aa) Perpetuating Factors

Trigger points can sometimes be very difficult to get rid of. You may find that after you’ve successfully deactivated them, they seem to come right back. The influence of perpetuating factors on myofascial pain is seriously underestimated, not only by the sufferer, but also by many therapists. Management of perpetuating factors often makes the difference in wether treatment will succeed and wether its benefits will last. A perpetuating factor is sometimes so important that its removal can allow a trigger point to deactivate on its own. Some systemic factors, such as vitamin deficiency, are so strong that they can be the initiating circumstance in the creation of trigger points (1999, 179).

Physical Factors

Congenital irregularities in bone structure, like Morton's toe, postural stress, poor work habits, repetitive strain, and lack of exercise can all contribute to the difficulty in getting rid of trigger points…

Vitamins and minerals

Travell and Simons state that nearly half the patients they treated for chronic pain were found to be lacking certain vitamins or minerals that are necessary for lasting relief. These critical nutrients include vitamins B₁, B₆, and B₁₂, vitamin C, and folic acid. The minerals calcium, iron, magnesium, and potassium are also critically important. Groups of people who are especially likely to be deficient in these are the elderly, pregnant women, dieters, the economically disadvantaged, the emotionally depressed, and people who are seriously ill. The problem in many cases is not an inadequate ingestion of vitamins and minerals, but the intake of other substances that cause their elimination... Magnesium is needed in conjunction with the body’s use of calcium. Low levels of magnesium are associated with muscle hyperexcitability and weakness...

Metabolic Disorders

You’re likely to have trouble getting rid of your trigger points when any chemical or glandular imbalance interferes with the metabolism in the muscles. Some conditions to watch out for are thyroid inadequacy, hypoglycemia, anemia, and high levels of uric acid in the blood (uricemia). Nicotine, caffeine, and alcohol cause enough irregularity in the metabolism to make it difficult to keep trigger points deactivaated (1999, 213-220)…

Psychological Factors

Tension, anxiety, and everyday nervousness can make trigger point therapy ineffective. Habitually holding your muscles tight (bracing) never gives them a chance to rest, not even at night when you’re sleeping. A tight muscle is working continuously, and the tightness should be considered a form of overuse. You may not be aware of just how much muscle tension you’re holding on to. Relaxing your muscles won’t get rid of your trigger points, but i twill allow therapy to work better…

Other factors

A number of other influences may affect your success with trigger point therapy. Chronic lack of sleep can be an important factor. Diseases of internal organs can produce and perpetuate trigger points in muscles. Chronic infections, including sinusitis, can keep trigger points going. An allergy to airborne irritants that causes respiratory distress can make it very difficult to keep up with trigger points in the neck, chest, and abdomen. Food allergies can make all the muscles of the body more vulnerable to stress. Infestation of the intestinal tract can perpetuate trigger points indirectly through depletion of essential nutrients. Infestation can be insidious and are more common than you may think (1999, 22-226).

You can’t depend on your control of perpetuating factors alone to get rid of your trigger points and myofascial pain. You may even fin dit hard to judge whether your control of perpetuating factors is having an effect. But keep an open mind and keep exploring. You may happen onto the one factor that makes all the difference.

Source : Clair Davies, The Trigger Point Therapy Workbook, p.29-32.