Myofascial trigger points

Imagine this: you feel a deep, spreading pain at your right shoulder. It feels better after a good night's rest, but as your day progresses, the knot-like feeling creeps up on you without invitation. The pain is sometimes very intense and sometimes moderate. And you note that sometimes it travels to different areas of your body.

These annoying little knots in our muscles and connective tissues are called myofascial trigger points. The "myo" part of the word means muscle and "fascial" refers to the elastic, connective tissue that runs throughout the body.

There are two basic types of trigger points: active and latent. Latent trigger points don't cause pain except when pressed. When latent trigger points become triggered and awakened by stress or injury, they become active. Active trigger points radiate (or refer) pain from muscle or fascia in a characteristic pattern. For example, trigger points in the shoulders often send pain and tension throughout the shoulders and up into the lower neck. Likewise, trigger points in your buttocks can refer pain down the leg just as in sciatica.

Two doctors, Dr. Janet Travell and Dr.
David Simons, revolutionized our understanding of trigger points. They mapped out the entire body and standardized a pain referral pattern for each muscle. Trigger points usually follow these maps, though some people have unusual pain patterns. In either case, deep breathing, stretching, applications of heat or cold, and massage can help.

A case in point

Travell and Simons say that the shoulders are the area most affected by trigger points. The levator scapula muscle connects your shoulder blade to your neck and is responsible for elevating your shoulder blade. It is especially prone to trigger points, and can refer pain to the neck, around the shoulders and down into the mid-back. Note the picture of the shoulders to the left. If you have pain in the shaded area, you may have trigger points (indicated by the X's) in the levator scapula.

To help relax this muscle, focus on the shoulder area. Breathe deeply and begin to let go of the tension with each exhale. Then inhale, shrug your shoulders up toward your ears, squeeze, and hold them to the count of three. Release them completely on the exhale. Repeat three to five times, then relax and breathe slowly and deeply.