The Link Between Myofascial Trigger Points And Pain

The Link Between Myofascial Trigger Points And Pain

A myofascial trigger point (MTrP) is a nodule or lump in your muscle that you can usually feel by rubbing your hand over the muscle. You may even be able to see it on the surface of your muscle through your skin. However, sometimes an MTrP may be hidden behind bone or beneath other muscles.

MTrPs are taut bands of fibrous tissue that cause your muscle to shorten, and may cause pain or weakness in the affected muscle. If the MTrP compresses a nerve, pain may be felt in areas of the body that are nowhere near the location of the MTrP.

Causes of MTrPs

MTrPs may result from injury, repetitive overuse during exercise, surgery, poor posture, chronic stress and muscle strain. Depending on their location, MTrPs can entrap or compress nerves, causing referred autonomic issues such as pain, dizziness, nausea, digestive and eliminatory problems, and more. If an MTrP compresses a blood or lymph vessel, it can cause swelling and restrict blood flow.

Types of MTrPs

There are basically three types of MTrPs: Primary, Secondary and Satellite Primary MTrPs: A primary MTrP is where the trouble begins, originating at a point where a muscle is overloaded in some way. Common causes of overload include:

  • sitting for long hours without muscular support, as when sitting at a computer with your head drooping forward
  • repetitive use activities, like lobbing a tennis ball for extended periods of time
  • muscle overuse, as when weight training muscles that have not recovered from their last workout
  • stress that causes you to tense your muscles, most notably around your neck and shoulders
  • injury to the muscle through trauma or surgery

Secondary MTrPs: When you fail to treat a primary MTrP, you may begin to compensate for the pain and discomfort it causes by shifting the workload to other muscles. Because you are using those muscles in ways they are unaccustomed to, and were not meant to be used, you may develop MTrPs in those muscles as well.

Satellite MTrP: A satellite MTrP develops in the referred pain region initiated by a primary trigger point. For example, if you develop a primary MTrP in your trapezius from staring at a computer all day, you may begin to feel pain along the SCM muscles in the sides of your neck. Over time, they in turn may develop MTrPs.

Stages of MTrPs

Once initiated, MTrPs go through two stages:

Active Stage: An active MTrP, whether primary or secondary, causes pain while at rest. The locus of the MTrP may feel tender, tight and weak. When pressure is applied, you may experience a twitch response, or you may feel referred pain in another area. The referral zone itself may even become tender.

Latent Stage: Unlike an active MTrP that is painful at rest, a latent MTrP is only painful when pressure is applied. It may be primary or secondary, but it still restricts muscle movement, and can affect joints in your spine and extremities, causing stiffness, weakness and autonomic effects. Because latent MTrPs are painless at rest, you may be unaware of them, yet they may be at the root problems like headaches, joint pain and other issues.

Diagnosis and Treatment

MTrPs are suspected to be at the root of chronic pain conditions like sciatica, low back pain, pelvic floor pain, testicular pain, hip pain, knee pain, shoulder pain, headaches, and others. Early detection and treatment are key to preventing a primary MTrP from becoming real chronic pain. At NYDNrehab we use high resolution diagnostic ultrasonography with sonoelastography to precisely locate trigger points. We then , either use extracorporeal shockwave or guided ultrasound dry needling to eliminate them. Studies show that the methods mentioned above are way more effective and do not require multiple sessions in comparison to neuromuscular massage and manual trigger point compression techniques.

Research at NYDNRehab

Constipation and gut motility is associated with posture instability: Role of muscle trigger points and potential to treat by targeted dry needling
Comparative Study of Dry Needling under Ultrasound Guidance and Extracorporeal Shock Wave Therapy for Myofascial Pain and Spasticity Management
September 2019 DOI: 10.26226/morressier.5d4434d506f5c40fc44887e5 Conference: EFIC Congress 2019 – Pain in Europe XIAt: Valencia, Spain

About the Author

Dr. Lev Kalika is clinical director of NYDNRehab, located in Manhattan. Lev Kalika is the author of multiple medical publications and research, and an international expert in the field of rehabilitative sonography, ultrasound guided dry needling and sports medicine Dr. Kalika works with athletes, runners, dancers and mainstream clients to relieve pain, rehabilitate injuries, enhance performance and minimize the risk of injuries. His clinic features some of the most technologically advanced equipment in the world, rarely found in a private clinic.


In this instance, an athlete was originally diagnosed with minor quadriceps muscle strain and was treated for four weeks, with unsatisfactory results. When he came to our clinic, the muscle was not healing, and the patients’ muscle tissue had already begun to atrophy.

Upon examination using MSUS, we discovered that he had a full muscle thickness tear that had been overlooked by his previous provider. To mitigate damage and promote healing, surgery should have been performed immediately after the injury occurred. Because of misdiagnosis and inappropriate treatment, the patient now has permanent damage that cannot be corrected.

The most important advantage of Ultrasound over MRI imaging is its ability to zero in on the symptomatic region and obtain imaging, with active participation and feedback from the patient. Using dynamic MSUS, we can see what happens when patients contract their muscles, something that cannot be done with MRI. From a diagnostic perspective, this interaction is invaluable.

Dynamic ultrasonography examination demonstrating
the full thickness tear and already occurring muscle atrophy
due to misdiagnosis and not referring the patient
to proper diagnostic workup

Demonstration of how very small muscle defect is made and revealed
to be a complete tear with muscle contraction
under diagnostic sonography (not possible with MRI)


Complete tear of rectus femoris
with large hematoma (blood)


Separation of muscle ends due to tear elicited
on dynamic sonography examination

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