Pain from Muscles

Muscles make up about 40% of our body mass, being the largest component. Muscle and the fascia that encompasses it are both very significant pain generators, and are capable of causing severe, debilitating and even chronic pain. This is contrary to popular belief, whereby people believe that if one ‘just has a muscle pain’, it should resolve itself within a couple of days. Many cases of debilitating chronic low back and neck pain and whiplash injuries, for example, arise from muscular sources. Trigger points are thought to result from an ‘energy crisis’ in which a vicious circle of physiological events perpetuate this painful condition, and these can occur on any muscle in the body. Three very common examples are depicted here; one of a very severe pain in the loin/ lower back, the second in the buttock and the third of a headache.

  1. The case of low back pain trigger points are particularly common after falls and car accidents, or may be brought on by improper bending to lift something, even if very light. Here is a quote by Travell and Simons, 1998:
    Our patients consistently report a persistent, deep, aching pain at rest often severe in any body position but excruciating in the unsupported upright position and in sitting or standing?. A minimal movement of the lower part of the torso may precipitate a burst of sharp pain with a knife-like cutting quality. Coughing or sneezing can be agony. Arising from the lying down position or getting out of a chair may be difficult or impossible without the help from the upper limbs.
  2. Gluteal muscle trigger points (in the buttocks) are capable of referring pain down the lower limb; the gluteus minimus can refer pain even as far as the ankle ( see figure 1). Pain may be misdiagnosed as coming from a disc prolapse resembling very much the pain pattern of a nerve root which is compressed by a disc prolapse, and also the pain referred from one of the sacroiliac ligaments.
    Many will see their doctor and return with the diagnosis of a slipped disc; some will be recommended an epidural injection or surgery, neither of which will help.
  3. Migraine headaches, if associated with neck pain, may stem from trigger points in the neck, particularly the sternomastoid muscles. See figure 2.
    These conditions can be treated with mobilisation, exercises, and especially with dry needling techniques, addressing also posture and ergonomics in order to prevent relapse of the pain.
Figure 1: Referred pain from the Gluteus minimus muscle
Figure 2: Migrainous type of headache referred from the Sternomastoid muscle.