What are trigger points
When certain areas of the muscle are overloaded, blood supply and metabolism are disrupted, and the fibers remain in a state of constant contraction. A tight cord is formed with a painful nodule - a trigger point. The active point hurts on its own and causes reflected pain according to a pattern characteristic of each muscle: for example, from the trapezius muscle pain goes to the temple and back of the head. Latent points hurt only when pressed, but they limit mobility and can be activated under load. At the same time, neighboring muscles are often involved in the process.
- Active trigger points - spontaneous and referred pain
- Latent - pain only when pressed
- Primary syndrome - when the muscle itself is overloaded
- Secondary - against the background of diseases of the joints, spine, internal organs
- Typical muscles: trapezius, levator scapulae, piriformis, quadratus lumborum
Causes and risk factors
The main reason is repeated or prolonged muscle overload. Working at a computer with your shoulders raised, carrying a bag on one shoulder, and an uncomfortable sleeping position keep the same muscles under tension. Acute overload occurs during sudden movement or unusual training. Muscle spasms increase with emotional stress and anxiety. Poor posture, scoliosis, different leg lengths, and flat feet are important. Lack of sleep, hypothermia, vitamin D and iron deficiency, and hypothyroidism can maintain pain and contribute to its chronicity.
- Static posture and sedentary work
- Sudden movements and unusual loads
- Stress, anxiety, lack of sleep
- Poor posture, scoliosis, different leg lengths
- Inactivity and detraining of muscles
- Muscle and ligament injuries
Symptoms
The pain is usually dull, aching, deep, and difficult to precisely localize. It intensifies with stress on the affected muscle, in the cold and after a long stay in one position. Referred pain can imitate other diseases: from the neck muscles - headache and dizziness, from the muscles of the lower back and buttocks - pain in the leg, similar to sciatica. Unlike radicular pain, with myofascial syndrome there is no numbness along the nerve, decreased reflexes and muscle strength. Movement in the affected area is limited due to pain.
- Aching pain in the muscles of the neck, shoulders, back, buttocks
- Painful lumps when palpating the muscles
- Referred pain to the head, arm, leg
- Restricted mobility and stiffness
- Rapid muscle fatigue
- Increased pain with stress and cold
Diagnostics
The diagnosis is made clinically: the neurologist probes the muscles, finds tense cords and trigger points, and reproduces the pain familiar to the patient when applying pressure. During the examination, the doctor also evaluates posture, leg length and joint mobility. There are no special tests or images confirming myofascial syndrome. Additional studies are needed to exclude other causes: for numbness and weakness, MRI of the spine and ENMG are prescribed; for widespread muscle pain, blood tests for inflammation, creatine kinase, and thyroid hormones are prescribed. It is also important to identify factors that maintain muscle tension.
- Palpation of muscles and search for trigger points
- Assessment of posture, leg length, joint mobility
- MRI of the spine for signs of radicular syndrome
- Electroneuromyography
- Tests: ESR, C-reactive protein, creatine kinase, TSH
- Vitamin D and ferritin - according to indications
Treatment and prevention
The goal of treatment is to relax the muscle, inactivate trigger points and eliminate the causes of overload. Stretching and strengthening exercises, post-isometric relaxation, massage, and ischemic compression of trigger points are effective. Physical therapy, shock wave therapy, dry needling, and local anesthetic injections into trigger points are used. To relieve pain, your doctor may prescribe nonsteroidal anti-inflammatory drugs or muscle relaxants for a short course. Treatment is selected individually, combining several methods. Without changing habits and workplace ergonomics, the pain often returns.
- Regular stretching and therapeutic exercises
- Work breaks and posture changes
- Correct height of desk, chair and monitor
- Massage and manual techniques
- Dry heat on affected muscles
- Stress management and adequate sleep
- Posture correction, orthopedic insoles for different leg lengths