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Paul
Dec 30, 2008 - 4:34PM
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Indications it may be trigger points
All the noise! Trigger points, joint popping, and crepitus
Active trigger points seem to be associated with “crepitus” — tissue noise! Crepitus can refer to any crunching, crackling, popping, snapping or grinding noise or sensation in the human body. In the context of trigger points, there are probably three common kinds of crepitus that are worse when trigger points are active:
“Rechargeable” joint popping, as in knuckle cracking. Joints will pop more loudly, and more often, in the vicinity of active trigger points or their referral zones. Note that no one really knows, despite commonly expressed theories, what the $!#@&! joint popping actually is! It is fairly well established that it’s harmless, fortunately.
Tearing of adhesions between layers of connective tissue. See the adhesions section for more information.
And tendon snap — muscles containing trigger points have a higher tone (tension), pull on their tendons more strongly, and the tendons may cause a snapping noise as they move over projections of bone or other bumpy anatomy. Common places for tendon snap are the shoulder and the hip.
There is no scientific evidence to support any of this. However, it makes sense, and it is certainly consistent with my own personal and professional experience. Numerous patients over the years have reported this phenomenon. Don’t be alarmed by it, it’s the least of your worries — simply consider it an interesting diagnostic sign of trigger points.
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Steven Hefferon
Dec 30, 2008 - 4:53PM
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Re: Indications it may be trigger points
"Click here to read a more detailed article on Trigger Point Therapy"
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Paul
Dec 30, 2008 - 6:03PM
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Re: Indications it may be trigger points
Muscles contract because sarcomeres contract.
A sarcomere consists of threads of protein that overlap like the tines of a fork, grab onto each other like Velcro, and pull towards each other.
In a sick muscle, a patch of sarcomeres contracts excessively and cuts off its own blood supply — a muscle knot — while sarcomeres up and down the line get overstretched.
This imagery makes it easy to understand four things in particular:
Trigger points are kept alive by a vicious cycle of super-contracted sarcomeres producing lots of waste molecules.
Massage may help to relieve them by mechanically “squishing” the condensed sarcomeres apart, and/or by relieving the sense of “stuckness,” and probably other factors.
Trigger points cause muscles to be be partly contracted and partly overstretched simultaneously, and therefore stretching may be futile or even even hurt the muscle.
Overextended sarcomeres make muscles weak and unresponsive to intense weight training.
And we know that trigger points are caused by neuromuscular junctions because Botox, which cripples neuromuscular junctions, completely deactivates trigger points.
Triggers for trigger points: what makes patches of sarcomeres go haywire?
Why would sarcomeres get into trouble in the first place? What exactly is their “damage”? What’s wrong with the system?
The exact mechanism by which the tissue becomes dysfunctional is simply unknown, and it may be a long time yet before we do understand it. However, there are many well-known factors that “trigger” your trigger points — forces and factors and physiological circumstances that seem to be associated with trigger point formation and aggravation …
Pain from any other cause, and other chronic health problems. Anything that stresses the system seems to increase trigger point pain, but there are conditions that seem to more directly aggravate trigger points. A classic example is fibromylagia, which is almost invariably complicated by many severe and stubborn trigger points.
Injuries in particular cause disturbance of muscle and joint function to limit movement.74 Muscles in the region develop trigger points in response to the generally abnormal demands on them, and probably also as a direct response to injury pain.
Sustained elongation or shortening. The further and longer a muscle strays from its most neutral length — neither stretched nor contracted — the more likely it is to form trigger points. This explains many common trigger point scenarios, because it particularly occurs with working postures, especially blatantly awkward ones, and it also happens by accident in sleep (we wake up with new trigger point pain because we slept in a weird position, with a muscle significantly stretched or shortened for hours).
Overexertion, either from strong contraction and/or general fatigue.
Stagnation and lack of stimulation of muscle tissue also seems to be a major risk factor.
Chills often lead to the formation of trigger points. The body reflexively increases muscle tone (tension) when the overlying skin is chilled, or when the body is struggling to maintain body temperature.
Psychological stress, especially anxiety about pain itself, has numerous consequences that lead in complex ways to trigger point aggravation. The most obvious is probably that activation of the sympathetic nervous system (“fight-or-flight” neurology) is known to activate trigger points.
Nutritional insufficiences — slightly inadequate levels of nutrients — are given great importance by Travell and Simons.
These factors will be discussed more below. In particular, I will discuss them in the context of perpetuating factors — “factors that make trigger points stubborn.”
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Paul
Dec 30, 2008 - 6:06PM
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Re: Indications it may be trigger points
Here is a snippet on Dr. Sarno and how Trigger Point therapists believe that it is actually trigger points that cause Sarnos TMS (tension myositis syndrome)....To me it makes perfect sense.....
Dr. John Sarno’s “tension myositis syndrome.” Dr. Sarno is the author of several popular books about back pain and muscle pain, which are excellent in many ways. However, it’s a real source of annoyance that Sarno never acknowledges the existence of myofascial trigger points or really anything about the well-established science of them, and instead uses only his own label for the same phenomenon, “tension myositis syndrome,” and attributes them almost entirely to stress-powered circulatory restriction. He’s only got a couple pieces of a much larger puzzle.
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Paul
Dec 30, 2008 - 6:09PM
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Re: Indications it may be trigger points
All of these comments are from a website and tutorial on the importance of trigger points and how muscles are responsible for most pain. It is loaded with clinical studies debunking many myths as well.
Paul Ingraham, publisher of SaveYourself.ca