Muscle pain

Myofascial trigger points : What are they?

Myofascial triggers points: What are they ?
by: Hans de Wit

Muscle pain

Did you know that the Skeletal muscle structure (also called voluntary muscles) is the largest single organ of the human body and can weight 40% and more of our total body weight ? All this muscle mass can be divided into an astounding number of  696 individual muscles, that are made up by millions of fibres , nerves and blood vessels.
Today I hope to shed some light on why this complex network of soft tissues is playing a much larger role in your health than you might think. And also why its is so often overlooked by medical specialists who prefer looking at bones, joints , bursae and nerves for diagnosis and treatment.

Our muscles are extremely subject to the winding and grinding of our daily activities and even more so to our daily lack of activities.  This causes trigger points in the fibers that can be classified into Active trigger points and latent trigger points.
They form as a local contraction in a small number of muscle fibers in a larger muscle or muscle bundle. The integrated hypothesis theory states that trigger points form from excessive release of acetylcholine which produces sustained depolarization of muscle fibers.

Unrecognized myofascial headaches, shoulder pain and low back pain that have become chronic are a major cause of lost time in the workplace and absenteeism in employees. Research has pointed out that chronic pain costs the american economy billions of dollars each year, and South Africa will be no different.

Some of the main causes of trigger points and pain are acute overload of muscles, overworking of muscles, chilling of the muscle fibers and traumatic events. Often times different diseases can cause soft tissue pain as well, with the heart, gallbladder and other visceral diseases being the major contributors. Emotional stress however , can play an even greater roll, causing the highest number of patients with muscle pain.

Trigger point are renowned for their ability to generate referred pain throughout your body. You might have a devastating headache on your temporal region of your skull , however the cause of your headache will be found down in your neck. This phenomenon can become very complex with different layers of muscle pain and stiffness surrounding a specific joint or vertebral body.

This is why different phases of rehabilitation is necessary. Stretch therapy will slowly remove all muscle stiffness and lack of range of motion. With this the outer and inner layers can be gently entered and trigger point therapy can be applied, putting pressure on very precise points in your body.
The therapist can also apply a stretch and spray technique. This technique involves an agent called vapocoolant, research has indicated that the use of a active coolant on the skin in combination with a stretch can inactivate trigger points very effectively.

Don’t hesitate to contact us to find a therapist near you

Common causes of back pain , Surgery or not ?

Common causes of back pain , Surgery or not ?

Slipped disk: A slipped disk is also called a herniated disc. Normally, disks in your spine provide space and cushioning between the bones in your spine. A slipped disk occurs when part of the much softer disk bulges out and pushes against nearby nerves. This causes severe pain and discomfort, as well as radiating pain symptoms down your legs or arms. Most cases of slipped discs heal over time, with the aid of physical therapy. ONLY most severe cases might need surgery.

Spinal stenosis: Spinal stenosis is a narrowing of the spaces between the spinal nerves and the spinal cord because of bony spurs and growths.. It is often caused by changes in the spine that get worse over time due to degeneration of the spine and arthritic changes. With severe spurs and osteophytes a surgical procedure can be beneficial to open the foramen and relieve pressure on the exiting nerve roots.

Sciatica: Sciatica is pain, weakness, numbness, or tingling in the leg. Sciatica is and overused term in the medical world, and should only refer to the actual hereditary condition where the sciatic plexus runs right through the hip external rotator muscle, called the piriformis. It is not caused by injury to or pressure on the sciatic nerve. This nerve starts in the lower spine and runs down the back of each leg. Sciatica is a symptom of another medical problem, not a medical condition on its own. Sometimes a condition called piriformis syndrome leads to sciatica. This condition affects a muscle in the buttocks and may cause pain or a dull ache in the buttocks. Surgery is not recommended.

Back strain: Back strain is injury to the muscles and ligaments in the back. Due to overworking the soft tissue by heavy lifiting or intense sport. The pain usually spreads to the muscles next to the spine. Muscle spasms (pain from muscles tightening in quick movements on their own) may also occur from back strain. The pain may move to the buttocks, but it does not usually go down the leg. No surgery recommended

Arthritis and degenerative spine disease: Many people with chronic back pain have arthritis and extra wear and tear on the spine. Osteoarthritis can affect any joint in the body, including the spine. The spinal disks dry out and become stiffer and can rupture more easily. You can lose movement in your spine. These changes can also develop in areas where you have a slipped disk or a spinal fracture. This problem may also be called spondylosis. This is the most common cause of chronic back pain in humans, and can cause many years of agony. This is also the segment of the population most operated on. In Fact, since 2003 the amount of low back surgeries has increased by well over 300% in the US alone. This is due to the general population’s lack of physical exercise, unhealthy diets and exposure to chemical components.  Physical therapy is starting to play a bigger role than ever, and in time more than 75% of these cases will be managed without any surgery.

Facet joint pain: Facet joints are joints that connect the vertebrae (bones of the spine). They allow the spine to move and make twisting and bending movements. Facet joint pain cannot be diagnosed using x-rays or MRI scans. A doctor who treats back pain may be able to diagnose this problem based on your symptoms and physical exam. Facet joint pain are treatable by physical therapy and should not be operated on.

Other causes of back pain

Osteoporosis occurs when the body does not form enough new bone, when too much old bone is absorbed by the body, or by both of these things.

  • Your bones contain the minerals calcium and phosphate, which make them strong. As you age, your body may absorb these minerals, and this weakens your bones. Weak bones are brittle and fragile, and they can break easily, even without injury.
  • A compression fracture of the vertebra occurs when one of the vertebra collapses.
  • When more than one vertebra may be affected. Osteoporosis is the most common cause for problems with multiple vertebrae.

Other types of arthritis, besides osteoarthritis, can also cause back pain. They make the joints of the spine become swollen and inflamed, and this leads to pain. These types of arthritis are called psoriatic arthritis, reactive arthritis, ankylosing spondylitis, and rheumatoid arthritis.

Stress fractures in the spine (also called spondylolysis) are a common cause of back pain in young athletes. Sometimes a stress fracture may not show up for a week or two after an injury. Stress fractures are more common in athletes who are gymnasts, defensive football linemen, weightlifters, and cheerleaders. Spondylolysis can cause spondylolisthesis, a condition in which the spine becomes unstable and the vertebrae slip over each other.

Does Your Tight Psoas Cause Your Lower Back Pain? – Ryno van den Berg –

There are various causes of low back pain, coming in different forms – some people experience a dull ache, while others have a sharp pain. Some experience pain that radiates into the back of the leg while others suffer the pain right into the foot. The back is made of various musculoskeletal components, and the role of these elements in various movements makes the back an important part of the whole body.

Regardless of the nature of the pain and how it makes you feel, one primary muscle that is involved in causing back pain is the Psoas, or perhaps more accurately – the Iliopsoas muscle. This muscle is shaped in the form of an “S” and runs down the five lowest spinal vertebrae, through your pelvic region ending in the femur bone. You have two of these muscles, one on either side of the body.

The psoas is involved in various movements, but one of the major tasks of this muscle is to stabilize your lower back whenever you lift the knee upwards. It is also critical for body balance, and you use it when executing basic body movements such as walking, bending forward and tilting to one side.

The muscle also helps you stand up from a sitting position, sit up from a lying down position and helps you to walk. It is vital in day-to-day life.

This muscle is responsible for your muscles’ and joints’ range of motion; therefore, if you have a psoas muscle that isn’t working correctly, you diminish your range of motion.


What Causes Injury to the Psoas Muscle?

A sedentary lifestyle and lack of activity can lead to contraction of the psoas muscle. When the muscle contracts, it leads to stiffness and consequent lack of mobility in your lower back or hip area.

You will also experience issues with the iliopsoas muscle due to strain, contracture, spasms, and tendinitis, which is an inflammatory condition that affects the muscle.

You also get a contracted psoas muscle if your back is misaligned. Misalignment causes the back to lean more to one side of the body as compared to the other. This can cause contraction of the muscle and result in other types of back pain as a result of sciatica and bulging discs.


The Symptoms of a Contracted Psoas

One of the major symptoms of back pain due to a contracted psoas muscle is back strain that doesn’t go away even with proper treatment. Instead of getting better, the condition even gets worse. The pain characteristically spreads from the lower back to the mid or upper areas, or it spreads to the surrounding regions of the anterior part of the hip.

The condition might also accompany various other conditions that affect the low back. It might even cause chronic low back pain that doesn’t go away easily.

This condition is more common in various professionals such as athletes and office workers who spend most of their times sitting. When it comes to sports, this condition is more prevalent in hockey, dance, and soccer.

When overworked or when it becomes too weak to handle the strain that is imposed on it, this muscle can go into spasm and tear. Tears in the muscle can heal but might lead to scarring that will cause weakness and pain. The surrounding muscles compensate and become painful and tight as well. When the muscles compensate, they can lead to herniation of the disc at levels L4 and L5.

This muscle is misunderstood by many people, and it makes it difficult for the patient to pinpoint the location of the pain. The patient also has a delay in achieving a fully erect posture when standing up.

In all these, the most characteristic feature of the pain is that of lower back pain that gets to spread to the rest of the back, the gluteal area, the hip regions and even the groin. You might experience initial pain when you rise from a seated position. Standing for some time might also result in pain. This pain doesn’t manifest itself when you lie down or when you walk unless it is severe.

Relief of the pain is experienced when you sit down. Extending the leg when driving makes the pain worse. The pain also gets worse when you twist at your waist without moving the feet.

Adopting any position that shortens the psoas muscle for more extended periods of the time can lead to spasm. This is possible when you sleep in a fetal position for long, sit for extended positions of time or when you work in a crouching or kneeling position.

A tear in the psoas muscle occurs when there is a forceful contraction. The damage can occur when you run up a steep slope, or perform an action such as kicking a ball or martial arts.


How Does a Contracted Psoas Muscle Cause Pain?

When the psoas muscle contracts, it shortens and pulls the spine into a condition called hyper lordosis and leads to an over-arched low back. This posture places a lot of strain on the spinal muscles, including an important muscle called the erector spinae. It also puts a strain on the vertebral joints, causing pain.

Low back pain also results when a tight psoas muscle leads to tension on the tendon that attaches the psoas muscle to the lumbar spine. While the tension occurs in the muscle, you feel the pain in the lower back. The tension can also affect the spinal nerve roots, which results in nerve pain. This is   why you feel the pain radiating to other areas of the body and lower body.

A contracted psoas muscle will pull and twist the vertebrae, which in turn causes compression of the vertebral joints and discs. The compression causes pain and gradual degeneration of these structures over time. This results in structural damage such as degenerative disc processes and potential herniation.



It’s worth mentioning that education is key for most people when rehabilitating their back. A specialist back pain book can be worth it’s weight in gold and allow you to fully understand your treatment process and to avoid the injury recurring in future.

The location of the iliopsoas muscle and its roles in the back and hip make it hard for a doctor to get his hands on it during the examination. It is tricky to get to and reach manually; therefore treatment of any issue that results needs a qualified professional who can rule out any other conditions.

The aim of any treatment strategy is to correct lifestyle problems that might be causing the pain in the psoas muscle. If you are working at a job that requires you to sit for several hours, you need to get some time to stand up now and again to stretch the muscle. Or maybe you need to start improving your walking posture.

Secondly, you need to loosen up the psoas muscle by developing a daily habit that allows you to stretch this muscle, doing this consistently helps relax the muscle and loosen the tension that has built up over time.

You might also need to get to a medical professional for assessment and treatment of the condition. The qualified professional  will perform a physical examination and rule out any other conditions to make sure it is a condition affecting the psoas muscle.

You can also go natural when it comes to treating this low back pain. Combining natural remedies such as turmeric, cayenne pepper & CBD oil with stretching gives you the ability to get relief faster.