Causes of Trigger Points

Trigger points are small, pea-like, contracted knots in the muscles that cause pain in the muscle attachments. The term "trigger points" was created in the 1940s by Janet G.Travell, M.D., who developed new anesthetic techniques to treat muscle spasms. Later, Travell and her colleague David G. Simons, M.D. continued their research and published "Myofascial Pain and Dysfunction: The Trigger Point Manual."

Symptoms

• Trigger points cause referred pain. For instance, lower back pain may actually stem from a trigger point in your buttocks or lower abdominal muscles. The pain may be deep only to turn sharp upon movement. Tension headaches, migraines, sinus pain, jaw ache, earache and sore throat, sore legs, feet and ankles may be caused by the referred pain of trigger points. Trigger points are classified as active or latent. Active trigger points cause pain at rest while latent points only cause pain when pressed on.

Causes

• There is little scientific evidence as to why trigger points develop, but the American Academy of Family Physicians says researchers believe they may be caused by repetitive motion--as in working on a computer keyboard--poor posture and structural problems such as unequal leg length and asymmetrical pelvis. Trigger points may also be caused by lack of exercise, trauma and vitamin deficiencies.

Diagnosis

• No laboratory or imaging techniques diagnose trigger points. Instead, physicians diagnose trigger points by touch. While trigger points hurt when pressed upon, they are not to be confused with the tender points that accompany fibromyalgia. Trigger points usually feel like a taut band and produce a localized twitch or visible dimpling of the skin, while tender points do not. Tender points do not cause referred pain like trigger points, but often cause total body sensitivity. Since fibromyalgia sufferers often have trigger points and myofascial pain as well, diagnosis can be difficult.

Conventional Treatments

• Physical therapy is often used to treat trigger points. Another commonly used treatment is injections in which a syringe filled with an anesthetic solution is injected directly into the trigger point. Deciding whether to use the injections or physical therapy may depend on the doctor's skill level as well as whether the trigger points have progressed from the acute stage to the chronic stage. Injections are considered more effective for chronic points.

Other Treatments

• Acupuncture, massage therapy, osteopathic and chiropractic manipulations may help alleviate the pain of trigger points. Finding a massage therapist specially trained in trigger point therapy may be helpful. In his book, "The Trigger Point Therapy Workbook Your Self-Treatment Guide for Pain Relief," Clair Davies outlines his own painful struggle with trigger points and how a particular massage therapist who knew how to perform deep stroking massage helped his condition. After the massage therapist moved away, Davies couldn't find another one with the same training, so he went to massage therapy school himself. In his workbook, Davies shows others how to locate and massage their own trigger points.