Myofascial Trigger Points
Understanding these painful muscle knots, often the source of local pain or pain referred elsewhere in the body.
What Is a Trigger Point?
A myofascial trigger point is a small, hyperirritable spot located within a taut band of muscle fibers. On palpation, it feels like a tender nodule, sometimes felt under the fingers, and pressing on it reproduces or intensifies the patient's pain.
These points can develop after an injury, repetitive mechanical strain (prolonged posture, repetitive movements), lack of physical activity, or a prolonged period of stress. They are common in the trapezius, suboccipital, and paraspinal muscles, as well as in muscles near joints stressed by sports activity.
Active or Latent Trigger Point?
- Active trigger point: spontaneously painful, causing local or referred pain (for example, a trigger point in the upper trapezius can refer pain to the temple).
- Latent trigger point: not painful at rest, but tender to pressure and responsible for stiffness or restricted range of motion.
Why Do They Sustain Chronic Pain?
An untreated trigger point keeps the muscle in a state of constant tension. This tension can create "satellite" trigger points in neighboring or compensating muscles, which explains why some pain persists despite rest, stretching, or superficial massage: these approaches relieve tension temporarily without always deactivating the trigger point itself.
How Are Trigger Points Treated?
Two complementary approaches are used to treat trigger points:
- Manual therapy: sustained pressure, myofascial stretching, and release techniques.
- Dry Needling: direct needling of the trigger point, which allows more precise access to deep fibers and often triggers a faster release response than manual techniques alone.
The choice of technique depends on the location of the trigger point, its depth, and patient tolerance. A clinical assessment is performed before any needling to precisely identify the muscles involved.