According to pain clinics, most common everyday aches and pains are caused by small contraction knots in the muscle tissue called myofascial trigger points. Pain is often misdiagnosed because the referred pain from the trigger points mimics the symptoms of many common diseases and conditions including hypothyroidism and fibromyalgia.
Trigger points are known to cause:
- Dizziness, imbalance, nausea, headaches, migraines
- Neck and jaw pain
- Low back pain, scoliosis
- Tennis elbow and symptoms of carpal tunnel syndrome
- Stiffness and pain in the joints such as knuckles, wrists, elbows, shoulders, knees and hips can be mistakenly attributed to arthritis, tendinitis, bursitis or ligament injury
- Specific muscle weakness
- Irregular heartbeat, chest and false heart pain
- Red eyes, excessive tearing and salvation, blurred vision, droopy eyelid
- Sore legs, feet and painful ankles
- Sinus pain and congestion, persistent nasal secretion
- Impaired movement and reduced range of motion by keeping muscles short and stiff
- Impaired coordination, stumbling and dropping things unexpectedly that can be mistaken for neurological health issues
- Pelvic pain, pain during intercourse
At the same time, muscle pain, stiffness, weakness, muscle cramps, nerve pain, arthritis like symptoms, pain on exertion, aching muscles and joints are also common symptoms of mild and subclinical hypothyroidism. Muscle changes occurring due to hypothyroidism can be reflected in the clinical signs of weakness and fatigue.
Moreover, about 15% of people with hypothyroidism are diagnosed with fibromyalgia, a condition that is characterized by musculoskeletal pain, non-restorative sleep and fatigue. The pain can be severe and affect multiple muscles, tendons, ligaments and soft tissues.
One of the official criteria for diagnosis of fibromyalgia is presence of tender points. It is not a well-known fact, that nearly all fibromyalgia patients have myofascial trigger points that contribute to their pain. Some patients are diagnosed as having fibromyalgia when in fact they only have multiple trigger points that can be successfully treated.
Difference between tender and trigger points
Fibromyalgia and myofascial pain syndrome are two separate medical conditions that both can cause severe muscle pain and frequently coexist but need a different treatment approach.
There is a clear clinical difference between trigger and tender points:
|Tender points/Fibromyalgia||Trigger points/Myofascial pain syndrome|
|Cause only local pain but can increase general body sensitivity to pain||Cause referral pain|
|Pain on touch||Need firm pressure to elicit pain|
|Dysfunction of central nervous system with generalized disturbance of how pain is processed. No palpable or pathological evidence that muscular fibre is involved||Musculoskeletal condition. Palpable knots or small lumps in the skeletal muscle fibers|
|No measurable electrical signals||Emit distinctive electrical signals that can be measured|
|Cannot be seen||Can be photographed in muscle tissue using electron microscope|
|Are located at 18 specific points of the body||Anywhere in the body and always occur at the midpoint of the skeletal muscle fibers|
|On average temperature is 0.65 grad C lower than in trigger points||Higher temperature due to increased metabolic activity|
|No muscle weakness||Muscle weakness|
|Muscle can be strengthened||Muscle strengthening makes condition worse|
How trigger points cause pain
A trigger point affects muscle by keeping it both tight and weak. When the muscle has a trigger point it becomes weaker, shorter, cannot stretch and it loses its range of motion.
The constant tightness and tension of the fibers of the trigger point itself, restrict circulation in its immediate area and inhibits the delivery of nutrients and oxygen as well as removal of the by-products of metabolism. As a result, trigger points can perpetuate for months or years until the patient receives a treatment.
Types of pain caused by trigger points
Referred pain feels as a deep ache and can be very intense. The pain level depends more on the trigger point irritability than on the size of the muscle. Metabolic factors such as underactive thyroid and anemia (folate, iron and/or B12 deficiency which often accompany hypothyroidism) additionally increase the irritability of trigger points. Despite this fact, mainstream medicine seldom considers multiple muscles with myofascial trigger points in hypothyroid patients as a manifestation of thyroid disease.
Nerve pain. Muscles that have been shortened and enlarged by trigger points frequently squeeze nearby nerves and nerves that pass through a muscle. Nerve compression can misguide the electrical signals that travel along it, resulting in abnormal sensations such as numbness, tingling, burning and hypersensitivity in the areas affected by the nerve.
This is a very common occurrence in the arms and hands, but also in the legs and feet which can be mistakenly diagnosed as peripheral neuropathy resulting in inappropriate treatment or unnecessary surgery.
Cold and swollen extremities. Trigger points can also cause a muscle clamp down on the blood flow in an artery, making a distant body part such as hands and feet feel cold and result in a swollen ankle, foot, wrist and hand. These patients also frequently feel cold and have a reduced basal temperature as do patients with hypothyroidism.
Back pain always has myofascial involvement. Although arthritis of the spine, herniated disks and displaced vertebrae are the first to check for when the back hurts, in most cases back pain is a referred pain from myofascial trigger points. Back pain treatment often fails when myofascial trigger points are not considered as a possible cause.
What causes trigger points:
- Mechanical stress due to skeletal stress, body disproportion, nerve impingement, muscles overloading and repetitive movements or work
- Nutritional deficiencies due to digestive disorders, celiac disease, chronic health conditions, dieting, excessive alcohol consumption and food allergies. Low or low normal levels of vitamins B1, B6, B12, C, folic acid and iron, calcium, potassium and several trace elements which are essential for normal muscle function.
- Metabolic and endocrine abnormalities such as subclinical or mild hypothyroidism, high levels of uric acid, estrogen imbalance and low blood sugar (hypoglycaemia).
- Psychological factors such as depression, anxiety, tension, feeling of hopelessness, behaviour and sleep disturbances.
- Viral or bacterial chronic infection.
To archive the long lasting pain relief it is important to find and treat the cause of trigger points. All factors listed above contribute to myofascial pain and reduce treatment effectiveness if not corrected.
Myofascial pain syndrome caused by muscle overload or unusual physical activity can revert spontaneously to a latent trigger point within one or two weeks provided the affected muscle is not overstressed. If metabolic factors are involved and not corrected, trigger points can be reactivated again by the same stress and the patient can develop chronic myofascial pain.
According to Dr. John C. Lowe, the majority of fibromyalgia patients have thyroid hormone resistance that is the main cause of fibromyalgia and also can trigger and reactivate latent trigger points. He introduced his simple but very effective natural treatment for fibromyalgia and had successfully treated thousands of patients.
Most conventional pain treatments are based on the assumption that the cause of pain will be found at the site of the pain, however trigger points almost always send their pain to other parts of the body. While it is a local problem, it is routinely treated with pharmaceuticals for the whole body which in reality only mask the problem.
Doctors are using drugs as a primary treatment for pain and often dismiss the fact that all pain medications have potential adverse side effects including muscle and joint pain. Despite its common occurrence, most physicians are uninformed about trigger points. Misdiagnosis of pain and ineffective treatments often result in unnecessary surgeries and diminished quality of life.
Although, there were numerous publications on trigger points in medical journals during the last 60 years, the majority of doctors are not familiar with this research. In The trigger point manual which was first published in 1983, doctors Travell and Simons list 24 examples of mistaken diagnoses that are likely to be made when a physician is unaware about myofascial trigger points.
The manual is written for medical professionals and is focused on two clinical methods that can be performed only in the doctor’s office:
- Local injections of trigger points with anesthetic procaine or lidocaine to reduce the post-injection pain
- Spray and stretch method where refrigerant spray is applied to the skin before stretching
Proper treatment of hypothyroidism and addressing of other contributing factors makes trigger points more responsive to physical therapy, treatment with injections and can result in its considerable reduction.
Dry needling is another method for myofascial pain relief that combines acupuncture techniques and identification of trigger points using the acupuncture needles. To be effective the trigger point need to be accurately localized. Dry needling causes less tissue damage and pain compared to injections.
How does trigger points massage work?
Trigger point massage is the most effective treatment for myofascial pain which is used by massage therapists for the relief of pain and is based almost entirely on Dr Travell research.
- It breaks into the chemical and neurological feedback loop that maintains the muscle contraction
- It increases circulation that has been restricted by the contracted tissue
- It directly stretches the trigger point’s knotted muscle fibers
What to expect from trigger points massage?
- Significant relief of symptoms often comes in just minutes
- Most problems can be eliminated within three to ten days
- Even long lasting chronic conditions such as fibromyalgia, chronic fatigue or widespread myofascial pain syndrome can be significantly improved and in the best cases clear up in as little as six weeks.
- Massage of trigger points in forearms, shoulder and neck is proven always to take away the pain and numbness in hands and fingers.
The problems caused by trigger points can be surprisingly easy to fix. In fact, most people can do it themselves if they have the right information. Once you know where to look, trigger points are easily located by touch and deactivated by hands.
Trigger Point Self-Treatment System is based on work published by Travell and Simons and is a more practical and cost effective approach to pain therapy. It is a self-instructional guidebook with a complimentary video that is designed for patients who want to learn self-massage techniques that is directed specifically at trigger points.
The guidebook provides you with numerous illustrations and hands-on techniques on how to find trigger points and deactivate it using massage techniques and some tools that help to control the depth of pressure and prevent damage to the hands. It is a comprehensive method for dealing with trigger points located anywhere in the body that any patient can understand and use.
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Fibromyalgia and muscle pain, Revised Edition: What causes it, how it feels and what to do about it by L. Chaitow, Thorsons, 1999
Pain Free 1-2-3: A Proven Program for Eliminating Chronic Pain Now by Dr. J. Teitelbaum, McGraw-Hill, 2005
Myofascial pain and dysfunction. The trigger point manual. Volume 1. Upper half of body by D.G. Simons, J.G. Travell, L.S. Simons, Lippincott Williams & Wilkins, 1999
Myofascial pain and dysfunction. The trigger point manual. Volume 2. The lower extremities by D.G. Simons, J.G. Travell, Lippincott Williams & Wilkins, 1992
The trigger point therapy workbook: Your self-treatment guide for pain relief by C. Davies, D.G. Simons, A. Davies, New Harbinger Publications, 2004