Myofascial Trigger Points (MTrPs) Almost all of us suffer from trigger points. MTrPs are clinically diagnosed as palpable taut bands in the muscle that are tender when pressed. Often, these trigger points refer lightning pain in distant areas and pain with stretching. A local twitch response with acupuncture confirms active MTrPs. MTrPs have been found in 147 different muscles. Here's how I like to destroy these obnoxious knots...
Headaches, rotator cuff pain, tennis elbow, carpal tunnel syndrome, repetitive strain injuries, sciatica, plantar fasciitis, frozen shoulder, back, neck, hip, pelvic, arm, hand, jaw, shoulder and leg pain can all be from MTrPs. Biopsies show MTrPs are larger and darker than normal muscle tissue fibers. They also have spontaneous electrical activity versus adjacent muscles with no trigger points. Referred organ pain and fibromyalgia should not be confused with MTrPs because they have a different pathology.
How Do They Form? MTrPs come from excess acetylcholine, abbreviated ACh, in the muscle fibers. ACh helps our muscles and brain be alert and active, but too much leads to clumps of ACh causing the painful muscle knots. Acetylcholine enzyme or AChE is a molecule that eats up excess ACh to prevent the formation of MTrPs.
ATP (adenosine triphosphate), which is cellular energy, is directly responsible for preventing excess ACh. So, if your cells don’t have the proper energy stores, ACh builds up, causing muscle cramps. Gene mutations can also cause AChE deficiency. Psychological stress, physical stress, lack of sleep, pesticides, nicotine and psychedelic mushrooms cause these gene mutations and act against AChE. Tight muscles are among the most clinically viable reasons we find MTrPs. They physically compress nerves, which reduces the ability of AChE and ATP.
Tight muscles cramp down on blood vessels causing a lack of oxygen. This can come from a variety of perpetuating factors including forward head posture, leg length inequalities, scoliosis, pelvic torsion, joint hypermobility, ergonomic stressors, and low level static exertions from job occupation. A study showed that sustained low level muscle contractions during continuous typing for as little as 30 minutes commonly resulted in the formation of MTrPs. Office workers, musicians, dentists and anyone else with a job that requires repetitive low level muscle activity are at high risk for developing MTrPs. Evidence is not conclusive whether weightlifting can cause MTrPs. However, maximal weightlifting can cause muscles to become so tight they cut off oxygen supply, resulting in MTrPs. Accidents also cause MTrPs. A retrospective review found 80 percent of 1,096 subjects involved in low velocity collisions had trigger points.
What Can You Do About It? Diet—Proper diet significantly changes the chemical imbalance that leads to MTrPs. Avoiding substances that build more ACh is helpful. This includes excess caffeine and nicotine. Too much acidity in the body or consuming acid forming foods should be avoided. Lower pH (acidosis) increases the amino acid CGRP (calcitonin gene-related peptide), which creates more space for ACh, which you don’t want. Not enough hemoglobin and iron in your blood can directly cause hypoxia or low oxygen, which contributes to MTrPs.
Janet Travell, M.D., who pioneered the study of MTrPs, found a strong correlation between vitamin deficiencies and MTrPs. Insufficiencies of iron, calcium, magnesium, zinc, folic acid, B12, B6, C and D have shown in many studies to increase MTrPs. Ask a qualified practitioner to help you identify which vitamins you might need to supplement with if you have MTrPs. An estimated 16 percent of patients with MTrPs have vitamin B deficiency and 90 percent have low vitamin D. Hypothyroidism and statin drugs also show strong correlation of perpetuating MTrPs.
Lavender, lemon balm, kava kava, rosemary, skullcap, passionflower, rose and valerian all contain the chemical linalool, which has been shown to inhibit the release of ACh. So try some herbs that contain these. However, I highly recommend against the ingestion of essential oils. Many Chinese herbs contain these products. THC from marijuana also contains linalool, although the herb’s efficacy may be due to the THC plugging into the same receptor as ACh and not actually inhibiting ACh itself. Smoking of any type reduces oxygen and encourages painful MTrPs.
Many case studies show patients who responded weakly to manual or needle therapies responded better when they added proper supplementation with the same treatments. Patients who continued supplementation showed no relapse.
Medical Acupuncture—The million dollar question I always get is, “How in the heck does sticking a needle into the muscle help with MTrPs?” Needling causes two main phenomenons. First, It physically stretches the muscle. Second, it causes a chemical reaction within the nerves in the muscles. Both physical therapy and a technique called “Pin and Stretch” plus needling techniques causes the muscles to lengthen. This decreases pressure on the nerves and allows oxygen to flow allowing ATP to eat up excess ACh.
Needling into designated acupuncture points that are near MTrPs (what we call “distal points”) affects A delta fibers, which causes the brain to release natural opioids. It also causes what we call an “Inflammatory Soup,” which is a myriad of cells and chemicals that help increase blood circulation, decrease pain and chemical homeostasis. Read more about this process on my website under “Medical Acupuncture.” Physical therapists are not allowed to needle into these distal points in the state of Colorado.
This chemical reaction to the needle lasts up to 72 hours and can cause permanent reversal of symptoms if treatment is continued for at least 7 sessions. Adding an electrical current to the acupuncture needle further enhances ATP production to decrease MTrPs. Laser is effective for short-term relief of MTrPs and TENs showed immediate relief but not much beyond that. Medical acupuncture, deep dry needling and shallow dry needling (all forms of needling that must include the needle to penetrate the MTrP) all proved effective to diminish MTrPs in studies.
Researchers discovered that the key to relief is allowing the needle to retain for at least 10 minutes. The group that performed the best in this study was the group that did any of the above needling techniques plus a stretching routine and proper supplementation. Through valid research, training and my experiences in China, I see that patients who take on a holistic approach to the trigger point epidemic have the best results. This is why I insist on performing a whole medical acupuncture treatment. I examine blood results to determine vitamin and dietary insufficiencies. I include in my treatments trigger point dry needling plus distal points, and I consult my patients on the importance of diet and proper exercise. This winning combination has proved to work extremely well for patients I see in my clinic in Evergreen, plus all the patients I treated in China!