a) The causes

Myofascial Pain and Trigger Point

Some of the activities and events that create trigger points are obvious, like accidents, falls, strains, and overwork. The onetime episode of overdoing, for example, is notorious for ending in a debilitating pain that long outlasts the event. Everyone occasionally lifts or carries unreasonable loads, ambitiously exercises when out of condition, or hammers away too long and too hard at some unaccustomed work. All of these things constitute abuse of muscles. It would pay to examine the varieties of abuse more closely.

Avoidable Muscle Abuse

The chronic overloading of muscles in work situations is so common nowadays that it has earned a number of fancy labels. We call it overuse syndrome, repetitive motion injury, repetitive strain, cumulative trauma disorder and occupational myalgia. All these terms look good on an insurance claim, but none of them mean anything other than that you’ve worked a group of muscles beyond their endurance and now they’re making you pay for it.

It’s important to look critically at a work situation that causes the overuse of muscles and results in myofascial pain. Trigger points are usually easy enough to deal with, but they tend to come righ back if you don’t change the conditions that bring them on. On the job, toughtless positioning the body is clearly hazardous when it causes strain, inefficient movement, and poor body mechanics. Maintaining an awkward position to long, habitual muscle tension, disregard of efficient methods, and reluctance to take rest breaks are some of the things you need to work on if you hope to end the pain that comes from overwork. Lack of commitment to making improvements may be the biggest obstacle of all.

Along with flagrant, mindless overwork, there are other less obvious ways to abuse muscles and create trigger points. Being overweight and out of shape can set you up for overstressed muscles. Carrying an overloaded purse or backpack just invites trouble. Carrying a fat billfolf in the back pocket is famous as a cause of sciatica, which is pain from the sciatic nerve itself and from the trigger point in buttock muscles, both created by pressure from the billfold (1999, 139, 147, 175, 182). Muscles of the back, neck, and hips can be severely stressed by the postures dictated by car seats, chairs, and other furniture designed for appearance instead of good support.

Unavoidable Muscle Abuse

Trigger points are also created in muscles when they suffer direct impact in accidents such as falls and auto collisons. The sudden wrenching movements that occur during these events, when muscles are either overcontracted or overstretched, can also be expected to result in trigger points. Trigger points are the major source of the pain of whiplash, though they often go unsuspected and unaddressed. They generally accompany fractures, muscle tears, sprains, and dislocations. Failure to recognize and treat trigger points as an inevitable part of any physical injury causes needless pain and can defer complete recovery indefinitely (1999, 437-439).

Unsuspected Muscle Abuse

According to Travell and Simons, many kinds of medical treatments can be unrecognized causes of trigger points and myofascial pain. Trigger points are sure to be provoked by the immobility imposed by braces, slings, and casts. When surgery leaves long-term residual pain, trigger points should be suspected in muscles that have been cut, stretched, or otherwise traumatized. Physicians may persist in trying to treat the site of the pain, not recognizing it as referred pain, and consequently overlook and fail to attend to the cause.

An ordinary injection in the gluteal muscle can set up trigger points, particularly in the gluteus minimus, leaving a patient with a mysterious agonising case of sciatica that can last for months.

Steroids injected into painful joints, though seeming to bring relief, may not be an appropriate treatment when the pain is of myofascial origin. The trouble is that the patient, thinking he or she has been cured, goes unmindfully on with the stressfull activity that caused the trouble in the first place. The critical trigger points go untreated and continue to pull incessantly on the bones of the joint, ultimately making the problem worse. Steroids themselves, if overused, can seriously degrade the connective tissue (fascia) of bones, muscles, ligaments, and tendons. Surgery may even be called for to repair the damage.

Pain medications continue to be the treatment of choice because they work so well in reducing the awarness of pain. But pain must always be viewed as a warning that something is wrong and needs attention : it’s not enough to murder the messenger and ignore the message. Many people, concerned about unknown side effects, are becoming leery of all medications or foreign substances put into or taken into the body. Medical history is full of tragic examples of the truth about a prescription drug coming out too late. It’s not unreasonable to wonder wheter your presription for pain, depression, anxiety, or such conditions as high blood pressure may cause more illness than it cures.

As an example, Travell and Simons tell about research indicating that calcium channel blockers for hypertension appear to irritate and perpetuate trigger points. In other words, your high blood pressure medicine may be worsening your pain (1999, 75). Sidney Wolfe, in Worst Pills, Best Pills (Wolfe et al. 1999), lists scores of drugs that are known to have the potential for causing muscle pain as a side effect. If you have a prescription drug for any reason, it would be worth your while to get this valuable book and study it thoroughly.

Source : Clair Davies, The Trigger Point Therapy Workbook, p.26-28.