Trigger points, muscle pain: what are trigger points? How to remove them?

We considerback and musclepain to be the civilisation disease of our time.
They force more than 75% of the world's population to go to GP surgeries. This means that more than one in two people reading this article suffer from them.

You are interested in:
What is a trigger point?
What are its symptoms?
How to remove trigger points, will massage help?
What therapy (treatment) is effective?

They represent a very diverse group of diseases, which include minor functional blockages to conditions requiring urgent surgery.
These diseases cause their owner at least pain, sometimes of severe intensity.

What is muscle spasm?

Muscle pain is often a symptom of vertebrogenic or other diseases. It is caused by muscle spasms.

A muscle spasm (cramp, crampus) is a reflex action that is a normal response to overloading a specific part. It is a sudden contraction of one or more muscles.

This increased muscle tone occurs at rest (e.g., during sleep, rest and inactivity) or even in the period just after the cessation of muscle activity during muscular activity, mainly during movements with muscle shortening.

It affects various striated muscles in the body, from the smallest (small muscles of the fingers) to the largest (large muscles of the back, large gluteal muscle). It cannot be controlled by its own will.

Table with the distribution of muscle spasms:

Trigger points

In muscle spasms, or tight muscle groups, a group of muscle fibers that form small points of muscle pain are shortened.

These pain points are also called trigger points. They get their name because of their ability to transmit pain to more distant sites.

Why do muscle spasms occur?

Muscle spasms can also be more technically defined as an extreme form of involuntary muscle contraction. They usually last for a few seconds, minutes at most. If they last longer, they can cause the patient to be unable to function normally.

Primary muscle spasms

Primary muscle spasms (idiopathic, benign spasms) occur in completely healthy individuals or in individuals in whom no other medical cause of the condition has been identified. Up to 75% of people will experience them during their lifetime.

They occur sporadically, have a low frequency and a short duration. Their occurrence is linked to a specific period of time.

They are more often seen in at-risk individuals. Risk factors include age over 50, pregnancy, varicose veins, the influence of alcohol, flat feet, excessive physical exertion, fatigue, dehydration and others.

• Resting muscle cramps - 70% occur during sleep (nocturnal muscle cramps), 10% occur during the day. The remaining 20% are a combined occurrence. Most commonly affecting the calf muscles. They cause significant discomfort associated with sleep disturbances.
• Muscle cramps occurring during or immediately after muscle activity - Preceded by physical activity (sport, work). Muscle cramps affecting professional athletes are well known, but are also common in workers in hot workplaces. The cause is probably depletion of energy substrates in the muscle. Other factors such as improper muscle movement, temperature factors or intermittent physical activity are also involved.

Secondary muscle cramps

Secondary muscle cramps arise secondarily as a consequence of another disease. Often this is the first manifestation.

• Muscle cramps as a manifestation of common diseases - They occur in diseases such as diabetes mellitus, liver disease, chronic renal insufficiency, dialysis patients, hypothyroidism, metabolic disorders.
• Muscle spasms as a manifestation of peripheral motoneuron damage - They occur in some diseases as a result of ectopic discharges from peripheral nerve endings. These include compressive vertebrogenic root syndromes, polyneuropathies, ALS, spinal amyotrophy.
• Muscle spasms as a manifestation of muscle disease - They are relatively rare. They include metabolic myopathies, dystrophinopathies, neuromyotonia, and others.
• Muscle cramps as a manifestation of toxicity of certain substances - This category includes primarily alcohol. Also, substances called statins and fibrates should be mentioned. These are used as a remedy for elevated cholesterol. With long-term use, hypothyroidism and statin myopathy develop, which is manifested preferentially by muscle cramps.

Interesting:
Some evidence suggests that the trigger node may not only be caused by overloading the muscle.
It is also a manifestation or consequence of the accumulation of toxic substances in the human body.
It is literally a kind of dumping ground for waste metabolites.

Mechanism of trigger points

Trigger points occur at the site of the tightened muscle groups. The tightened muscle groups shorten, and an imaginary painful knot is formed at the site of the short circuit.

In reality, it is not a real knot, but only a pain point of the tightly contracted muscle. One could say that it is a microscopic spasm, which, unlike spasm, does not affect the whole muscle, but only a small part of it.

Small point, big pain

Trigger points are so small that it's incredible how much muscle pain they can cause. And not just at the site of the pulled muscle!

Trigger points are a common cause of muscle pain in the location where they are located, but they also cause referred pain in another part of the body. In this way, they can mimic the pain of another part of the body, with the primary cause of the pain being somewhere else entirely.

They are confusing even for the experienced practitioner because the patient experiences pain in a completely different location. This results in misdiagnosis and long-lasting pain that tends to escalate.

Trigger points may be the reason:

• headaches, migraines
• neck and neck tendon pain
• back pain
• chest pain
• joint pain
• lumbar pain
• muscle pain in the limbs
• complicate post-traumatic pain

Interesting:
Many mysterious and unexplained physical pains in different parts of the body have their origin in trigger points.
This is proven by the clinical experience of physicians and physiotherapists.

What indicates that it is a trigger point?

The basic and common manifestation for trigger points is an otherwise unexplained and usually intense pain in a muscle or an entire muscle group. Most often this is back or head and neck pain.

There are palpable lumps (nodules) of a few millimetres to a centimetre in size in any skeletal muscle, but most often at the point of greatest pain intensity, which increases when the point is pressed.

Another accompanying phenomenon of trigger points is somatic dysfunction of the affected or more distant part. This means that, for example, back pain with a peak around the right shoulder blade may cause impairment of the function of the right upper limb in terms of pain, impaired mobility or tingling.

There is often psychological distress from prolonged pain that restricts the patient in their daily life. It is understandable that people suffering from daily pain are hypersensitive, anxious, depressed, irritable, even angry.

Other accompanying symptoms are excessive fatigue, muscle weakness and stiffness, exhaustion, a feeling of tension or tightness, balance disturbances, tinnitus.

Risk factors for trigger points

Classification of trigger points:

1. Primary and secondary muscle trigger points (formed in muscles)
2. active and latent trigger points (formed in muscles)
3. diffuse trigger points (formed in muscles and tendons)
4. attachment trigger points (formed at tendon junctions)
5. ligamentous trigger points (form in tendons)

How to release a trigger point?

It is very important to relieve the patient of the trigger point, as this is the only way to relieve them of severe pain and often impaired function of some part of the body.

The easiest way to get rid of a trigger point is to apply concentrated pressure towards the point. The pressure should be applied at a fairly long interval. Subsequently, the point is released and the symptoms subside.

Probably this procedure is not unfamiliar to most readers. They may even have it at home, without even suspecting that it is a procedure of gradual removal of trigger points.

Interesting:
I'm sure you've heard of acupuncture. Its principle is sticking needles into problem areas and places that are causing pain.
Acupuncture works on the same principle. The difference is that instead of finger pressure, needles are used.
The results are comparable.