NEUROSURGERY ARTICLES

MYOFASCIAL TRIGGER POINTS

Laura Paré, M.D.

Low back pain and neck pain caused by myofascial trigger points (MTPS) are often not recognized and diagnosed. MTPS are local tender spots in a nodule or band of muscle. They are an extremely common source of pain in nearly everyone's life at one time or another. The most common ways that MTPS become activated is by overwork fatigue, direct impact trauma to the muscle, or nerve compression. However, many other conditions can indirectly activate trigger points such as arthritis, joint dysfunction, medical illnesses, and emotional distress. Active MTPS cause an aching pain in the region in which they are situated. The pain is poorly localized and may be referred to a distance away from the trigger point. The pain can range from mild to excruciating and can occasionally persist for months or years. Some patients notice numbness or tingling rather than pain. The most common locations for MTPS are the neck, shoulder, pelvis, chewing muscles, upper back, and lower back. The involved muscle feels weak and is easily fatigued. Sleep disturbance is common, often aggravating the pain the next day.

MTPS are identified as a localized spot of exquisite tenderness in a nodule of a "taut" band of muscle fibers. When MTPS are compressed, the patient's pain is reproduced. The muscle that contains the tender point cannot reach its full stretch range of motion and has less strength and endurance. Many times the pain produced will not be located just at the tender point but will travel away for a distance in a pattern that is distinct for each muscle (referred pain). Activation of one myofascial trigger point can lead to the activation of satellite MTPS. The key to treating MTPS is to lengthen the muscle fibers that are shortened by the trigger point mechanism. MTPS treatment, or inactivation can be accomplished by many different methods. The goal is to first inactivate the trigger point by using either massage, trigger point pressure, injection, or vapocoolant spray. The second step is to prevent the trigger point from becoming contracted again by stretching out the muscle to its full length.

Unfortunately, there is no blood test, x-ray or any kind of scan that can diagnose MTPS. Proper diagnosis and treatment is best performed by a specialist who is fully trained to do so, usually a Physical Medicine and Rehabilitation doctor, also known as a physiatrist. This trained specialist will make the diagnosis by a careful history and examination and then suggest a treatment plan. However, there are also several excellent self-help books available which patients can use to gain more understanding of the syndrome and embark upon a self-treatment program. Because treatment can be as simple as massage and stretch, once the appropriate muscle is identified, it is something that can easily be done at home by most patients.

Suggested books:
Trigger Point Self-Care Manual: For Pain-Free Movement by Donna Finando
The Trigger Point Therapy Workbook: Your Self-Treatment Guide for Pain Relief, Second Edition by Clair Davies

University of California, Irvine • Irvine, CA 92697
(949) 824-5011
© 2006 The Regents of the University of California.
All Rights Reserved.

Comments & Questions: Privacy & Legal Notice
Copyright Inquiries