Wednesday 28th February 2018

How “pain free” trigger points cause muscles and joints to malfunction: causing injury and long term damage

Summary

Latent (pain free) trigger points are the tender spots in tight muscle you don’t know you have until a masseur presses upon them causing shooting pain.  Research done in Melbourne Australia found that even without pain most adults have them in their shoulders muscles.    Various things such as prolonged or repeated use can cause these latent trigger points to become active (pain producing).  As show in a previous summary active trigger points are an extremely common and often undiagnosed cause of long term shoulder pain.

Apart from potentially becoming active and pain producing the research found that the latent (pain free) trigger points have another very sinister effect that can indirectly cause pain, increase the risk of injury and cause rapid wear and deterioration of the joints and muscles.  They do this by altering the nervous systems control of muscles.  Normally muscles work together in a synchronised manner to produce smooth efficient movement without placing abnormal stress on tissues and pressure on joints.  Latent trigger points change this so muscles become uncoordinated, producing movement analogous to a car with wheels out of alignment and out of balance.  As an example, with normal control the joint surfaces move across each other evenly, and normal spaces are maintained so there is no impingement.   When latent trigger points alter the control there becomes uneven pressure on the joint surfaces and the risk of creating impingements of various soft tissue structures.

The positive news is that when the researchers treated the trigger points the nervous system’s control of the muscles reverted back to normal.


This research has many serious clinical implications. These will be mentioned briefly below, and dealt with more completely in future research summaries.

Trigger point assessment and treatment should be considered for shoulder pain
It has been shown the latent trigger points can cause shoulder pain directly by becoming active, or indirectly by changing the shoulder function resulting in impingements, uneven joint pressure and so forth.  They should be considered in cases of shoulder pain.

The prescription of exercises alone to correct pain syndromes should be seriously re-considered
Patients are often given exercises alone to remedy shoulder and other pain syndromes. Research has shown that trigger pointss are highly likely to be involved.  This study showed they caused the nervous system to produce movements that were abnormal and detrimental.    The MAPs are not under conscious control so patients cannot be instructed to perform exercises correctly.  During exercise movements will likely continue to be abnormal and detrimental.   This research indicates that trigger point therapy should be done concurrently to normalise neurological control.

Regular screening and treatment of trigger points Trigger point therapy should be considered.
Regular soft tissue therapy or a regular massage would arguably find and deminish latent trigger points, thus preventing them from becoming active (painful) and causing abnormal function.

Everone using a gym or exercising should be regularly screened for trigger points
Joint pains, injuries and impingement syndromes are too common among those who use a gym or exercise.  This research suggests that latent trigger points causing abnormal joint function would make joints and tissues far more vulnerable to these.  The risks would be magnified by the increased loads placed on these joints.  As shown in the research the treatment of trigger points normalises muscular control.

Implications for sports performance
Whether one swings a golf club, a tennis racquet, or shoot basketballs you want the coordination of your muscles to be normal to produce the best results. 

Keeping it practical

As shown in our previous research summary the treatment of trigger points can sometimes deactivate active MTPs  making them pain free (latent).  However, complete removal requires a course of therapy over a considerable length of time.   The care these clinical implications suggest would involve a course of care to remove trigger points then regular maintenance screenings.  If done by therapists alone this would be very expensive and time consuming, therefore be something only available to people such as elite sports persons.  This is the reason the DrGraeme serious hand held massagers able to be used at home were developed.  Under the guidance of a professional supplementary massage can be done at home, making this type of care affordable and practical.

 

More information

For more detailed information and references please see the practitioner version of this article.

Future articles and sharing

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ORIGINAL ARTICLE

THE EFFECTS OF LATENT MYOFASCIAL TRIGGER POINTS ON MUSCLE ACTIVATION PATTERNS DURING SCAPULAR PLANE ELEVATION, by K.R. Lucas PhD.
https://researchbank.rmit.edu.au/eserv/rmit:6364/Lucus.pdf

Future articles and sharing

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About Dr Graeme

Several years ago Dr Graeme, a Chiropractor practicing in Victoria, Australia was looking for a serious hand held massager his patients could use at home to get the extra quality massage they needed. The ones he found in the shops and on-line for home use looked nice but were not serious, and ... read more