If you hurt all over and feel worn out, you may have stress on muscle fibers what leads to the formation of Trigger Points in muscles innervated by sciatic nerve. Trigger points may also manifest as tension headache, tinnitus, temporomandibular joint pain, decreased range of motion in the legs, and back pain. These symptoms are very similar to Fibromyalgia or Chronic Fatigue Syndrome symptoms, where Fibromyalgia can be diagnosed by 18 specified painful Tender Points around the neck, shoulder, chest, hip, knee, and elbow regions. Finger pressure to these areas for patients with Fibromyalgia can be very painful. This happens because 90 percent of the 18 predetermined Tender Points are actually Myofascial Trigger Points. Trigger Points are firm nodules that you can often feel in your tight, rope-like muscles. Pressing on a Trigger Point hurts in the area and also shoots pain to other regions, while pressing on just a Tender Point is believed to only cause discomfort to the local area. These 18 specific Tender Points are located at nine bilateral locations and occur on both the right and left sides of the body symmetrically:Occiput: bilateral, at the suboccipital muscle insertions. (Where the neck muscles attach at the base of the skull) Low cervical: bilateral, at the anterior aspects of the intertransverse spaces at C5-C7. (Front lower neck) Trapezius: bilateral, at the midpoint of the upper border. (Midway between the neck and shoulder) Supraspinatus: bilateral, at origins, above the scapula spine near the medial border. (Muscle over the upper inner shoulder blade) Second Rib: bilateral, at the second costochondral junctions, just lateral to the junctions on upper surfaces. (Edge of upper breast bone) Lateral epicondyle: bilateral, 2 cm distal to the epicondyles. (2 cms below side bone at elbow) Gluteal: bilateral, in upper outer quadrants of buttocks in anterior fold of muscle. (Upper outer buttock) Greater trochanter: bilateral, posterior to the trochanteric prominence. (Hip bone) Knee: bilateral, at the medial fat pad proximal to the joint line. (Just above the knee on the inside)
Pain in at least 11 of the 18 Tender Points is required for an FM diagnosis. The Trigger Points generally involve taut, ropy bands of muscle fibers. There may also be hard lumps or nodules in the area. Trigger Points are formed when acute trauma or repetitive microtrauma leads to the development of stress on muscle fibers. Although anyone can have Trigger Points, they are frequently associated with a form of chronic muscle pain called myofascial pain syndrome. It’s not unusual for someone with Fibromyalgia to also have MPS, which may be one of the reasons Tender Points and Trigger Points are often confused.
Difference Between Tender Points and Trigger Points
|Tender Points||Trigger Points|
|The specific point is tender.||The point itself may or may not be tender.|
|Tender points do not cause referred pain.||Trigger points refer pain to other areas.|
|There are always multiple points.||There may be a single point or multiple points.|
|Points occur in specific symmetrical locations.||Points may occur in any skeletal muscle.|
So, let’s talk in a little more detail about Muscle Knots or Trigger Points
Muscles account for more than 60% of the human body mass, making up the largest part of our bodies. They are responsible for all movement of the human body. With such an enormous responsibility, it is easy to see how muscles can be subjected to wear and tear, fatigue, overuse, and repetitive injury.
When we want to move or use our muscles, the muscle contracts, and this is typically a voluntary action. However, sometimes the entire muscle contracts involuntarily, which we call a spasm. Muscles are also subject to another condition, known as a Trigger Point, which is essentially an involuntary contraction of only a small portion of the muscle, creating pain as a protective muscle function.
Trigger Points have been studied and shown to be the most common cause of musculoskeletal pain. Pain clinic doctors have found that Trigger Points are the main source of pain nearly 75% of the time! A unique feature that distinguishes Trigger Points from other muscle pain is that Trigger Points almost always refer pain to other areas of the body. This is why many treatments are ineffective. Most treatments assume that the area of pain should also be the source of pain, yet the actual cause could be in a completely different location.
So, Trigger Point therapy can reduce pain, increase movement, and allows the muscles to lengthen and become stronger again. To treat Trigger Points, moderate pressure must be applied to the Trigger Point. If you press hard into your muscle, this creates pain, which leads to muscle tension. If it hurts – you’re not doing it correctly!
Pressure should be applied slowly and released slowly for best results. The pressure should be maintained until there is a change in light moderate pain. If there is no decrease in pain after one minute, stop the pressure—this is probably not a Trigger Point! After applying pressure to Trigger Points, the relaxed muscle can be carefully stretched.
Trigger Point Therapy can be used to help you with these common conditions:
• MIGRAINES • TENSION HEADACHE • NECK AND JAW PAIN • UPPER BACK PAIN • BURNING BETWEEN SHOULDERS • THORACIC OUTLET SYNDROME • FROZEN SHOULDER • TENNIS ELBOW • CARPAL TUNNEL SYN- DROME • ARM AND HAND PAIN, NUMBNESS, AND TIN- GLING • ARTHRITIS • BURSITIS • TENDONITIS • SINUS PAIN AND CON- GESTION • FIBROMYALGIA • MUSCLE AND JOINT STIFFNESS
Tips for safe and successful treatment
- Before treatment, rate your pain on scale of 0 -10 (0=best, 10=worst)
- Maintain pressure until your pain has increased to a level of 2 or 3.
- Deep (but NOT too hard) stroking is just sometimes more effective than fixed pressure.
- Do NOT murder the tight spot! Attacking the muscle may bring temporary emotional relief, but when you press hard into your muscle, this creates pain, which leads to muscle tension. So you’re actually working against the muscle release!
- Apply and release pressure slowly (or like I learn from my Siberian Shaman Teacher, you can release muscle knots by slowly pulling the Pressure Point area).
- Apply pressure or pulling for 1 minute – if there is no decrease in pain, leave it alone…this is not a Trigger Point.
- Treat Trigger Points on both sides of the body, not just the effected side.
- Repeat treatments for best results.
- Use Hot type ( NOT Cold type of therapy what slows blood circulation) of noninvasive and nonaddictive pain-relief therapy. Heat opens up blood vessels, which increases blood flow and supplies oxygen and nutrients to reduce pain in sore muscles, ligaments and tendons. The warmth also decreases muscle spasms and can increase range of motion.
- Trigger Point Therapy you can combined with Pain Relieving Herbs.
Please carefully read this additional material “The Top 10 Trigger Points Every Health and Fitness Professional Should Know!” by Perry Nickelston, DC, FMS, SFMA, before using any information contained in this article.
The Infraspinatus Muscle Location and Trigger Points
The Infraspinatus, one of the rotator cuff muscles, lies on the outside of the lower 2/3 of the shoulder blade. It functions primarily to rotate your arm outwards and to pull your arm back, such as when swinging a bat or golf club.
Trigger Points in the Infraspinatus are commonly overlooked, due to the unique referral pattern. Although this muscle is located on the back, the primary referral pain is to the front of the shoulder. Pain can also be found along the outer portion of the shoulder, extending into the upper arm as well.
A common condition known as “Frozen Shoulder” causes weakness and stiffness in the shoulder. This true condition is caused by adhesions and scar tissue in the joint. Trigger Points in the Infraspinatus muscle can mimic the symptoms of “Frozen Shoulder.” Trigger Point treatment with the Pressure Pointer can help to alleviate many of these symptoms.
Infraspinatus is a very common cause of anterior shoulder pain, bicep pain, mid-scapular pain even tingling and numbness into the forearm/hand.
The Trapezius muscle location and Trigger Points The Trapezius is a major source of headache pain, typically the type of pain experienced as a “tension headache.” It can also be a cause of dizziness, jaw, and toothache pain. Tightness felt in the neck and back of the skull often comes from Trigger Points in the Trapezius. If neck massage does not relieve the sensation of tightness in the neck, Trigger Points in the Trapezius are the most likely culprit. Computer users and others who use their arms for extended periods of time will recognize the burning pain between the shoulder blades. Referred pain from the Trapezius can be found in such a wide variety of locations, that it commonly leads to misdiagnosis, including shoulder bursitis, headaches, disc compression, or a “pinched nerve.” Using the Pressure Point may help alleviate your symptoms.
The Levator Scapula muscle location and Trigger Points The Levator Scapula muscle’s main function is to raise the shoulder blade. Stress and tension keep the shoulders raised, creating increased tension in the Levator Scapula Muscle. Poor posture can also be a factor. When Trigger Points exist in this muscle, it can be very painful. This muscle is typically involved when you find yourself unable to turn your head. In this case, the direction which you cannot turn is the side that of the problematic Trigger Point. Using the Pressure Pointer to treat the Trigger Points can help restore full movement. Trigger Points in this muscle also create pain and stiffness along the neck and the edge of the shoulder blade.
The Subscapularis muscle location and Trigger Points The Subscapularis trigger point is very elusive and causes all sorts of problems in function and creates pain. This is the number one trigger point that is overlooked in most shoulder pain problems. BE CAREFUL! This trigger point can be excruciatingly painful when pressure is applied. It can feel like your arm is being ripped out of the socket. That is a normal side effect feeling of an intense trigger point but will subside in time. Trigger Points in Subscapularis also create pain along the shoulder, mid-back, wrist, and arm. You also can have headaches or Cervical pain.
The Soleus muscle location and Trigger Points Every condition and symptom from the bottom of the foot up should have the Soleus mixed into the evaluation process. It can be linked to many dysfunctions because of its intense integration into the gait cycle. The Soleus is also a primary muscle to help pump blood back to the heart from the lower extremity. This pump movement mechanism can be slowed down when the muscle is not functioning at max capacity, thus decreasing blood flow to the heart. This can lead to decreased endurance and sports performance because of the decreased supply of oxygen. Sudden onset of dizziness when standing from a seated position can also be a problem with this trigger point. The delayed blood flow upon rising makes you dizzy. Work the muscle and notice an improvement. It has even been linked to chronic jaw pain! The gait cycle is altered as a result of dysfunction in this muscle. The toe off phase and ankle joint dorsiflexion will be compromised leading to increased movement in the hip joint. This is a recipe for disaster. So if there is a hip issue, check the Soleus. Checklist for symptoms of the Soleus is Plantar Fasciitis, heel pain, shin splints, neck, back, hip and knee pain, Headaches and TMJ.
The Scalene muscle location and Trigger Points The Scalene muscles are actually three muscles found in the side of the neck. Blood vessels supplying the arm actually pass between these muscles. Trigger Points in these muscles can be very problematic, and cause a wide variety of symptoms. Thoracic Outlet Syndrome is caused by compression of these blood vessels. Common symptoms include pain, numbness, tingling, swelling, and weakness of the arms and hands. These symptoms are often incorrectly assumed to be Carpal Tunnel Syndrome, as the symptoms are similar. In addition, Trigger Points here can cause chest pain similar to angina, as well as upper back pain because Scalene are also accessory muscles of breathing. When they are dysfunctional your endurance level will suffer because your breathing is labored and less oxygen gets into the body. If you’ve had difficulty finding relief from these symptoms, addressing the problematic Scalene muscles could provide better results. Remember, the pain location is not always the same location as the source of pain. Checklist for symptoms of the Scalene is neck, shoulder, arm, wrist, hand and mid-back pain, dysfunctional movement in the shoulder due to rib fixation and possible restriction in diaphragm.
The Piriformis muscle location and Trigger Points You probably heard of this muscle and the syndrome associated with its name ‘Piriformis Syndrome.’ This syndrome got its name due to the symptom of sciatica (nerve) pain down the back of the leg where the Piriformis muscle actually pinches down on the sciatic nerve as it exits the sacral area. The Piriformis laterally rotates the extended thigh and abducts the flexed thigh. Abduction of the flexed thigh is important in the action of walking because it shifts the body weight to the opposite side of the foot being lifted, which keeps us from falling. Many people will have a problem with this muscle due to the fact that we sit on our butts most of the day. So many conditions and dysfunctions may be connected to the Piriformis muscle. Referencing the picture, there is typically pain near the sacral notch, belly of the buttock region, and the outside hip. Because of its intricate part in pelvic function and hip movements, when the Piriformis loses tone almost every surrounding muscle jumps on board to help stabilize you. A torrent of events occur when you have rotational dysfunction in the hip socket, sacral torque (twisting), the gluteus Medius and Minimus muscles go nuts with activity and are loaded with their own trigger points. The Sacrotuberous ligament now comes under extra tension and pulls on the posterior Fascial connective tissue slip from the hamstrings, to the Gluteus, to the Lats working its way up to the head. Checklist for symptoms of the Piriformis is pelvic, groin, hip joint, sciatic and lower back pain, knee clicking and popping or knee pain.
The Quadratus Lumborum muscle location and Trigger Points If you press into the space between the lower ribcage and pelvis (ilium), you will jump if you have hip muscle pain and dysfunction. There will usually be a significant difference in muscle development from one side to the other. This is an alarm for an asymmetry problem in muscular control and balance. Foam rollers fit perfectly in this space for some acupressure techniques. Be careful not to stay on these points too long or the muscle may go into spasm from the direct pressure on the lumbar spinal vertebrae. It does not take much to make an improvement in how this muscle refers pain. List of symptoms possible with the Quadratus Lumborum muscle is Lateral thigh, hip, buttock and lower back pain, opposite side shoulder pain, weakened Obliques and mimicked bursitis.
The Tensor Fasciae Latae muscle location and Trigger Points The Tensor fasciae latae (TFL) is a tensor of the fascia lata; the oblique direction of its fibers enables it to abduct the thigh and assists with internal rotation and flexion of the hip inward (medial rotation). Many people address the iliotibial tract and neglect the TFL. Reaching the TFL is more difficult and a little tricky, but pays big dividends in pain relief. Most every case of chronic knee pain will have an issue with the TFL. Checklist of possible symptoms with the Tensor Fasciae Latae muscle is groin, knee and hip pain, tingling and numbness on the lateral thigh, pain in the anterior thigh, Chronic SI fixations.
The Iliopsoas muscle location and Trigger Points Classic symptoms of an Iliopsoas muscle spasm are diffuse achy- type low back pain of a few days onset. The pain seems to spread to the rest of the low back, lower thoracic and even into the gluteal and lateral hip regions. Most often a key factor is initial pain upon rising from a seated position which may dissipate in a short time. It is difficult to stand upright quickly. Standing, walking and laying down don’t seem to affect it badly. Occasionally there may be pelvic discomfort and bowel complications in the history. Relief of pain is often experienced by sitting down. However, extending the leg, as in driving, can make the pain worse. The types of physical actions which seem to cause this condition are standing and twisting at the waist without moving the feet; any action which causes the leg to externally rotate while in normal extension; and even doing too many sit ups (this is the muscle which completes the last half of a sit up). Checklist of possible symptoms of the Iliopsoas is lower back, hip, thigh, knee and shoulder pain, hypermobility in the lumbar spine and sometimes just everything you can imagine…
The Gluteus Medius and Minimus muscle location and Trigger Points The pain from a Gluteus Minimus point can be so excruciatingly painful that you cannot move. It immobilizes you and actually mimics the severe pain of an actual disc herniation in the lumbar spine. Needless spinal surgeries could have been avoided if these muscles were properly treated. Radiation of pain down the back of the leg is common. You may also feel pain in the lateral side of the thigh and calf with sharp pain at the proximal and distal end of the fibula. With the leg in neutral (straightened) the Gluteus Medius and Gluteus Minimus function together to pull the thigh away from midline, or “abduct” the thigh. During gait, these two muscles function principally in supporting the body on one leg, in conjunction with the tensor fascia lata, to prevent the pelvis from dropping to the opposite side. Additionally, with the hip flexed the Gluteus Medius and Minimus externally rotate the thigh. With the hip extended, the Gluteus Medius and Gluteus Minimus internally rotate the thigh. You will often see muscle atrophy and flattening on the glutei side with chronic trigger points. Just envision the movement dysfunctions that will occur with the decrease in stability and tone from these muscles. The compensation mechanism is out of control. You may find opposite side shoulder pain in relationship to glute trigger points and fascial restrictions. The adductors will typically be loaded with trigger points as well, so make sure you do not neglect them. Often times they are the primary points which can prevent the glutes from totally engaging. Checklist of possible symptoms of the Glute Medius and Glute Minimus is back, hip, leg, knee, ankle, shoulder, thoracic and cervical pain, plantar fasciitis…..and just about anything else you can name.
The Posterior Neck muscle location and Trigger Points Headaches
are the most troublesome pain experienced as a result of Posterior Neck muscle Trigger Points. Migraine headaches, with pain inside the head all along one side generally result from Trigger Points in the muscles at the base of the skull. Headaches which feel like a constricting band around the head are also attributed to these muscles. In addition, these muscles can be a cause of blurred vision and pain behind the eyes. Trigger Points in the lower neck muscles can cause pain in the neck itself, but also frequently cause numbness, burning, or tingling in the back of the head and scalp. They can also cause pain along the angle of the neck and upper shoulder.
The Sternocleidomastoid (SCM) muscle location and Trigger Points Although the SCM muscles are located toward the front of the neck, this is rarely where the pain is felt. Trigger Points in the SCM mainly refer pain into the head, the jaw, and the sternum. Headaches in the front of the head, as well as accompanying facial pain, are usually from the SCM. This muscle can also refer pain to the sinuses, the teeth, and the tongue. SCM Trigger Points can affect the inner ear, causing balance problems such as dizziness, fainting, staggering, or even falling. There can also be hearing loss and ear pain. Finally, SCM Trigger Points can cause eye problems such as drooping eyelids, watery eyes, and reddening.
Rhomboid muscle location and Trigger Points The Rhomboid muscles are often overlooked, but they are frequently a location of Trigger Points. The Rhomboids are very thin muscles which have the tremendous responsibility for much of the movement of the shoulder blades. Due to the enormous amount the shoulder blades are used daily, the Rhomboids are often overworked and over tired, leading to chronic Trigger Points. Rhomboid Referred Pain Patterns The referral pattern of the Rhomboids is not as widely distributed, but nearly everyone suffers from the pain of Rhomboid Trigger Points. The pain generally extends from the edge of the shoulder blades to the spine. Since the Rhomboids on both sides are almost always affected, this is a primary source of mid back tightness or aching between the shoulder blades. This pain is felt when the muscles are in use, but also at rest. Snapping or crunching noises when moving the shoulder can also be traced to the Rhomboid muscles.
Serratus Posterior Superior muscle location and Trigger Points The Serratus Posterior Superior looks very similar to the Rhomboid muscles, but is, in fact, very different. This muscle runs underneath the shoulder blade and attaches to multiple ribs. Its primary function is to help raise the ribcage when breathing in. Since the muscle runs under the shoulder blade, treatingthis muscle requires moving the shoulder blade out of the way. Trigger Points in the Serratus Posterior Superior cause a deep aching pain under the shoulder blade. Additionally, pain or numbness can be found in the back of the shoulder, the elbow, and the pinky finger of the hand. Finally, the Serratus Posterior Superior can refer pain to the back of the upper arm and forearm, as well as the pectoral, or chest, region.
Serratus Anterior muscle location and Trigger Points The Serratus Anterior muscle attaches to the ribs and the shoulder blade. Its main functions are to assist in raising the arm and to expand the ribs while breathing in. Trigger Points in the Serratus Anterior muscle typically refer pain to the side and the lower portion of the shoulder blade. Although the pain distribution isn’t large, the pain itself can be very uncomfortable. When Trigger Points are present in this muscle, breathing in causes a sharp pain in the side. Some people also describe feeling unable to breathe out fully. The pain of Serratus Anterior Trigger Points can mimic the pain of lung disease and heart attacks. Although these symptoms should be taken seriously, if no lung or heart problems have been found, it is worthwhile to address these Trigger Points with the Pressure Pointer.
Thoracic Paraspinal muscle location and Trigger Points The Thoracic Paraspinal muscles run lengthwise, parallel to the spine. There are actually two layers of muscle that lie one on top of the other. Because these muscles attach to the vertebrae, or bones of the spine, they can cause problems with spinal misalignment and damage to the intervertebral discs.
The pain of Trigger Points in the Thoracic Paraspinal muscles often feels like it originates in the spine itself. The muscles feel hard and rigid, causing stiffness and decreased Thoracic Paraspinal movement. It often feels as though the entire back is in spasm, which should respond to treatment with heat and superficial massage. When these treatments do not decrease the pain and spasm, Trigger Points are more likely the cause. Extreme tension in these muscles can lead to scoliosis, or a curvature of the spine. Due to the close proximity of these muscles with the spine and nerves, Trigger Points in these muscles can also refer pain that mimics problems with organs of the chest and abdomen, such as appendicitis, kidney stones, angina, and lung problems.
Supraspinatus muscle location and Trigger Points The Supraspinatus, another rotator cuff muscle, lies on the outside of the upper 1/3 of the shoulder blade. The function of this muscle is to assist in raising the arm above the head. Although it is a small muscle, it has an incredibly important function, and should not be overlooked. Supraspinatus Trigger Points cause a deep, aching pain in the shoulder. It is extremely painful, if not impossible, to raise your arm above your head. This interferes with many simple, daily tasks, and makes normal life very difficult. If you’ve ever been diagnosed with bursitis, it’s possible the Supraspinatus is the true source of your pain, not the shoulder bursa. In this case, the pain does not resolve with typically prescribed anti-inflammatory medications. Another interesting pain referral location of Supraspinatus Trigger Points is the outer portion of the elbow. This pain is often misdiagnosed as Lateral Epicondylitis, more commonly known as “Tennis Elbow.” Working on the computer with no elbow support, carrying a heavy purse or briefcase at your side, or moving heavy objects can overwhelm the Supraspinatus, causing increased incidence of Trigger Points. Use the Pressure Pointer to keep this important muscle healthy and happy.
Teres Major/Minor muscle locations and Trigger Points The Teres major and Teres minor are two muscles that are closely related, and also comprise part of the rotator cuff muscles. Teres minor helps rotate the arm outward, while Teres major helps extend the arm backward and pull the arm down. Teres Major/Minor Referred Pain Patterns Trigger Points in the Teres minor refer pain to a very small and specific area of the back of the shoulder, near the outer edge of the shoulder blade. Numbness and tingling, but not pain, in the fourth and fifth fingers is also commonly associated with Teres minor. Teres major Trigger Points create a feeling of sharp pain in the back of the shoulder and arm, often feeling like pain in the Deltoid muscle. These muscles are small, but important. They become easily fatigued and affected by Trigger Points. Using the Pressure Pointer to treat these muscles can help decrease these symptoms.
Latissimus Dorsi muscle location and Trigger Points The Latissimus
Dorsi is a large, broad muscle that brings the arm down and back. For this reason it is often known as the “swimmer’s muscle.” Trigger Points in the Latissimus Dorsi cause pain in the mid back, below the shoulder blade. They also refer pain to the lower back and stomach. Additionally, they cause pain along the inside of the arm, all the way to the fourth and fifth fingers of the hand. Pain in the fingers, with no numbness, is usually due to the Latissimus Dorsi. Activities which involve repetitive motions of the entire arm, such as swimming, rowing, throwing, tennis, and golf, are common causes of Latissimus Dorsi overuse. Addressing Trigger Points with the Pressure Pointer allows pain free participation in many of these activities.
In addition, please read HAC Topic “A Future Without Chronic Pain”, maybe this information will be helpful, supportive and useful.
Wise words by Dr. Jonathan Kuttner,
MBBCH, Dip O&G, Dip Sports Med, Dip MSM, FRNZCGP, FAFMM, Musculoskeletal Pain Medicine Specialists:“Killing Triggers – There’s a certain kind of trigger treatment I really don’t recommend. It’s called the ‘killer’ trigger point treatment. It’s when someone is so irate at the knots in their muscles that are causing them pain that when they find them they want to kill them. This means: pressing as hard as possible, drilling in, squashing the point, murdering the tight spot. Now, this is not recommended for a variety of reasons. Firstly, attacking the muscle may bring temporary emotional relief (like a ‘gotcha’) feeling. But when you press hard into your muscle, this creates pain, which leads to muscle tension. So you’re actually working against the muscle release…”
Reference:Life After Pain, Killing Triggers by Dr Jonathan Kuttner Alvarez, D.J. and Rockwell, P.G. (2002, February, 15). “Trigger Points: Diagnosis and Management.” American Family Physician, 65/No. 4, Retrieved May 25, 2008 “Fibromyalgia Tender Points Identified”. The American College of Rheumatology in 1990. Retrieved May 25, 2008, “Pressure Pointer Manual” TRIGGER POINTS by Pressure Pointer Dr. Perry Nickelston, “Stop Chasing Pain”, LLC “Trigger Point Maps” by PainClinic.org