The term trigger point refers to a tight band of skeletal muscle within a larger group of muscles. Typically, you can feel the trigger point as a knot under the skin. This knot can be extremely tender and irritable, especially when the spot is compressed or the surrounding muscle group contracts. Pressure on a trigger point usually results in intense pain that can cause you to wince or even cry out in a response which seems out of proportion to the trigger.
This response is known as the jump sign. Often, the jump sign makes you move other parts of your body in an involuntary way. You may also experience trigger point pressure through referred pain, which is pain perceived at a location other than where the stimulus is. If you believe you have a trigger point, you should discuss this with a physician; there are treatment options available.
Why People Develop Trigger Points in Their Muscles
Trigger points tend to form in the center of a muscle belly and can happen in any of the skeletal muscles in the body. Everyone has trigger points, even babies and children, but they do not always cause pain. In general, trigger points become more numerous and painful as we get older. Trigger points can also be related to stress on a muscle, especially from falls.
These points tend to be related to lack of exercise and bad posture. However, the points can also result from muscle overuse and repetitive microtrauma, such as that caused by weightlifting. Research has also connected painful trigger points to a variety of chronic stress conditions, including depression, generalized anxiety, and post-traumatic stress disorder, as well as deficiencies in iron, folic acid, and vitamins C, D, and B. Physicians become concerned about trigger points when patients complain of chronic pain syndromes, including tinnitus, morning stiffness, diffuse body aches, and headaches. Because of referred pain, these syndromes often relate to trigger points that are physically distant from the site of pain; treatment includes identifying and addressing the trigger points. Patients with inflamed trigger points may also report changes in their range of motion, as well as muscle weakness. Movement often makes the pain worse. Abnormalities in posture can also make physicians think about potential trigger point issues.
The Physical Exam Signs that Point to a Trigger Point
When physicians examine a patient who potentially has a trigger point, they will palpate or feel the area affected. While pressing into your skin, physicians look for small or large nodules directly in the muscle tissue. Often, these lumps are accompanied by a temperature change in skin. Depending on the trigger, the affected area may be warmer or cooler than the surrounding areas. This palpation helps physicians identify the exact location of a trigger point and determine if more than one are implicated in the symptoms felt by the patient.
In general, pain will be reproducible by pushing on a trigger point. This pain should feel muscular in origin. Importantly, this pain can be referred locally or at a significant distance. If the referred pain is consistent with palpation of the trigger point, that helps solidify the diagnosis.
The pain that gets referred should be located somewhere that makes sense given the projection of the muscle in question and typical patterns noted by clinicians. Physicians will also feel for muscle stiffness and hardening of the spot in a way that feels like a taut band. Stimulation of the trigger point should result in a twitch response and jump sign as described above. Finally, physicians will look at the range of motion of the included muscles and examine your overall posture.
Medical Management of Trigger Points in Your Muscles
Once trigger points have been identified as a problem, physicians have several options to treat them. The most conservative approach to management involves physical therapy. Physicians will help you identify the factors in your everyday life that lead to trigger points so that you can make some key changes, such as improving posture. Other recommendations may include stretching and massage. The type of massage that helps with trigger points involves a deep, rhythmic stroke in only one direction. Physicians may also recommend strength training or applying steady pressure to the trigger point.
In addition to these techniques, medications like Tylenol, nonsteroidal anti-inflammatory drugs (NSAIDs), and muscle relaxants can be used. In rare instances, narcotic pain relievers may be prescribed on a short-term basis. More commonly, physicians will suggest trigger point injections.
This method of treatment involves using a small needle to inject a local anesthetic or a corticosteroid directly into the trigger point. These injections help disable the trigger point and ameliorate the pain. Typically, the injections result in lasting relief. Each treatment takes only a few minutes, and several different sites can be injected during the same visit. For many patients, a trigger point injection is the best option when more conservative options do not work.