Role of Trigger Points (Myofascial Pain Syndrome) in Neck Pain

It feels like a knot of stiff spinal muscle that won’t move or relax. When you touch it, it spreads pain to your neck, shoulders, and upper back. Many people relate to this type of pain in the neck—a trigger point, or myofascial pain syndrome when several trigger points exist together—but there’s still much that clinicians don’t understand about them. What can you do to ease the pain and prevent them from coming back?

Trigger points aren’t only found near your neck—they can form in muscles all over your body. This article focuses on myofascial pain syndrome in the neck, when trigger points develop in the muscles of the shoulders, upper back, and of course, the neck itself.
Woman in pain, holding her upper neck regionTrigger points or myofascial pain don’t only affect your neck, they can form in muscles all over your body.What Is a Trigger Point?
Trigger points have an interesting connection to an American political dynasty. They were first characterized in the 1940s by Janet Travell, MD, who was John F. Kennedy's personal physician. JFK struggled with chronic back pain and underwent trigger point injections to ease his pain.

A trigger point is a tender spot within your muscle. People often describe them as “knots”—a bundle of tense, contracted muscle that twitches and spreads pain when pressed or moved. When the pain spreads, that’s called referred pain. For example, a trigger point might be in your shoulder but shoot pain up your neck when prodded.

Trigger points cause your muscles to become stressed and to contract, which results in muscle weakness and numbness, along with limited muscle movement.

How Do You Get a Trigger Point in Your Neck?
Trigger points are typically caused by mechanical factors—that is, factors that put strain or stress on your muscles. A spinal trauma, like whiplash from a car accident or a sports-related injury, can cause trigger points to form.

You can also encourage a trigger point to develop by doing repetitive and routine things every day that hurt your spine health over time. For example, you can strain your neck muscles by holding a poor posture for an extended period (like sleeping on an unsupportive pillow or craning your neck while working on a computer) or carrying a heavy handbag that burdens the muscles of your neck, upper back, and shoulders.

Are Trigger Points the Same as Fibromyalgia Tender Points?
Trigger points are often confused with tender points of fibromyalgia. Trigger points and tender points are both localized areas of pain, but they are not the same.

Tender points do not cause referred pain, or pain that spreads, but trigger points do. Fibromyalgia tender points are also symmetrical—they exist on both sides of the body. Trigger points do not emerge in a symmetrical pattern.

But here’s where things get complicated: People with fibromyalgia may have both tender points and trigger points. It’s not uncommon for people with fibromyalgia to also have myofascial pain syndrome. In those cases, it’s important to talk to your doctor about the specific ways to address those different types of pain.

Why Are Trigger Points Hard to Diagnose?
Trigger points are a common cause of several types of spine pain—from neck pain to low back pain—but there’s still a lot doctors have yet to learn about them. Doctors don’t have a set definition for trigger points or understanding of how trigger points produce referred pain.

Trigger points are complex: They’re both easy to pinpoint but hard to diagnose. They can directly cause muscle pain, which may be apparent to detect. But they’re elusive because they can mimic other problems. Myofascial pain syndrome and fibromyalgia are often confused for one another. Jaw pain, earaches, or toothaches that just won’t go away may actually be caused by a trigger point in the neck.

If you have chronic neck pain that doesn’t have a clear cause, ask your personal doctor about whether trigger points could be behind it. Your doctor may refer you to a physiatrist or other spine specialist to test for trigger points in your upper back, shoulders, and neck.

Pulling the Trigger: How to Treat Trigger Points and Myofascial Pain Syndrome
Treating trigger points and myofascial pain syndrome ranges from simple at-home therapies to injections that your doctor must administer. Because the medical community is still learning about myofascial pain syndrome, there’s no one “magic” treatment that will do the trick each time. You may need to explore a few options to find pain relief.

At-home therapies
The pain of a trigger point may be extremely bothersome, and you may want to jump into an at-home fix immediately. But before you start any home therapy, talk to a trained professional—your doctor, massage therapist, or physical therapist—to pinpoint the location of the trigger point so you can effectively treat it.

Trigger points are typically treated by massaging the area, which can be a challenge when they’re in a hard-to-reach place near your upper back. If you can’t reach the trigger point with your hand, slowly and gently rolling over a golf ball or tennis ball can provide quick relief.

Massage therapy
Licensed massage therapists are trained to relieve muscle pain, and deep tissue massage may relieve an irritated trigger point. If you have myofascial pain syndrome and chronic trigger points, regular massage appointments may help reduce their occurrence.

Dry needling
Researchers aren’t exactly sure how dry needling relieves trigger point pain, but it involves injecting an empty needle and moving it around. This therapy is thought to encourage blood blow to the trigger point muscle area, which may reduce muscle contraction. This therapy may also help block pain signals near the trigger point site, but more research is needed to confirm this.

Physical therapy
Physical therapists can treat trigger points in several ways, including massage, heat, electrical stimulation, and ultrasound. They may also cover the trigger point area in a cooling spray before performing targeted stretches to relax and relieve the contracted muscle.

Medications
Various muscle relaxants have been used to reduce the symptoms of myofascial pain. These are often sedating or have other side effects, so their use should be limited and also used in conjunction with a good physical therapy program. Medications such as Valium® (diazepam) should be avoided as they cause sedation and can be habit forming.

Trigger point injections
If you have myofascial pain syndrome and still experiencing recurring trigger points despite trying the therapies above, your doctor may recommend trigger point injections. These injections are considered a later-stage therapy for trigger points—that is, your doctor may recommend you try less invasive treatments, like massage, before moving on to injection therapy. Your doctor may also prescribe the injections in conjunction with an exercise or physical therapy program for maximum relief and effectiveness. These should not be repetitively performed, and steroid medications should not be included in what is injected. Usually just a saline injection with some Novocaine (procaine) is all that is needed for these injections to have a good effect in reducing pain and facilitating better rehabilitation.

Trigger Points in the Neck: “Knot” as Clear Cut as You Thought
Most of us have experienced a tight bunch of muscle around our neck, but trigger points are still shrouded in mystery when it comes to diagnosis and treatment. By practicing good posture and healthy spinal mechanics, you can help prevent trigger points and myofascial pain syndrome. If you experience chronic trigger points, being open to different therapies—including massage and physical therapy—may help keep the pain from interfering in your daily activities.

Updated on: 07/20/18
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