Myofascial Trigger points

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Myofascial Trigger points are one of the most common causes of Physical pain in the body. They are a huge part of what Physical therapists and neuromuscular therapists treat in their clinics. The Word myofascial stems from the link between Myo as in muscle and fascial as in fascial and a trigger point is so named because when this “point of the muscle is stimulated” The pain can intensify whether that's by somebody poking it or by the muscle being used.

What I will serve to do is give a brief overview of what these are , why they occur , and how to treat them when they start to produce pain. I will also dive a little bit more into the science behind muscular contraction and how exactly these muscles can become “stuck” and become painful. 

Muscular contractions

Firstly we must look at how a muscle contracts. The important thing to remember about a muscle is that its only function is to contract. It does not relax as many textbooks suggest, Rather it lessens the degree of contraction so that you can lengthen it. Muscles importantly also do not lengthen. They Have a length and if that length is exceeded the muscle will tear, The reason we don't tear when we stretch a muscle is largely down to Elastin which is found in Muscle tissue and fascia which as you guessed is elastic meaning it will return to its original form (if not stretched too hard). So how does a muscle contract?

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If you look at what a muscle is in a textbook or on google it will show something like this. Red vibrant and fibrous. 

Although in reality this is not the full picture it's a decent enough representation to start. You can see that there are fibres of muscles and all these fibres coming together to create (The muscle). Inside these fibres are the muscle cells which contain protein strings called myofibrils. And within these fibrils is a structure called a sarcomere. The sarcomere is where the magic happens. If you reference the picture below you will see a muscle cell and sarcomere. 

Without going into detail about the chemical processes needed for contraction, When the muscle contracts the Thin filament mentioned above actin and the thick filament myosin are pulled together and this area between the two shortens. When these are all stacked up and millions of sarcomeres are shortened you get movement of the muscle. When we want to release the contraction and allow the muscle to lengthen or “relax” the actin and myosin will become apart again due to another round of chemical processes. There are a number of things required for muscular contraction to happen 

Some of these include : 

Presence of calcium ions To Expose the binding sites of actin.

ATP To supply the energy for the contraction.

Nerve impulse to stimulate the process.

etc

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I have only highlighted a few because we are looking at trigger points and how they form. 

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So now we have looked at how muscles work and function. Let's look at why they stop working and functioning?

Most people will say that their muscles become tight and painful and more often than not say the word “Tension”. When muscles become sore the become nociceptive which means they are irritated and stimulate a pain response. When a pain response is present more often than not an inflammatory response is present also. This is your bodies way of trying to heal. Inflammation is often talked about as a bad thing but in truth if we had no inflammation we would not heal. Inflammation brings with it healing agents to fight infection like white blood cells, energy , heat, blood flow and nutrients as well as clotting proteins and a host of other recruits. When inflammation is present in a muscle and won't go away why is that ? Trigger points.

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A trigger point is when a piece/area of muscle is stuck in a contracted state. I mentioned calcium ions above. In order to contract calcium ions essentially unlock the muscle so that it can move. When the portion of muscle is stuck in contraction these calcium ions accumulate and can give the impression of “hardened” tense tissue. Now that the muscle is locked no nutrients or oxygen can enter the portion of the muscle which rings alarm bells to the nervous system and induces an inflammatory response.

 The normal response by a person to this is to stretch it for relief but we know through the reflex arc that the muscle isn't lengthening so nothing happens when you're stretching. 

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Some of the cardinal signs of trigger point related pain are : 

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Twitching responses

Pain

Painful movements of the arm/sore to stretch

Reduced range of motion

Hot/red appearance of the skin

Jump sign on palpation of the area.

Shooting type pains upwards and downwards 

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Trigger points have Referral patterns in which depending on which muscle houses the trigger point a different sensation or referral area may be felt. Some common examples of this include the upper trapezius , hamstring and supraspinatus muscles pictures below with the referral.

As you can see ; and this is the case for a lot of muscles in the body; the referral patterns where a person may experience pain from a trigger point may not be where their trigger point actually is. Shoulder pain problems in the front of the body a lot of the time originate on the back of the rotator cuff, Headaches and neck pain from the trapezius and that common hamstring strain of a kick in the bum is all too common. 

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Why do they form ? and how to stop them?

This is one of the harder answers. In short every muscle in your body currently has trigger points. Not all of them are currently producing pain. Pain generally comes in a trigger point when many sarcomeres are shortened in the same area and can form a nodule of sorts. They can form because of : 

Injury 

Postural issues including desk jobs

Repetitive strain

Protection across joints

Nutritional and recovery aspects

Improper use of muscle tissue

Hydration 

Stress 

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Ultimately to prevent painful trigger points we need to look at the body as a whole, The best chance to ward off Painful trigger points for any individual is to live a stress free life, East a balanced diet, Not get hurt, no stress, Use your body to move perfectly and through full ranges…..etc which doesn't happen. We have lives and we don't always get it right.

The best approach is to exercise regularly and stimulate the cardiovascular system, Eat a healthy balanced diet and supplement for deficiency, Take limbs through full ranges of motion. Move a lot and regularly , avoid long periods of inactivity, try to change how you perceive stress, do things that energise you and do less things that de-energise you and sleep and recover well. 

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Outlook? With proper treatment Myofascial trigger points themselves are not a problem. But sometimes they can be a highlight to other things which may be happening. Trigger point related back pain can be due to facet joint inflammation/arthritis and sometimes trigger points can even be caused by referral from organs. To Get these assessed, always go to someone who knows what to look for.

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