Muscle pain from trigger points associated with the lumbar spine
What are trigger points?
Trigger points are foci of secondary micro tension in the muscle tissue due to chronic mechanical irritation of the motor neurons of the spinal nerves serving that muscle. They may also be present in different tissue of the musculoskeletal system. They are like little knots inside the tissue which can become spontaneously painful after a sudden or a prolonged exertion, after stretching, a movement or a poor postural position maintained too long, or simply after chilling of the muscle itself, and finally after a trauma.
The trigger points cause a pernicious decrease in motor function and muscle strength in the neuromuscular areas involved, initially unnoticed they are capable of creating a gradual stiffness and a chronic or spontaneous pain.
Their elimination or reduction is fundamental path for resolution of neuromusculoskeletal pathology regardless of their cause.
Trigger points are foci of secondary micro tension in the muscle tissue due to chronic mechanical irritation of the motor neurons of the spinal nerves serving that muscle. They may also be present in different tissue of the musculoskeletal system. They are like little knots inside the tissue which can become spontaneously painful after a sudden or a prolonged exertion, after stretching, a movement or a poor postural position maintained too long, or simply after chilling of the muscle itself, and finally after a trauma.
The trigger points cause a pernicious decrease in motor function and muscle strength in the neuromuscular areas involved, initially unnoticed they are capable of creating a gradual stiffness and a chronic or spontaneous pain.
Their elimination or reduction is fundamental path for resolution of neuromusculoskeletal pathology regardless of their cause.
If a trigger point does not resolve with local muscle treatment or if it returns after local treatment then there is a problem with its motor neuron at the level of the spine. Therefore remote treatment at the correct level of the spine must be applied simultaneously to resolve the trigger point.
Why are trigger points overlooked by mainstream medicine?
Muscles are mainstream medicine's orphans. No medical specialty specializes in them. However muscle tissue is the largest organ in the body, very complex and vulnerable to dysfunction and among the first targets for the wear and tear of everyday life, however, it is the bones and joints which are the focus of medicine's attention. Family doctors deal with other problems and are not experts on the causes and treatments for neuro musculoskeletal aches and pains. It is also a topic more complicated than it seems on the surface. The neuromusculoskeletal mechanism has simply not received the correct attention it deserves and is often misdiagnosed and poorly treated. These patients come to our clinic with a long list of diagnostic procedures, none of which has satisfactorily explained the cause or eased the pain.
Trigger points may explain much pain and discomfort.
Almost everyone has had the initial advantage of self diagnosis of trigger points, because almost everyone already knows how it feels to have a muscle knot. If you have ever felt stiff muscles, pulled on your neck trying to stretch it and free yourself from discomfort, or asked a friend to massage your shoulders, then you have already had experience with the trigger points. It is a pain and stiffness that seems to be in the muscles.
In addition to minor aches, muscle pain often causes unusual symptoms in remote places. For example, many people diagnosed with carpal tunnel syndrome are actually suffering from pain caused by trigger points in turn caused by irritation of the dural sac, spinal cord or spinal nerve roots at the cervical spine. This strange phenomenon of pain by a trigger point in a remote location to it's pain is called "referred pain". Below are listed interesting factors of "referred pain" that will lead to a misdiagnosis.
- Sciatica (pain in the buttocks and legs) can be caused by trigger points in the piriformis or other gluteal muscles associated a with piriformis syndrome in the pelvis, which is different from an irritation of the sciatic nerve (e.g. secondary to a disc pathology). Many trigger points are wrongly mistaken for "some nerve problem."
- Earaches, sinusitis, toothache, tinnitus and loss of balance may be symptoms of trigger points in the muscles around the jaw, face, head or neck.
- The pain of a trigger point often comes "out of nowhere". Trigger points are unpredictable. While pain of a lesion tends to be substantial, the pain from the trigger point usually is not, but it can be. They can spontaneously come and go depending on daily activity.
- Trigger points are much more common than neuropathic pain. Neuropathic pain is a phenomenon of irritation of the sensory portion of a nerve (neuron) for various reasons. Trigger points are common reactions to chronic irritation of the dural sac, spinal cord or spinal nerve root at the level of the spine.
- The pain of a trigger point tends to occur in response to a series of common aggravating factors: muscle fatigue, maintaining muscles in strange positions (shortened or lengthened), chills, postural fatigue (like carrying a bag on the shoulder), lifestyle choices such as doing too much physical work at once or prolonged bad posture at the computer.
- Trigger points are generally not at the point of pain. This phenomenon (referred pain) can fool even the most experienced clinician. It's not always easy to be sure of the position of the trigger point that is creating the pain.
- There is no other explainable reason to have pain. If not do to trauma or some other obvious factor, then perhaps a trigger point is the cause of pain.
- You suffered an injury in the past. An injury that happened months or years ago that has healed, but there is still pain or discomfort. Any residual pain that remains could be caused by trigger points.
- Pain but not acute. The pain is mainly chronic and annoying. Although some muscle pain can be described as "burning" or "acutely" intense, most of the time the muscle pain is chronic and periodic.
- Pain caused by too much activity. Note that a muscle can become irritated due to overuse, an obvious effort or fatigue such as mopping the floor, or from an effortless postural stress such as continuous use of the mouse while seated at the computer. If you feel any pain in situations where the muscle is under chronic load, the problem is typically a trigger point.
- The pain is caused by lack of movement. Stiffness and muscle pain caused by trigger points are often aggravated after periods of inactivity and immobility, like sleeping in bed. I call it bed trauma. If getting out of bed in the morning is difficult and after moving you begin to feel better you probably have chronic trigger points.
- Pain on muscle contraction. The trigger points can cause pain or an increase in pain when you contract the muscle in question. Trigger points may tolerate less forceful contractions without creating pain.
- Pain in other parts of the body. Trigger point problems are "regional". For example, people with chronic neck may have other painful areas in the body, perhaps the shoulders, arms, elbows or wrists. Or the lower back with the hip, knee, calf or ankle. Although muscle aches do to trigger points may be anywhere, some parts are more likely than others: neck, shoulders, upper back, lower back and hips.
- Trigger points can be consistent, but they can also be quite irregular. While the pain of a lesion tends to be quite constant, with symptoms that recur in the same spot every time the lesion is moved. The pain of a trigger point may recur chronically in the same spot, or it can spread unevenly through a larger area area.
- Weak and "numb" sensations. Trigger points can cause a weakening of the muscles affected and a type numbness that is often mistaken for a pinched nerve like a sciatica for example. The numbness is however a heavy deep feeling, not a numbness of the skin that comes in specific areas when you have cut or pinched nerves. The presence of this feeling, however, strongly indicates the presence of trigger points
- The feeling that you want to move and stretch. You want to because you feel stiff. Stretching does not resolve the trigger point, but the sensation it gives is often desirable. In contrast, it is not at all correct to stretch lesioned tissues! The nervous system warns us and pain is a warning.
- Heat helps. Hot showers and baths, or a hot water bottle are almost always soothing and pleasant.