Most likely, many painful areas of muscle tightness were found in themselves or their loved ones on the body. Most consider them salt deposition; in official medicine they are known as trigger points. These areas of local compaction and increased sensitivity in muscle tissue cause pain in various parts of the body, often located at a considerable distance from them.
Theory of J. Travel and D. Simmons
Such a concept as a trigger point was introduced by American doctors J. Travel and D. Simons back in the seventies of the last century. Thanks to their studies, certain points were described, affecting which you can relieve pain in parts of the body that are quite distant from them. For example, the targeted impact on a painful point that is located in the neck or shoulder blade, allows you to relieve headache or pain in the elbow joint or hand. Also, acting on the trigger zones (this is another name for these points), you can affect the condition of the musculoskeletal system and internal organs.
What is a trigger point
According to the definition of Trevel and Simons, these points are hyper-excitable sites with local muscle tension. They are located in the skeletal muscles and fascia associated with them. Trigger points appear as small, painful palpations of the seal. They can form in all soft tissues of the body, but are usually localized in large skeletal muscles that perform static functions. So, most often you can find trigger points in the muscles of the shoulder girdle and neck (muscle that raises the shoulder blade, trapezius, scalene, rotators of the neck), chewing muscles, as well as in the muscles of the pelvis and lower extremities. In addition, such points are a source of reflected pain. For example, a trigger point in the upper part of the trapezius muscle can provoke pain in the behind-the-ear area, jaw and temple. Also, the danger of these formations is that even if at the moment they do not cause severe pain, then over time the dysfunction of the muscle where they are located will inevitably progress.
Causes of occurrence
Despite the studies, today there is no definite answer to what factors are the direct causes of trigger points. As a rule, myofascial trigger points are formed in muscles that experience strain or prolonged and constant stress. Most often this is due to the position of the body in space - raised shoulders, a hunched back and a lowered, overly tense chest, a strong deflection in the lower back. This inevitably causes pronounced mechanical stress in both individual muscles and muscle groups, which leads to their spasm and, as a result, to circulatory disturbance. Also, the trigger point can form due to lesions of the spine (with blockade of the motor segment) or with pathology of the internal organ, when the muscles surrounding it reflexively strain. Another reason for the occurrence of such points may be acute or repeated muscle microtrauma.
However, as research data indicates, all these factors lead to the formation of latent trigger points. In order for them to enter the active phase, and a clinically defined myofascial syndrome appears, a trigger factor is needed. Often in this role there is hypothermia, work in an uncomfortable position, a psychoemotional factor.
Risk group
The risk group for trigger points and myoskeletal pain can be attributed to people who, by the nature of their work, are forced to maintain a static, often uncomfortable posture, for a long time. These include vehicle drivers, office workers, hairdressers, surgeons, etc. Also, persons with impaired motor function and any impaired gait and posture have a high risk of formation of trigger points. This is due to chronic overstrain of various muscle groups.
Types of trigger points
There are two types of them. The most common latent trigger points - spasmodic areas of the muscles that are found only on palpation. A large number of latent points can be found in older people. The trigger point may also be active. It is characterized by acute pain, aggravated by stretching of the spasmodic area. Such manifestations are less common. As a rule, they can be observed in middle-aged people (in women they occur 2.5 times more often than in men). Under the influence of provoking factors, latent points can go into the active phase, but adequate therapy can return the active point to a latent state. Both active and latent trigger points can become a source of limitation of movements, spasm, weakness and deformation of the affected muscle groups.
Disease phases
To date, it is customary to distinguish three stages of the development of the disease.
- The acute phase. It is characterized by constant severe pain in areas where active trigger points are located and in the area of reflected pain.
- Subacute phase. At this stage, pain occurs during movement and physical activity, but is absent at rest.
- Chronic phase. During the examination, only latent points are detected, while there is slight discomfort and dysfunction in the area of the detected seals.
Symptoms
Symptoms with myofascial starting points can be very diverse, and not limited to pain. Muscular dysfunction can be manifested by stiffness, muscle weakness, swelling, dizziness, impaired gait, posture. Actually, the trigger point is defined as a painful compaction, a cord ranging in size from a few millimeters to a centimeter. Pressure on it provokes a sharp pain, which has the greatest intensity in the place of maximum resistance during palpation (the hardest part).
An active trigger point is not only painful, but can also cause reflected (radiating) pain in areas quite distant from it, forming a pain pattern - a characteristic pattern of pain localization. Thanks to many years of research, chart maps have been compiled, thanks to which you can determine the true source of reflected pain.
Reflected pains caused by trigger points are most often felt as constant, deep, bruising and dull, but in some cases they can also be very intense, burning, stitching. Due to the fact that the spasmodic part of the muscle can squeeze the nerve ending passing through it, the reflected pain can be accompanied by a decrease in sensitivity and numbness. The intensity of pain can also vary from minor to intense, while it can be observed both at rest and during physical exertion. It should be noted that the prevalence and intensity of pain depends on the degree of irritation of the trigger point, and not on the size of the muscle where it is located. Some trigger points can also cause phenomena such as inflammation of the mucous membranes, lacrimation, visual disturbances, perception of space, vestibular disorders.
Examination and Diagnostics
For the effective treatment of this pathology, it is important to correctly identify the cause of pain in the patient and determine the exact location of the trigger point. To do this, the doctor must not only identify the area where the pain syndrome manifests itself, but also compare it with the characteristic areas of the reflected pain. To do this, most often use cards that are in almost all books devoted to this topic.
During a palpation examination, the specialist determines the total elasticity of the muscles in comparison with the area where the presence of a trigger point is suspected. In this case, the fingers first pass across the muscle fiber, noting the deformation, spasmodic areas and muscle cords. When the seal is found, by dragging a finger along it, find the area of maximum seal, pressing on which causes maximum pain. The fact that this will be the trigger point will be indicated by the following signs:
- pressure on the point causes reflected pain, while it may not occur immediately, but within ten seconds;
- directly when pressing on a point, you can observe a “convulsive response” - the muscle twitches at hand and often it is noticeable even visually;
- another sign of the trigger point is the so-called jump of the patient, in which the patient tries to pull away sharply or cry out in response to pressing;
- with increasing pressure on the point, all areas of the pain pattern are perceived by the patient as a whole.
Trigger Points - Treatment
Today, medicine uses several methods for treating trigger points, while drugs are not at all leading in them. It is proved that NSAIDs and analgesics can only partially relieve pain, and muscle relaxants have the same effect due to the partial elimination of spasm.
The most effective and cardinal method of treating trigger points is blockade. Their implementation is possible only when determining the exact location of the pathology. To carry out the blockade, a needle pierces the seal area with the subsequent introduction of an anesthetic.
Massage and exercise therapy
Despite the fact that blockade gives an almost instant effect, the most common methods of treating this pathology are exercise therapy, manual techniques and massage of trigger points. And if the patient can perform the complex of therapeutic exercises after consultation with the doctor on his own, then the massage should be carried out only by a qualified specialist.
If we talk about massage, then the most effective help with trigger points can be provided using phased compression. To do this, the massage therapist, finding a point, begins to gently press on it, continuing it until the patient has mild soreness in the reflected area, which corresponds to 2 on a ten-point scale. This press is stored for 10-15 seconds. During this time, the pain should significantly decrease or completely disappear. After that, the pressure is reinforced again, and after the appearance of discomfort, it is again held for 15 seconds. These actions continue until the characteristic pain disappears. Usually, 3 click amplifications are enough for this. After this inactivation of the trigger point, a warm moist compress is applied for 5 minutes, after which passive muscle tension is performed.
Despite the apparent simplicity of the procedure, do not self-medicate. All examinations and medical manipulations should be carried out by a qualified specialist, otherwise the risk is very high that the situation will not only not be corrected, but also worsen significantly.