Excerpts from The Trigger Point Therapy Workbook by Clair Davies, NCTMB
The solution for your back pain may be simpler than you've been led to believe. Many people are haunted by the fear that pinched nerves, ruptured disks, or arthritis are causing their back pain, when there's a good chance that their pain may be coming solely, or at least in part, from myofascial trigger points in muscles. Even when back pain is due to genuine problems in the vertebral column, myofascial trigger points always contribute a major part of the pain. In fact, there's reason to believe that trigger points are the root cause of many spinal problems because of the muscle tension they maintain. Muscle tension displaces vertebrae and causes compression of nerves and disks. When investigating back pain, trigger points should be at the top of the list, because pain that comes from trigger points is usually self-treatable (Travell and Simons 1999, 804-809).
The reason there are so many differing opinions about the cause of back pain is that it's mostly referred pain. This is especially true of low back pain. You may never find the real cause of low back pain if you look for it only in the low back. Surprisingly, trigger points in the buttocks muscles are a frequent cause of low back pain. The reverse is also true: trigger points in the low back often refer pain down to the buttocks and hips. In addition, trigger points in the abdominal and psoas muscles can send pain to the back, though they're easily overlooked, even by people who know trigger points well. For pain in the back and buttocks, the old rule applies more than ever: "Never assume the problem is at the place that hurts!"
Confusing the issue further, back pain is usually a composite, with components sent from trigger points both above and below where you feel the pain. The key to success in self-treating back and buttocks pain lies in your troubleshooting skills.
Superficial muscles are muscles that are closer to the surface (towards your skin) and inferior or deep muscles are those under superficial muscles and closer towards your inner body (bones/spine). Deep spinal muscles are actually "one of the few examples of trigger points that cause pain right at the site rather than referring it away." "Pain from trigger points in the deep spinal muscles may feel like it's in the spine itself." Even so, they also can still refer pain "forward to the abdomen and downward into the buttocks."
Superficial Spinal Muscles on the other hand: In addition to pain, trigger points cause tightening of the superficial spinal muscles over their entire length. They can bulge out in a hard contraction, giving the impression that one whole side of the back is in trouble, when a single trigger point somewhere is actually the prime instigator. Although this is commonly called a "back spasm," it's not a true spasm that will respond to treatment with heat and stretching. A contraction that's being maintained by trigger points won't give up until you locate the trigger points and deactivate them (1999, 921, 926).
Superficial spinal muscle trigger points can refer pain from shoulder blade, top of iliac crest (hip bone), buttocks, and "may also be projected to the front of the body or to the internal organs, and can be mistaken for the pain of angina, pleurisy, appendicitis, or other visceral disease. Pain from trigger points in any of the superficial spinal muscles can be misinterpreted as a symptom of kidney stones, tumors, rib inflammations, ligament tears, or disk problems."
Stiffness or tightness in the back is a sign of latent trigger points in the back muscles, even when you're not presently having pain. Latent trigger points should be taken seriously because they're an indication that you're verging on trouble. Any little additional stress can quickly turn a latent trigger point into an active one. Trigger points that keep the muscles in one side of the back contracted can cause scoliosis curves. Muscle tension maintained by trigger points can also pull the sacroiliac joint out of place, keeping the pelvis twisted or cocked. When tight superficial spinal muscles squeeze the sensory nerves, the skin on your back may be hypersensitive or have patches of numbness (1999, 923-924).
Part of your low back pain can be coming from trigger points in the soleus muscles in your calves. The soleus muscles actually can maintain a hard, spasmlike contraction in the low back muscles. You may also know that trouble with your feet can make your back hurt (1992, 428-429).
Pain from trigger points in gluteus medius muscles is felt in the low back just above and below the belt line and often extends into the buttocks and hips. Back pain from this source can be excruciating and disabling, seriously undermining endurance. Pain in both the hips and low back can make walking almost impossible (1992, 150-151; Sola 1985, 683).
The common assumption is that pain in the low back is caused by some problem in the lumbar spine, such as arthritis, a herniated disk, disarticulated vertebrae, a compressed nerve, or a sacroiliac joint dysfunction. Trigger points in the quadratus lumborum can sponsor trigger points in the gluteus medius. This is because the gluteus medius lies in the referral area for the quadratus lumborum. It's wise to search for tender spots in both muscles when you have low back pain. A common condition called Morton's foot can cause unstable foot placement, which can bring about trigger points in gluteus medius muscles (1999, 155-156). Sitting a lot with your legs crossed is bad for these muscles, especially if you always cross the same leg.
You may prefer to take your injections in a hip rather than an arm or shoulder. Just be aware that injections into a gluteus medius muscle can set up trigger points and leave you with an annoying backache. When this happens, it's good to be able to recognize a myofascial problem and know what to do about it.
There are several techniques and tools to work the trigger points in your back, but the best one is a tennis ball against the trigger point and a wall or floor. For all the info on back trigger points symptoms, causes, and treatments be sure to check out The Trigger Point Therapy Workbook.
Now, just a little something regarding all types of headaches (even migraines), TMJ, frozen neck, ear aches, stuffy ears, ringing ears, bags under your eyes, sinusitis, and even teeth sensitivity to heat/cold/touch, can be caused by trigger points in your sternocleidomastoid, trapezius, levator scapulae muscles (just to name a few) in your jaw, neck, and upper back. All outlined in the chapters dealing with head and neck pain in The Trigger Point Therapy Workbook.
Even though I am posting excerpts from Mr. Davies' book The Trigger Point Therapy Workbook, I am by no means able to post every important facet on this subject and highly recommend you purchasing this book for your own reference...it is that good! Clair Davies' story is amazing as is his entire book. I am very grateful to his dedication and revelation of this subject matter!!!
For other posts of this series: Trigger Points
Referred Pain,Trigger Point & Symptoms
Shoulder Trigger Points
Referred Pain,Trigger Point & Symptoms
Shoulder Trigger Points
The solution for your back pain may be simpler than you've been led to believe. Many people are haunted by the fear that pinched nerves, ruptured disks, or arthritis are causing their back pain, when there's a good chance that their pain may be coming solely, or at least in part, from myofascial trigger points in muscles. Even when back pain is due to genuine problems in the vertebral column, myofascial trigger points always contribute a major part of the pain. In fact, there's reason to believe that trigger points are the root cause of many spinal problems because of the muscle tension they maintain. Muscle tension displaces vertebrae and causes compression of nerves and disks. When investigating back pain, trigger points should be at the top of the list, because pain that comes from trigger points is usually self-treatable (Travell and Simons 1999, 804-809).
The reason there are so many differing opinions about the cause of back pain is that it's mostly referred pain. This is especially true of low back pain. You may never find the real cause of low back pain if you look for it only in the low back. Surprisingly, trigger points in the buttocks muscles are a frequent cause of low back pain. The reverse is also true: trigger points in the low back often refer pain down to the buttocks and hips. In addition, trigger points in the abdominal and psoas muscles can send pain to the back, though they're easily overlooked, even by people who know trigger points well. For pain in the back and buttocks, the old rule applies more than ever: "Never assume the problem is at the place that hurts!"
Confusing the issue further, back pain is usually a composite, with components sent from trigger points both above and below where you feel the pain. The key to success in self-treating back and buttocks pain lies in your troubleshooting skills.
Superficial muscles are muscles that are closer to the surface (towards your skin) and inferior or deep muscles are those under superficial muscles and closer towards your inner body (bones/spine). Deep spinal muscles are actually "one of the few examples of trigger points that cause pain right at the site rather than referring it away." "Pain from trigger points in the deep spinal muscles may feel like it's in the spine itself." Even so, they also can still refer pain "forward to the abdomen and downward into the buttocks."
Superficial Spinal Muscles on the other hand: In addition to pain, trigger points cause tightening of the superficial spinal muscles over their entire length. They can bulge out in a hard contraction, giving the impression that one whole side of the back is in trouble, when a single trigger point somewhere is actually the prime instigator. Although this is commonly called a "back spasm," it's not a true spasm that will respond to treatment with heat and stretching. A contraction that's being maintained by trigger points won't give up until you locate the trigger points and deactivate them (1999, 921, 926).
Superficial spinal muscle trigger points can refer pain from shoulder blade, top of iliac crest (hip bone), buttocks, and "may also be projected to the front of the body or to the internal organs, and can be mistaken for the pain of angina, pleurisy, appendicitis, or other visceral disease. Pain from trigger points in any of the superficial spinal muscles can be misinterpreted as a symptom of kidney stones, tumors, rib inflammations, ligament tears, or disk problems."
Stiffness or tightness in the back is a sign of latent trigger points in the back muscles, even when you're not presently having pain. Latent trigger points should be taken seriously because they're an indication that you're verging on trouble. Any little additional stress can quickly turn a latent trigger point into an active one. Trigger points that keep the muscles in one side of the back contracted can cause scoliosis curves. Muscle tension maintained by trigger points can also pull the sacroiliac joint out of place, keeping the pelvis twisted or cocked. When tight superficial spinal muscles squeeze the sensory nerves, the skin on your back may be hypersensitive or have patches of numbness (1999, 923-924).
Part of your low back pain can be coming from trigger points in the soleus muscles in your calves. The soleus muscles actually can maintain a hard, spasmlike contraction in the low back muscles. You may also know that trouble with your feet can make your back hurt (1992, 428-429).
Pain from trigger points in gluteus medius muscles is felt in the low back just above and below the belt line and often extends into the buttocks and hips. Back pain from this source can be excruciating and disabling, seriously undermining endurance. Pain in both the hips and low back can make walking almost impossible (1992, 150-151; Sola 1985, 683).
The common assumption is that pain in the low back is caused by some problem in the lumbar spine, such as arthritis, a herniated disk, disarticulated vertebrae, a compressed nerve, or a sacroiliac joint dysfunction. Trigger points in the quadratus lumborum can sponsor trigger points in the gluteus medius. This is because the gluteus medius lies in the referral area for the quadratus lumborum. It's wise to search for tender spots in both muscles when you have low back pain. A common condition called Morton's foot can cause unstable foot placement, which can bring about trigger points in gluteus medius muscles (1999, 155-156). Sitting a lot with your legs crossed is bad for these muscles, especially if you always cross the same leg.
You may prefer to take your injections in a hip rather than an arm or shoulder. Just be aware that injections into a gluteus medius muscle can set up trigger points and leave you with an annoying backache. When this happens, it's good to be able to recognize a myofascial problem and know what to do about it.
There are several techniques and tools to work the trigger points in your back, but the best one is a tennis ball against the trigger point and a wall or floor. For all the info on back trigger points symptoms, causes, and treatments be sure to check out The Trigger Point Therapy Workbook.
Now, just a little something regarding all types of headaches (even migraines), TMJ, frozen neck, ear aches, stuffy ears, ringing ears, bags under your eyes, sinusitis, and even teeth sensitivity to heat/cold/touch, can be caused by trigger points in your sternocleidomastoid, trapezius, levator scapulae muscles (just to name a few) in your jaw, neck, and upper back. All outlined in the chapters dealing with head and neck pain in The Trigger Point Therapy Workbook.
Even though I am posting excerpts from Mr. Davies' book The Trigger Point Therapy Workbook, I am by no means able to post every important facet on this subject and highly recommend you purchasing this book for your own reference...it is that good! Clair Davies' story is amazing as is his entire book. I am very grateful to his dedication and revelation of this subject matter!!!
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