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October 10th, 2016

What is a Trigger Point?

by Kristin Stromberg, ATC

What are these knots in my back and neck?? Are these normal? How do I get rid of them? This is a very popular question that we get asked here in the office at North Shore Pro-Active Health. Before we answer the question above let us talk about how muscle fibers work. Within skeletal muscle there are three types of fiber. Type one (I), type two A (IIa) and type two B (IIb). Each fiber types has different qualities in the way they perform and how quickly they fatigue.

Types of Trigger Points

Type I fibers are also known as slow twitch fibers. They are red in color due to the presence of large volumes of myoglobin (iron-oxygen binding protein) and high numbers of Mitochondria (power house of the cell). They are very resistant to fatigue and are capable of producing repeated low-level contractions by producing large amounts of ATP (Adenosine triphosphate) through an aerobic metabolic cycle. The muscles containing mainly type I fibers are often postural muscles such as those in the neck and spine due to their endurance capabilities.

Type IIa fibers are also sometimes known as fast oxidative fibres and are a hybrid of type I and II fibers. These fibers contain a large number of mitochondria and Myoglobin, hence their red colour. They manufacture and split ATP at a fast rate by utilising both aerobic and anaerobic metabolism and so produce fast, strong muscle contractions, although they are more prone to fatigue than type I fibers.

Type IIb often known as fast glycolytic fibers they are white in colour due to a low level of myoglobin and also contain few mitochondria. They produce ATP at a slow rate by anaerobic metabolism and break it down very quickly. This results in short, fast bursts of power and rapid fatigue. As mentioned above, this type of fiber can be turned into type IIa fibers by resistance training. This is a positive change due to the increased fatigue resistance of type IIa fibers. These fibers are found in large quantities in the muscles of the arms.

Muscles make up between 36-42% of body weight, on average. They are a large percentage of our total weight and have a corresponding impact on our health. When all is in working order, muscles allow us to perform normal activities with ease. When our muscles harbor trigger points, we experience pain, stiffness and tension, physical limitation and loss of normal function.

Factors commonly cited as predisposing to trigger point formation include but are not limited to: de-conditioning, poor posture, repetitive mechanical stress, mechanical imbalance (e.g. leg length inequality), joint disorders, non-restorative sleep, vitamin deficiencies, muscle clenching and tensing due to emotional/mental stress, direct injury or being inactive for long periods of time such as sitting or bed rest.

Active Trigger Points versus Dormant Trigger Points

After forming, trigger points have two phases, active and dormant. The active, painful phase of the trigger point is the one which produces the unrelenting, debilitating pain symptoms and which motivates people to seek relief. The active trigger point hurts when pressed with a finger and causes pain around it and in other areas. It causes the muscle in which it’s located to be weak and due to the taut bands, to have limited flexibility. The active trigger point referral symptom may feel like a dull ache, deep, pressing pain, burning, or a sensation of numbness and fatigue. The affected dense, shortened muscles, laden with taut bands may even compress and entrap nerves, leading to another secondary set of symptoms. If unaddressed or ineffectively treated, eventually, other muscles around the dysfunctional one may be required to “take up the slack”, becoming stressed and developing secondary trigger points. It is not unusual for chronic pain patients to have multiple, overlapping referred pain patterns, making diagnosis and treatment more complex.

Trigger points can also lie quietly in muscles, sometimes for years. This type of trigger point is called dormant or in-active. These trigger points are very common. Unless you press on the trigger point and feel the tenderness, you probably don’t know they are there. Most people have at least a few. They may persist for years after apparent recovery from injury. Dormant trigger points cause; restricted movement, distorted muscle movement patterns, stiffness and weakness of the affected muscle and generally do not cause pain unless compressed.

How Many Trigger Points Can I Have?

Since a trigger point is an abnormal biochemical and mechanical area in contracted muscle tissue, the number and exact location on each person can vary.  All muscle tissue is potentially prone to developing trigger points. Sometimes people have one trigger point but more often they have many. Prolonged referral of pain and weakness from a one trigger point to another area of the body will generally cause other trigger points to develop in that area. These, in turn, if left untreated, can activate and also refer pain, creating multiple pain patterns. The more areas that have pain and the longer you have had the pain, the more trigger points you are likely to have. It is rare for someone with pain to only have one or two muscles with trigger points.

What Can I Do For My Trigger Points?

Here at North Shore Pro-Active Health we see patients every day that deal with some sort of trigger point issue. Whether it is in their neck, low back, forearm, calf or hamstrings there are ways to help reduce the symptoms of pain and correct the muscles so they do not come back again. A few tools we use in the office are foam rollers, lacrosse balls and Tiger Tails. These are items that can be used at home on a daily basis or if there is going to be a lot of travel and then the patient can do self care. We also encourage trigger point release massage with our massage therapist. The length of time can be from 60 minutes to 90 minutes depending on how severe the pain is for the patient.

If you have any questions or concerns please call the office at 847-362-4476 for a free consultation and also mention this blog to receive 15% off either a Tiger Tail or Foam roller!

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