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The entire body system is covered by a thin layer of connective tissue called fascia, which acts as an interconnected network within the body. When the fascia is healthy, it moves freely and stretches with body movement. Myofascial pain occurs when there is inflammation or irritation to the fascia, causing inhibited movement and discomfort. This pain is characterized by the presence of muscular trigger points.
Trigger points are hyperirritable spots felt in taut bands of skeletal muscle, often referred to as “knots”. When pressed, these spots elicit pain locally and may cause referred pain. Trigger points can restrict range of motion, inhibit normal movement, and contribute to poor posture.
Trigger points may be active or latent in nature, depending on their clinical presentation. Active trigger points are felt at rest, are painful with compression and follow a referred pain pattern. Latent trigger points are present when direct pressure is applied to the exact area, which results in localized pain, but relieved once pressure is removed (Alvarez et al, 2002).
Pain may be felt constantly, when direct pressure is applied, or when the affected area is moved, and can be deep, dull aching, tingling, or burning in nature (Bordoni et al, 2023). Persistent pain may decrease the range of motion of the affected muscle.
Trigger points affect the shoulders, neck and pelvic girdle most frequently. Pain may radiate into a point other than the location of the trigger point itself. For example, pain in the low back may be caused by a trigger point in the gluteus maximus or medius. Due to this radiating pattern, trigger points may present as other ailments, and must be considered as a possible source of pain upon evaluation.
Myofascial trigger points can be located by direct palpation of the tender or painful areas of the patient. When moving your fingers perpendicular to the muscle fibers typically a knot is felt compared to the soft tissue surrounding it.
Several diagnostic tools may be utilized to determine the presence of trigger points in the muscle. Ultrasound imaging is often used to analyze the thickness and consistency of muscle and its mobility between tissue layers, looking for focal nodules in the muscle, indicative of trigger points. Electromyography (EMG) is used at both rest and during activity to measure the muscle response or electrical activity in response to a nerve's stimulation of the muscle (Bordoni et al, 2023).
Pharmaceutical interventions include analgesics and medications that aim to induce sleep and relax muscles. Non-steroidal anti-inflammatory medications (NSAIDs) may also be used to address pain associated with trigger points.
Active and passive stretching of the affected body region can lengthen the taut muscle and relieve myofascial pain. Stretching improves range of motion, reduces stress and muscle tone, both relieving active trigger points while preventing additional tender areas from forming.
Postural adjustments work to elongate tensioned, shortened muscle, commonly seen in the presence of myofascial pain and trigger points while strengthening antagonist muscles to restore proper alignment and function.
Ultrasound, with its deep- heating thermal effects, in combination with additional modalities, may be successful at decreasing muscle spasm and pain and stimulating healing (Bordoni et al, 2023).
OMM treatment focuses on the manipulation of muscle and joints to restore normal alignment, release accompanying muscle tension and improve myofascial pain patterns associated with somatic dysfunctions.
Direct pressure is applied at varying degrees to tender areas to restore normal circulation and mobility, improve function and decrease pain, relieving symptoms both locally and referred.
Dry needling, which involves the insertion of a needle directly into the trigger points, can reduce myofascial pain. Lidocaine may be injected directly into the trigger point, effectively inactivating the point of tension. Relief may be felt in as little as one session or may take multiple visits to achieve desired response.
Alvarez DJ, Rockwell PG. Trigger points: diagnosis and management. Am Fam Physician. 2002 Feb 15;65(4):653-60. PMID: 11871683.
Bordoni B, Sugumar K, Varacallo M. Myofascial Pain. 2023 Aug 4. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2023 Jan–. PMID: 30570965.