What exactly is a Trigger Point?

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This article explains some of the complications of a muscle spasm/trigger point of the pelvic floor. It’s detailed, but some of you wanted a better understanding of why pelvic floor trigger points seem so complicated.


Trigger Points & the Asthma Attack.

Did you know that a muscle spasm is similar to a flute player with asthma? All sorts of other reactions flow from one single event, and have unwelcome consequences. Understanding the similarities can help us understand that pelvic floor muscle trigger points are more than just a muscle spasm.

When the flute symphony goes all bad.

Four components of a pelvic floor muscle exist, all of which play a part in the formation of localized muscle spasms: individual muscles, monitors of muscle function, sensors of disturbances, and nerve coordinators.

  • Muscles: An entire muscle is constructed as a symphony--made of many individual sections--and when we hear a symphony perform, we hear all of the parts working together at the same time. Unlike a symphony though, muscle is constructed of identical instruments, so that when one part plays it sounds like a solo flute, but when all of the muscle parts play, it sounds like 500 flutes playing simultaneously.

    "Metropolitan Metropolitan Flute Orchestra, New England Conservatory, Boston MA, 7/06

    So imagine a trigger point/spasm as being a problem for “Flute Player X” in one section of flutes: most of the flute symphony plays correctly, but “Flute Player X” is suffering from an asthma episode, and produces sounds painful to the ears of everyone listening.

  • Monitors: Throughout muscle, there are monitors (intrafusal fibers IIa) which assess the function at all times. It’s like section leaders in a part of a single symphony, where the monitors wander around endlessly, never sleeping, assessing the flutes playing in its section.

    "Eric Eric Rombach-Kendall leads the UNM Wind Symphony 9/06

    When the monitors detect playing off key, they automatically put a warning out, and put a temporary flag over their section until the problem is straightened out. The muscles, like “Flute Player X”, don’t like the warnings, and become tense and edgy when the warnings are issued.

  • Building Security Sensors: Most symphonies play inside buildings, and it’s not uncommon for buildings to have security patrol. When there’s a problem somewhere in the building, the security patrol can alert the symphony to the problem, but can also initiate defensive measures of its own.

    "San San Francisco Chronicle, 5/27/05, photo by John Storey.

    Whereas, building security patrol persons might sense intruders, fire or theft, the nerve pain sensors (C fibers) detect trauma (intrusion or destruction), inflammation (pain from oxidation chemicals) or a lack of blood flow (theft of oxygen or hypoxia). Nerve pain fibers can also set off alarms (secrete chemicals like substance P) the same way patrol persons can alert local fire stations to a problem.

  • Communications director for the municipal building: Sometimes, other things are happening in the same building complex that houses a symphony. Just as a symphony hall is used for symphony practice and performance, it might also house lectures, plays and poetry slams.
  • "John John Shallman, New York Region Communications Director, Social Security Administration, 2006

    But the communications director has some powerful tools for quelling dangerous situations which might include closing off all exits, or using extreme methods to bring chaotic situations under control. Although not used lightly, these major tools can be helpful as well as inadvertently destructive.

    The communications director is the pelvic plexus of the pelvic floor. When thinking of the pelvic floor muscles, arousal nerves of the pelvic plexus coordinate many different activities: passive and active control of urination, active participation in sexual arousal and orgasm, and coordination of bowel movements just to name a few. At different times, the pelvic plexus nerves will facilitate relaxation of the floor muscles, while at other times the plexus nerves will increase sexual arousal signals by increasing release of nitric oxide, increasing blood flow and tension of the muscles.

    While nitric oxide is a very valuable gaseous neurotransmitter specifically related to sexual arousal, nitric oxide can be very dangerous when combined with radical oxygen species, such as those produced in highly inflammatory, or highly painful, muscle regions. Nitric oxide diffuses away quickly, but peroxynitrate (ONOO) is very destructive, and once present destroys muscle fibers, blood vessels, connective tissue, etc.
    "Interaction

So, in our symphony demo,

  • Flute Player X is having a bad practice, from untreated asthma and can’t play any better.
  • The section conductor sends up a warning, and pays special but unwelcome attention to the flute player, and the Flute Player X begins to steam under the attention.
  • The auditorium police notices the problem on stage, and misinterpreting the steam coming out of Flute Player X, alerts the local security to a possible fire, and quickly closes all of the doors to the hall.
  • The communications director, notified by a cell phone call of a passer-by the flute players are being held hostage in the symphony hall, asks the police to break through the doors to the hall where the security guard and section monitor are worried about the disabled Flute Player X. In responding to the internally locked doors, the police decide to splash gasoline on the doors and burn them down.

In our corresponding pelvic floor spasm:

  • A trigger point spasms, and does not have the energy to relax itself.
  • The muscle monitor detects a problem, and sends up a red flag, which causes muscle tensing, or a guarding reflex to be set up.
  • This continued spasm, in addition to the muscle guarding reflex, sends pain messages to the spinal cord, which correctly identifies the pain, and alerts the brain, while sending out additional pain signals to other nerves, and releasing proteins which stimulate inflammation.
  • Eventually, the muscle spasm causes nitric oxide from the pelvic plexus to combine with inflammatory compounds, causing an explosive mess, swelling the muscle body and cutting off blood circulation.

What a mess x 2

What a mess. Now Flute Player X, whose performance was suffering due to this asthma attack, is stressed by the section coach, freaked out by the locked auditorium security, and coughing and sputtering because of the toxic smoke pouring into the auditorium.

What a mess. Now the trigger point, whose inability to relax from a lack of energy, is made worse by the guarding reflex of the interfusal fibers, the increase in inflammation signals from the pain receptors, and the overwhelming inflammation of the toxic byproducts of the dysfunctional nitrergic nerves.

(This isn’t going to be easy to unravel. How will the inflammation go down while there is a muscle spasm? How will the monitor turn off the guarding reflex when the spasm is still unrelaxed? If one deadens the pain with medications, does the cause of the pain go away? Does Flute Player X support single payer health insurance? Will the communications director make it to his date with the lovely Rachel?)

Clearly this situation needs direct intervention. The underlying the problem of the flute player was the asthma attack, just as the muscle spasm was first created by the lack of energy to relax. None of the subsequent cascades help resolve the underlying problem, and the reflexive responses make the situation worse and more complicated to sort out.

Therefore, to achieve resolution of a trigger point often takes a combination of trigger point identification, & trigger point massage (to resolve the spasm), but also improved diet with a healthy focus on colored (antioxidant) foods (see the Good Sex Diet), and physical (whole body) exercise.

Hope this helps.

Dr. Myrtle