Probably, many found small painful areas of muscle seals on their bodies or on their loved ones. Most consider them to be s alt deposits, but in official medicine they are known as trigger points. These areas of local compaction and increased sensitivity in the muscle tissue cause pain in various parts of the body, often located at a considerable distance from them.
Theory by J. Travel and D. Simmons
Such a concept as a trigger point was introduced by American doctors J. Travel and D. Simons back in the seventies of the last century. Thanks to their research, certain points were described, by acting on which you can relieve pain in areas of the body that are quite remote from them. For example, a targeted impact on a painful point, which is located in the neck or shoulder blade, allows you to relieve a headache or pain in the elbow joint or hand. Also, by acting on the trigger zones (this is another name for these points), you can influence the state of the musculoskeletal system and internal organs.
What is a trigger point
As defined by Travel and Simons,these points are hyperexcitable areas with local muscle tension. They are located in the skeletal muscles and fascia associated with them. Trigger points appear as small, painful seals on palpation. They can form in all soft tissues of the body, but are usually localized in large skeletal muscles that perform static functions. So, most often you can find trigger points in the muscles of the shoulder girdle and neck (the muscle that lifts the scapula, trapezius, scalene, neck rotators), chewing muscles, as well as in the muscles of the pelvis and lower extremities. In addition, such points are a source of reflected pain. For example, a trigger point in the upper part of the trapezius muscle can provoke pain in the behind the ear, jaw, and temple. Also, the danger of these formations lies in the fact that even if at the moment they do not cause severe pain, then over time, dysfunction of the muscle where they are located will inevitably progress.
Causes of occurrence
Despite the research, today there is no clear answer to what factors are the immediate causes of trigger points. As a rule, myofascial trigger points form in muscles that experience overexertion or prolonged and constant stress. Most often this is due to the position of the body in space - raised shoulders, a hunched back and a lowered, overly tense chest, a strong deflection in the lower back. This inevitably causespronounced mechanical tension both in individual muscles and muscle groups, which leads to their spasm and, as a result, to impaired blood circulation. Also, a trigger point can form as a result of lesions of the spine (with a blockade of the motor segment) or in the pathology of an internal organ, when the muscles surrounding it reflexively tighten. Another reason for the appearance of such points can be an acute or repeated microtrauma of the muscle.
However, according to research data, all these factors lead to the formation of latent trigger points. In order for them to pass into the active phase, and a clinically defined myofascial syndrome appears, a triggering factor is needed. Often this role is played by hypothermia, work in an uncomfortable position, a psycho-emotional factor.
Risk group
The group at risk of trigger points and myoskeletal pain include people who, by the nature of their work, are forced to maintain a static, most often uncomfortable posture for a long time. These include drivers of vehicles, office workers, hairdressers, surgeons, etc. Also, persons with impaired motor functions and any disorders of gait and posture have a high risk of trigger points. This is due to chronic overexertion of various muscle groups.
Types of trigger points
There are two types of them. The most common latent trigger points are spasmodic areas of the muscles that are found only on palpation. bigthe number of latent points can be found in the elderly. A trigger point can also be active. It is characterized by acute pain, aggravated by stretching the spasmodic area. Such manifestations are less common. As a rule, they can be observed in middle-aged people (in women they occur 2.5 times more often than in men). Under the influence of provoking factors, latent points can go into an active phase, but adequate therapy can return the active point to a latent state. Both active and latent trigger points can become a source of limitation of movement, spasm, weakness and deformity of the affected muscle groups.
Phases of disease
Today, it is customary to distinguish three stages in the development of the disease.
- Acute phase. It is characterized by constant severe pain in areas where active trigger points are located and in the area of reflected pain.
- Subacute phase. At this stage, pain occurs during movement and physical activity, but is absent at rest.
- Chronic phase. During the examination, only latent points are revealed, while there is slight discomfort and dysfunction in the area of the detected seals.
Symptoms
The symptoms of myofascial trigger points can be very varied and not limited to pain. Muscle dysfunction can be manifested by rigidity, muscle weakness, edema, dizziness, gait and posture disorders. The actual trigger point is defined aspainful compaction, strand ranging in size from a few millimeters to a centimeter. Pressing on it provokes a sharp pain, which has the greatest intensity at the point of maximum resistance to palpation (the hardest area).
An active trigger point is not only painful, but can also cause reflected (radiating) pain in areas far enough from it, forming a pain pattern - a characteristic pattern of pain localization. Thanks to many years of research, maps have been compiled, thanks to which it is possible to determine the true source of reflected pain.
Reflected pains caused by trigger points are most often felt as constant, deep, bursting and dull, but in some cases they can be very intense, burning, stabbing. Due to the fact that a spasmodic area of \u200b\u200bthe muscle can compress the nerve ending passing through it, reflected pain can be accompanied by a decrease in sensitivity and numbness. The intensity of pain can also vary from mild to intense, and it can be observed both at rest and during exercise. It should be noted that the prevalence and intensity of pain depends on the degree of irritation of the trigger point, and not on the size of the muscle where it is located. Some trigger points can also cause such phenomena as inflammation of the mucous membranes, lacrimation, visual disturbances, perception of space, vestibular disorders.
Examination and diagnostics
Foreffective treatment of this pathology, it is important to correctly identify the cause of pain in the patient and determine the exact localization of the trigger point. To do this, the doctor must not only identify the area where the pain syndrome manifests itself, but also compare it with the characteristic zones of reflected pain. For this, cards are most often used, which are in almost all books on this topic.
During a palpation examination, a specialist determines the overall elasticity of the muscles in comparison with the area where the presence of a trigger point is suspected. In this case, the fingers first pass across the muscle fiber, noting the deformity, spasmodic areas and muscle cords. When the seal is found, running a finger along it, they find the area of maximum seal, pressing on which causes maximum pain. The fact that this will be exactly the trigger point will be indicated by the following signs:
- pressure on the point causes reflected pain, while it may not occur immediately, but within ten seconds;
- directly when pressing on the point, you can observe a "convulsive response" - the muscle twitches under the arm and often it is noticeable even visually;
- another sign of a trigger point is the so-called patient jump, in which, in response to pressing, the patient tries to abruptly move away or scream;
- with increasing time of pressure on the point, all zones of the pain pattern are perceived by the patient as a whole.
Trigger points - treatment
Today, medicine usesseveral methods of treating trigger points, while drugs are not at all leading in them. It has been proven that NSAIDs and analgesics can only partially relieve pain, and muscle relaxants have the same effect by partially eliminating spasm.
The most effective and cardinal method of treating trigger points are blockades. Their implementation is possible only when determining the exact localization of the pathology. To carry out the blockade, a needle is pierced at the site of compaction, followed by the introduction of an anesthetic.
Massage and exercise therapy
Despite the fact that the blockade gives an almost instant effect, the most common methods of treating this pathology are exercise therapy, manual techniques and trigger point massage. And if the patient, after consulting a doctor, can perform a complex of therapeutic exercises on his own, then only a qualified specialist should conduct a massage.
When it comes to massage, the most effective help for trigger points can be provided with gradual compression. To do this, the massage therapist, having found a point, begins to gently press on it, continuing it until the patient has mild soreness in the reflected zone, which corresponds to 2 on a ten-point scale. This pressing is maintained for 10-15 seconds. During this time, the pain should decrease significantly or completely disappear. After that, the pressure is again strengthened, and after the appearance of discomfort, it is again held for 15 seconds. These actions continue until the moment when the characteristic pains disappear. This is usually enough3 pressure gains. After such inactivation of the trigger point, a warm wet compress is applied for 5 minutes, after which a passive muscle stretch is performed.
Despite the apparent simplicity of the procedure, do not self-medicate. All examinations and medical manipulations should be carried out by a qualified specialist, otherwise there is a very high risk that the situation will not only not improve, but will worsen significantly.
