2077

Fernández-de-las-Peñas, C., & Dommerholt, J. (2017a). International consensus on diagnostic criteria and clinical considerations of myofascial trigger points: A delphi study. Pain Medicine, 19(1), 142–150. https://doi.org/10.1093/pm/pnx207