Trigger points/Knots/Myofascial Pain/Muscle Spasm

Written by Dr. Jason Ngan, DC

What are Myofascial Pain Syndrome / Trigger Points?

Myofascial pain syndrome is a broad term to describe local pain originating from a muscle. The term myofascial is derived from muscle (myo) and fascia (fascial). Fascia is a thin layer of connective tissue that surrounds each structure in the body. In myofascial pain syndrome, there are tender focal spots on a muscle called myofascial trigger points (aka muscle knots). Trigger points are sensitive areas of contracted muscle fibers. When touched, they feel like a section of a muscle is knotted up.

What Causes Myofascial Pain Syndrome / Trigger Points?

There are many causes of myofascial pain syndrome and trigger points.

  • Overuse of muscles including repetitive stress and poor posture

  • Trauma

  • Abnormal breathing: using other muscles to breath such as SCM, scalenes puts additional stress in these muslces

  • Joint dysfunction

  • Emotional stress

  • Vitamin deficiency

  • Radiculopathy

  • Other trigger points can cause surrounding muscles to tense up

  • Secondary to other diseases and conditions such as disc herniation, heart, and gallbladder

    • In disc herniation, the nerve roots are irritated and causes continuous stimulation to the associated muscle. The muscle will then contract and spasm repeatedly, creating a trigger point.

The leading explanation of trigger points is described by the Energy Crisis Hypothesis, an endless cycle of muscle tightness, blood flow restriction, and nutrient imbalance. In this model, overuse or injury causes a muscle to tighten up. The tight muscle constricts blood flow. Blood contains nutrients, specifically ATP, that is used for movement. The ATP deficiency causes the muscle to tighten up even more. The tighter muscle causes more blood flow restriction and thus even less ATP nutrients.

What are the Signs and Symptoms?

Myofascial pain syndrome can affect any muscle. The affected muscle’s function is disrupted. Some of these functions may include:

  • Tearing, runny nose, increased salivation, ringing in the ears, and goosebumps

  • Dull, diffuse, achy pain

  • Muscle tenderness (pain on palpation)

  • Numbness and tingling

  • Muscle tightness

  • Muscle weakness

  • Muscle twitching

  • Referral pain

  • Spasms of other muscles

  • Limb feels cold (due to restricted blood flow)

  • Decreased range of motion

How is Myofasical Pain Syndrome and Trigger Points Diagnosed?

To find a trigger point, it must be a palpable band (knot) in a muscle. The knot will be tender to touch. Applying pressure will refer pain to another site of the body or elicit a twitch response.

When diagnosing myofascial pain syndrome, it is important to rule out other more serious conditions that can cause trigger points.

What are the Treatment Options?

Since trigger points can be a symptom of other conditions, it is crucial to treat the cause first.

Dr. Ngan’s methods are highly effective in treating myofasical pain.

  • Chiropractic manipulation and mobilization

  • Flexion-distraction

  • Spinal traction

  • Myofascial release therapy

  • Spray-and-stretch

  • Gua-sha

  • Cupping

  • E-stim

  • Ultrasound

  • Ergonomic/postural counseling

  • Nutrition/hydration counseling

  • Rehabilitative exercises

Other treatments that patients may seek (not provided at Ngan Chiropractic) include acupuncture, muscle relaxer medications, and injections (lidocaine, botox, steroid).

References

  1. Desai, M.J., Saini, V. & Saini, S. Myofascial Pain Syndrome: A Treatment Review. Pain Ther 2, 21–36 (2013). https://doi.org/10.1007/s40122-013-0006-y

  2. Jafri MS. Mechanisms of Myofascial Pain. Int Sch Res Notices. 2014;2014:523924. doi: 10.1155/2014/523924. PMID: 25574501; PMCID: PMC4285362.

  3. Minerbi A, Vulfsons S. Challenging the Cinderella Hypothesis: A New Model for the Role of the Motor Unit Recruitment Pattern in the Pathogenesis of Myofascial Pain Syndrome in Postural Muscles. Rambam Maimonides Med J. 2018 Jul 30;9(3):e0021. doi: 10.5041/RMMJ.10336. PMID: 29944114; PMCID: PMC6115483.

  4. Tantanatip A, Chang KV. Myofascial Pain Syndrome. [Updated 2022 Jul 4]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2022 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK499882/

  5. Vernon H, Schneider M. Chiropractic management of myofascial trigger points and myofascial pain syndrome: a systematic review of the literature. J Manipulative Physiol Ther. 2009 Jan;32(1):14-24. doi: 10.1016/j.jmpt.2008.06.012. PMID: 19121461.