Trigger Points – Part 2
So, what’s so bad about having a trigger point or two?
Trigger points can cause all sorts of mayhem in the body. In Part 1 we mentioned pain in muscles and joints; headaches, too. But did you know they can cause tooth pain? Trigger points in the masseter and temporalis muscles (used in chewing and teeth grinding movements) have referral patterns into the teeth.
What is meant by a referral pattern?
Because they travel through the nervous system and involve the spinal cord, their impact is felt in areas other than where the trigger point is located. This is called a referral pattern. The nerve impulses generated by a trigger point in a muscle are transmitted to the brain where they are interpreted. The brain is where pain is “felt” or where the eyes “see”. The centers in the brain send out messages to the body in response to the trigger point impulses. Often the brain responses are to areas other than where the trigger point is located. It’s kind of like a ventriloquist who projects their voice so that it sounds like it is coming from “over there” and you can barely see their lips moving. This is why a trigger point in the pectoral muscle, for example, can be felt in the elbow (see illustration). The areas affected by the trigger point referrals are called “referral zones”. Massaging the referral zones provides only temporary relief of symptoms (like pain) because the cause (trigger point area) has not been directly addressed so the symptoms will eventually return. That is what many people do when they rub the painful area and get temporary or little relief. Pain killers serve to interrupt the transmission of pain impulses rather than address their cause.
What does that mean to you and me?
Everything found in the referral zones are affected by trigger point activity. Structures that may be found in a referral zone include: Muscles, blood vessels, lymphatic vessels, organs (brain, heart, stomach, intestines, lungs for example), nasal sinuses, skin to name a few. The effects of trigger point activity can include: joint pain; muscle stiffness; constipation; irregular heartbeat; blurred vision; running nose; sinus congestion; headaches; ringing in the ear; insomnia (loss of sleep); sweating; and muscle weakness.
It is always advisable to seek medical advice for health concerns that persist over time. It is also within your rights to do some self-care maintenance and working on trigger points to relieve them certainly qualifies.
But wait…there’s more!
As some of you know, symptoms like pain and stiffness can come and go – be gone for weeks at a time and then suddenly reappear. How does this happen? Dr. Travell found that there were two different types of trigger points which she termed Active and Latent.
Active trigger points
You know you may have an active trigger point if you feel pain whether you are standing still or moving. Remember that all pain is NOT trigger point related. You may have an arthritic joint, for example, that hurts when moving or not. Suspect trigger points when there is no other plausible reason for the pain you are experiencing.
Active trigger points prevent muscles (and joints) from moving through a complete range of motion and can cause muscles to be weak. So you might feel pain when reaching overhead or turning you head to one side as a result of active trigger point activity. You might have difficulty holding a pot of water in your hand or using hand tools due to weak grip strength. If you have this type of pain you find yourself taking smaller steps, limiting your reach, avoiding certain movements to avoid feeling pain. Taken over time we attribute the compensations to “old age” or getting older. Not all movement restrictions are due to long term trigger point activity. Sometimes our muscles and connective tissues shorten for reasons other than trigger points. Excessive weight, poor water intake, poor circulation and lack of movement are some factors.
Latent trigger points
These are the type of trigger points that can cause that “all of a sudden” pain because they do not cause problems unless they are pressed on. They can lay dormant for long periods of time until they are activated. You activate them by over stretching or over using the involved muscle. Another common activator is when the trigger point tissue is chilled like when you fall asleep in a draft, have an air conditioner blowing on you, hike up your shoulders when you wear too little clothing in cool weather (I’ve done that one, too). I am sure you can think of an instance where any of these happened to you.
And even more… Primary. Secondary and Satellites
Just when you think you have a handle on trigger point pain you find out there is more to it than you think. For instance, when you initially overdo activities or overuse a muscle (lifting things that are heavier than you are used to lifting, for example) you can create a trigger point. This is called a “primary” trigger point and they can be enough to deal with. Unfortunately a lot of us tend to ignore them or mask them with pain killers so they fester, cause pain and weakness and make us use additional muscles to do the work of one. (Be honest with yourself…have YOU ever worked or played through pain in the hopes that it would just go away?) Using additional muscle power can cause the additional muscles to work harder than they are used to so they develop trigger points, too. Those are called “secondary” trigger points.
Taking it one step further, Dr. Travell found that muscles located in the referral zones of other trigger points could develop trigger points, in part due to poor circulation. She called these “satellite” trigger points.
So now you figure out the pain you are feeling in your wrist is from a trigger point. So you massage the forearm muscles and the wrist pain gets better for a while, only to return a day or two later. Perhaps the forearm trigger point was secondary to a primary trigger point in the upper arm or shoulder, or a satellite trigger point from a trigger point in a neck muscle.
Think back to the source of the pain – the activity that sets the whole thing off in the first place and you may come up with the answer. And know that the originating event could have happened months or years ago, before you knew about trigger points and the like.
Trigger Points – Part 3 a real life example