What Causes Chronic Muscle Pain Problems and What are Trigger Points?

Self Care for Your Chronic Pain

By Dr. Greg Fors

The most common cause of chronic pain is the muscles and joints of the musculoskeletal system. According to a study published by the American College of Rheumatology, at any time about 75 million adults in the U.S. are affected by pain and stiffness of the musculoskeletal system. Muscle and joint pain disorders are the leading cause of work related disability among men and women aged 16 to 72 years. Also, chronic back pain is now the most common cause of disability in Americans younger than 45 years old. It is estimated by some that more than 10 million individuals struggle with the horrible pain and fatigue of fibromyalgia and the number diagnosed cases is growing.

Americans are now battling this epidemic of chronic pain by taking exorbitant amounts of Nonsteroidal anti-inflammatory drugs, often referred to as NSAIDS.  More than 70 million NSAIDS prescriptions are written each year plus more than 30 billion over-the counter tablets swallowed annually in the United States alone. If you have been seeing the news lately you know how important it is to find a more natural approach to your recurrent back, neck, extremity or headache symptoms. Research has now shown numerous side effects to the drugs we use to control our muscle and joint pain, everything from rebound headaches, liver damage, heart attacks and especially gastrointestinal bleeding.

According to the American Journal of Medicine "Conservative calculations estimate that approximately 107,000 patients are hospitalized annually for nonsteroidal anti-inflammatory drug (NSAID)-related gastrointestinal (GI) complications and at least 16,500 NSAID-related deaths occur each year among arthritis patients alone. The figures of all NSAID users would be overwhelming, yet the scope of this problem is generally under-appreciated."(1)   Food and Drug Administration suggests even higher figures, estimating NSAID use accounts up to 20,000 deaths per year in arthritis patients.(2)  According to a 2005 FDA government memorandum, between 1999 and 2003 selective COX-2 NSAIDs had injured at least 160,000 patients and killed an estimated 26,000 to 55,000 patients. It is statistics such as these that moves many individuals to pursue safe natural alternatives for their chronic muscle and joint pain disorders.

The good news is that there are now new regimes of self-treatment therapy available that are proving to be long-term solutions without the pitfalls of drug or surgical intervention. To conqueror your chronic muscle and joint pain, it’s important to know how to self treat the causes of these common problems. But first with any muscle and joint pain problem, you must have your doctor rule out all possible pathology’s such as infections, tumors or fractures. Thankfully, more than 90% of all chronic pain problems arise from dysfunction of the muscle and joints, not pathology. This muscle and joint dysfunction arises from physical and nutritional changes in your muscle and joint tissues that must both be addressed for real and lasting recovery. The primary pain-causing changes in muscle tissues are known as myofascial trigger points, but are commonly referred to as “muscle knots.”

These common myofascial trigger points are hyperirritable tissues in muscles that cause three things to happen. First, the tissue becomes locally tender and refers pain to other areas of your body, for example trigger points in the neck can create headaches and in the shoulder they can cause severe arm pains. Second, these trigger points will cause your myofascial tissue to shorten leading to the feeling of stiffness. Third, they can cause the muscle to weaken. These muscle knots causing pain, stiffness and weakness in the muscle group create alterations in your patterns of movement causing even more stress to your muscles, tendons, and ligaments leading to more myofascial trigger points. This can lead to a vicious cycle of more and more recurrent pain in your back, neck, or extremities. The pain, ache and stiffness will continue until you remove all of your active and hidden myofascial trigger points.

These pain-causing muscle knots first start out as taut muscle bands in the tissue. These tight bands are contracted and shortened muscle cells that obstruct good blood flow in the muscle tissue. This lack of blood in the muscle tissue means there is a lack of adequate oxygen and nutrition. A lack of oxygen and nutrients in the taut bands causes the muscle tissue to run low on energy. With this low energy state any added physical, nutritional, chemical or emotional stress to the tissues will cause painful myofascial trigger points to form. These myofascial trigger points are made up of dysfunctional muscle cells and sensitized free nerve endings that create a painful nerve reflex.

Because it actually takes energy to relax contracted muscle cells, this lack of energy in the trigger points means muscle cells can not release on their own. In this way the myofascial trigger points can become a self-sustaining vicious cycle until manually released. To accomplish this you need to apply deep sustained digital pressure to these knotted up trigger points to change the state of the tissue. Research has shown that sustained deep pressure on the point changes the tissue releasing the pain-causing muscle knots. This is called trigger point therapy, myofascial release, pressure therapy or acupressure. By creating these physical changes in these muscle knots utilizing sustained pressure you substantially increase blood flow into the muscle tissue. This brings in much needed oxygen and nutrients to the muscle cells. The muscle tissue can then produce more energy allowing it to relax. You can see why just rubbing the surface with a lotion or a vibrating massager isn’t adequate to fully remove pain-causing trigger points.

As effective as trigger point therapy is, to truly be effective it takes repeated treatments over time with stretching of the myofascial tissue after each treatment. The problem with this is that it can become expensive to have someone properly do this for you over the many treatment sessions that are necessary for real and lasting relief. This is especially true when a doctor or therapist actually spends the time releasing all the active and hidden trigger points involved in a chronic back pain, neck pain, or shoulder-arm pain problem. The answer is to turn this amazingly effective therapy into a home-care program with a self care trigger point tool.

There are many hand held devices in the shape of a large hook to reach around your body and pressure trigger points. With these devices you have to pull with your upper extremities to apply effective pressure on your muscle knots. There are also products that allow you to lie down and apply pressure by using a portion of your body weight if against a therapeutic digit. One of these products utilizes a stable platform with interchangeable soft rubber tipped therapeutic digits of various lengths and sizes to self treat your trigger points. Before starting any self care program please check with your doctor first. There are also many good books in print to assist you in your endeavor in trigger point self-care. One book that I highly recommend is my own titled “Why We Hurt”, which goes into great detail on how to find and treat these pain causing myofascial trigger points.

After checking with your doctor and doing some research, if you're still curious to see if you would respond to this type of self care therapy you can try utilizing either a tennis ball or golf ball to apply pressure to your trigger points. Start by slowly resting the targeted trigger point against a tennis ball or golf ball. Relax into the ball to produce a sustained pressure creating a mild local discomfort with a distinctive pattern of referral pain, which will usually be similar to the symptoms of your complaint. Treatment is useless if you tense the involved muscles in order to protect the trigger point from pressure, as this will cause spasms and aggravate your condition.

If the treatment is properly applied, generally the local discomfort and referral pain will abate within 30 to 60 seconds. As this tolerable discomfort lessens, you may get a sensation of your pain causing trigger point releasing or "melting away." Go easy! Release of the muscle knot can bring you pain relief, increased flexibility and improved performance. Excessive pressure can irritate the tissues and cause increased excitation of nerve receptors, thus increasing spasms and pain. A mild state of discomfort while performing the therapy is ideal. Ideal therapeutic pressure depends upon many factors, your age, health status, level of toxicity and inflammation of your tissues.   

In conjunction with this it is vital to improve your diet by removing junk foods and increasing your intake of fruits and vegetables. Also it’s important to exercise, consider walking 20 to 30 minutes per day. You can spice-up your pain-relief wellness program to assist in overcoming your muscle and joint pain problems by utilizing specific herbal extracts and needed nutrients to improve metabolic function!