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A Treatise on the Role of Trigger Points in Pain and Spasticity

This article is the first in a series about the role of trigger points in pain and spasticity conditions.

Trigger Points are areas of taut, hyper-contracted bands or nodules within a muscle. They are tender to touch and have a predicted pain referral pattern. These hyper-contracted nodules within the muscle are palpable.

Myofascial pain may be categorized in many ways, but the majority of cases are associated with trigger points. It is important to continue to consider other sources, such as, muscle spasm, muscle tension, and muscle deficiency. Clinicians need to keep in mind that chronic pain may involve all types of soft tissue dysfunction and varied techniques should be incorporated to achieve maximal healing and restoration of function (Kraus H: Muscle deficiency. In Rachlin ES, Rachlin IS, editors Myofascial pain and fibromyalgia, ed. 2, St. Louis 2002, Mosby).

Knowledge of the histology and physiology of muscle is essential to the understanding of trigger points. Most of this information can be found in any modern physiology textbook.

Each muscle is composed of thousands of tiny fibers that make up the bulk of the muscle itself. At various points within a muscle, nerve fibers attach to groups of these tiny muscle fibers. When muscles contract nerve impulses cause groups of muscle fibers to contract or shorten. When muscles relax, the nerve impulse stop and the groups of muscle fibers relax and lengthen

A trigger point is caused by an event that leads to a physiologic malfunction that causes the group of muscle fibers to stay contracted, even when the muscle itself is relaxed. This group of contracted muscle fibers forms a firm nodule, which can affect the muscle in the following ways:

• Increased Muscle Tension: The contracted group of muscle fibers prevents the muscle from completely relaxing, increasing muscle stiffness.
• Muscle Weakness: The presence of the contracted fibers prevents the muscle from contracting fully and smoothly.
• Muscle Fatigue: The constantly contracted group of muscle fibers uses an incredible amount of energy, causing an “energy crisis” for the rest of the muscle fibers.
• Muscle Spasm: A trigger point can be considered a tiny spasm in a muscle. These spasms can collect more groups of muscle fibers as the pathology progresses. This can lead to a full fledged muscle spasm.

The next article will discuss muscle spasm and progression.

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