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Trigger points are the great mimickers of a lot of other health problems.  Trigger points can produce symptoms that closely match those of such diverse conditions as heart attacks, disc herniations, gallbladder attacks, liver problems, migraine headaches, tooth pain, carpal tunnel syndrome, diverticulitis, inner ear problems, and all manner of sprains and strains.

So what is a trigger point?  It is a tight “knot” of contraction in a muscle or in connective tissue (fascia).  They are sometimes called myofascial (”myo” meaning muscle,  and “fascial” referring to the connective tissue that compartmentalizes muscles and organs) trigger points, and the presence of trigger points is often called myofascitis.  The knots of contraction may or may not be tender to the touch, but when “active”,  the trigger point will cause pain, tingling, numbness, burning, and/or other sensations in that trigger point’s “referral zone”.  Some trigger points will cause additional symptoms such as dizziness, nausea, and tinnitus (ringing in the ears).  Each muscle has a typical referral zone that most individuals will experience symptoms in when an active trigger point is present.

For example, one or more trigger points in the scalene muscles (which are found in front of the spine in the neck) will produce symptoms in the chest, shoulder blade area, and/or down the arm to the hand.  This pain pattern is very similar to and is often mistaken for cervical disc herniation.  It can also be mistaken for heart attack (especially when felt on the left side), or a gallbladder attack (when felt on the right side).  Obviously, these other more serious conditions should always be evaluated for and ruled out, but when symptoms persist with no detectable cause, very often the problem is trigger points. 

Although they have been recognized as the cause of many different symptoms, trigger points remain largely unknown (or at least ignored) by the majority of the medical profession.  It seems that some medical providers view trigger points as an imaginary problem created by alternative medicine practitioners, despite the fact that the groundbreaking work in this area was done by a prominent medical doctor, Janet Travell, who served as President Kennedy’s personal physician.  Whatever the reason, trigger points are rarely considered in the differential diagnosis for most patients, even though they are an extremely common cause of numerous symptom patterns.  Even among alternative healthcare practitioners who as a group are far more aware of them, trigger points are often overlooked.

Among the more common causes of trigger points are trauma, stress, nutritional deficiencies, nutritional excesses (especially excess refined carbohydrates), dehydration, overexertion, repetetive motion, exposure to cold temperatures or drafts, inactivity, poor posture, and organ dysfunction/disease. 

Treatment of trigger points can be done by a variety of means, but the primary goals of treatment are to increase circulation to the area of the trigger point and to mechanically stretch or “loosen” the contraction.  This can be achieved through massage (particularly “deep tissue” or “neuromuscular”) massage,  specific stretching for the involved muscles/fascia,  the application of heat (or heating therapies like ultrasound and infrared), and/or electrical muscle stimulation.  In addition, getting some generaly aerobic exercise (walking, swimming, etc.) and improving hydration is usually helpful, as is supplementing with magnesium and B-vitamins.  In some cases, trigger points may be treated by use of injections (usually with either saline solution or an anaesthetic drug such as lidocaine), or simply by “dry needling” with a syringe or acupressure needle to stimulate the trigger point to release.  In my experience, deep massage along with a home stretching regimen is the most effective approach, particularly if the patient is consistent with the stretching and is also cooperative in eating a reasonably healthy diet and staying well hydrated.  In some individuals, additional attention needs to be given to stress management as well.

 In most cases, the pain and other symptoms of trigger points can be relieved relatively quickly, once one knows where to check for the trigger points and how to apply treatment. 

Stay tuned to my natural remedies blog for more about trigger points.

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