Trigger Points

What are trigger points?
  • Trigger points are lumpy spots in your muscle that are tender and irritable
  • Pressing on a trigger point can cause pain over an area or somewhere else
  • Symptoms tend to be consistent i.e. pressing on the same trigger point should lead to the same site and type of pain
What is myofascial pain syndrome?
  • This happens when someone has 2 or more trigger points in the muscle and the covering over the muscle, known as the ‘fascia’
What is the cause of trigger points?
  • Nerve impingement
    • A herniated disc or bony spur presses on the nerve, leading to trigger points in the area controlled by that nerve
  • Prolonged pain
    • Pain in a certain area that is not treated causes changes in the nerves that carry the signal to the brain, leading to extreme sensitivity over the area
  • Muscle overuse
    • The frequency of the muscle usage and small tears results in insufficient time for the muscle to heal up
    • There is inflammation and less oxygen and nutrients; the muscle fibres shorten and need even more nutrients, leading to a vicious cycle
    • There are ‘polymodal’ nerve receptors inside the muscle that can turn them into trigger points
  • Poor physical fitness
  • Ageing
    • Middle aged people between 30-60 are more likely to get it
  • Poor posture
  • Stress and mental illness like anxiety, depression, PTSD
  • Lack of vitamins and iron
  • Poor sleep
  • Trauma and accidents
How do we treat trigger points?
  • Medications
    • Paracetmaol and NSAIDs and COX 2 inhibitors
    • Muscle relaxants
    • Weak opioids like tramadol for a short time
    • Strong opioids are not recommended
  • Physiotherapy
    • Cold packs to reduce inflammation
    • Hot packs to increase blood flow and circulation
    • Stretching and strengthening
    • Posture training and changes in office ergonomics
    • Massage
  • Laser light therapy
  • TENS machine
  • Acupuncture
  • Pain procedures
What pain procedures are available for treatment of trigger points?
  • Trigger point injections with:
    • Dry needling
    • Steroid
    • Concentrated Glucose
    • Local anaesthetic
    • Biologics like PRP (under research)
  • Ultrasound guided nerve blocks to target the underlying nerve responsible
  • Radiofrequency procedure to target the joint that is in pain that is causing the trigger point
  • Nucleoplasty to treat the disc herniation and relieve pressure on the irritated nerve

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