Trigger Points and Referral Pain

You’re receiving a deep tissue massage.  So far, you’ve experienced a good hurt with each heavy glide from your massage therapist.  It’s been an overall relaxing session… and then suddenly you feel a sharp pain radiating from your shoulder blade, down your arm, and into the tip of your pinky.

Ouch!  What was that?

That hyperirritable little nodule is what’s known as a trigger point.  Trigger points are tender spots located in the myofascial layer atop tight muscular tissue.  Direct compression, especially deep pressure, can cause a sudden burst of pain to travel from the palpated area to a seemingly unrelated part of the body.

Ok, but why does the pain travel to another part of the body?  What happens when a trigger point goes untreated?  How do we release trigger points?

Referred Pain Patterns

Always at work, there is a network of interconnecting sensory nerves carrying signals to your brain to keep your body functioning.

At the 1-minute mark on the video below, you’ll see some images of commonly felt referral pain pathways.  Has your therapist ever prodded at one of these trigger points shown below and sent referral pain in these patterns?

Results of Untreated Trigger Points

These radiating points aren’t just nasty when you press down on them.  Their presence alone does some other unkind things to your body, and the effects can worsen overtime if the trigger point goes untreated.

Trigger points are found in tight muscular tissue, and these taut bands restrict movement in the affected muscle groups.  If a muscle becomes so tight that it prevents full range of motion, its surrounding tissues will weaken and be at higher risk for injury.

The palpated location of the trigger point isn’t the only area affected, though.  The referral pain pathways indicate another issue.  The area in which the referral pain ends is also impacted by the trigger point.  For example, if pressure is applied to a trigger point on the neck and pain radiates into your temporalis and jaw muscles, this particular sensitive spot can lead to headaches and chronic jaw pain if it isn’t removed.

Trigger Point Treatment

Have you ever heard of trigger point therapy?

Trigger point therapy, though effective, isn’t always the most pleasant bodywork modality to receive (unless you’re one of those weirdies like myself and think it feels amazing).

During this type of bodywork session, the trigger point is either rubbed or pressed into submission.  A massage therapist may use an elbow, fist, finger(s), or massage tool (such a T-bar or massage gun) on the pinpointed area.  The intense pressure increases circulation to the tight contracted area, and the delivery of oxygen-rich blood flushes waste materials out of the trigger point.  We’ll touch base on the significance of the waste material buildup in the next section.

Sometimes all it takes is one 10-second-long elbow-stab into the tender spot for the pain to diminish, and it’s pretty awesome when that’s the case!  Usually, however, the trigger point has to be pressed multiple times before pain subsides and muscular function – in both the site of the trigger point and the site of referred pain – improves.  If the idea of repetitive digs into a sensitive spot sounds torturous, don’t fret too much!  Therapists will only sink into a trigger point until you’ve reached your pain threshold, and once you’re there you’ll be asked to take a deep breath while they slowly remove the pressure from your trigger point site.  A good therapist will never subject you to crippling pain, let alone force you to stick it out.

Other than localized pressure application, heat therapy can also be incorporated into trigger point therapy to make the modality more tolerable.  Heat, a natural analgesic, can help relax and loosen the trigger point area before the more intense work begins.

Waste Material in Muscular Tissue

Waste materials?  How did you get waste materials in your muscular tissue and why are they causing trigger points?

Lactic acid, a normal byproduct of muscular activity, fuels cells when they’re working harder than usual.  When muscles are overused or overcompensating for weaker muscular tissue, this buildup of lactic acid becomes a trapped waste product blocking adequate blood flow to the muscle.  When this congestion occurs, the muscles and the protective fascial layer encasing them can’t receive adequate oxygen and nutrients from the blood.  Nutrient deprived fascia compresses not only on the muscle it encapsulates, but also on the nerves in between itself and the muscular tissue.

Remember when we talked about that network on interconnecting sensory nerves and their referral pain patterns?  Now you know those sharp radiating twitches are a result of lactic acid buildup!

Now You Know!

So, what can you do to stop the lactic acid from building up before it causes dysfunction at the sites of trigger points and the areas they refer to?

• Try not to overexert your muscles!
  • And if you do, get those tight muscles massaged!
• Get your weak muscles strengthened so the surrounding ones don’t have to pick up the slack!
  • But remember, don’t overdo that strength training
• Be mindful of posture .  A well-aligned body is at lower risk of injury!

Stay happy, healthy, and keep those trigger points under control!

Resources

Dydyk, A.M. and Conermann, T. (2020). Chronic pain. [online] PubMed. Available at: https://www.ncbi.nlm.nih.gov/books/NBK553030/.

Hammi, C., Schroeder, J.D. and Yeung, B. (2022). Trigger Point Injection. [online] PubMed. Available at: https://www.ncbi.nlm.nih.gov/books/NBK542196/.

Katherine (2018). Referred Pain from Trigger Points – Rebalance PT Philadelphia PA. [online] Rebalance Physical Therapy and Wellness. Available at: https://www.rebalancept.com/referred-pain-trigger-points/.

V, D.-G., Ts, P., P, H. and T, G.-N. (2016). Pressure-induced Referred Pain Is Expanded by Persistent Soreness. [online] Pain. Available at: https://pubmed.ncbi.nlm.nih.gov/26808146/.

Photo Credit

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