Neck pain coming from your shoulder blade? Calf pain coming from your hip? Back pain coming from your stomach? It seems a little far fetched when your chiropractor, osteopath, RMT, or physiotherapist tells you that the agony you’ve been feeling in your elbow for the last three weeks is actually a muscle in your neck, but it’s quite likely the key to fixing the pain.
This is because of a concept that practitioners use called muscle trigger point therapy. In general, muscle trigger points are areas within a muscle that become flared up (commonly known as a “knot”), which send pain to another part of the body. An example of this referral is reported pain in the left arm with a heart attack, the heart being the affected muscle, and the arm being the referral point. While this is a severe example, muscle trigger points can also happen on a smaller scale, being responsible for many causes of body pains, including the arms, legs, hands, feet, back, ribs, organs/abdomen and more. As well, trigger points can be a large culprit in headaches.
With trigger point pain, where you experience your headache is actually the map to its source, which includes face pain as well. Trigger point headaches are known as secondary headaches – the cause being external to the head itself. There are many muscles within the face, jaw, head, and neck that can refer pain to the head in a variety of patterns. The pattern in which the pain is experienced can indicate exactly where the offending trigger point is located. Chiropractors, osteopaths, physiotherapists, and more, have been successfully treating headaches using cervical spine trigger point targeted therapy, which incorporates their deep understanding of muscular pain, and trigger referrals, with soft tissue therapy, mobilizations, acupuncture, or modalities targeted at the points matching your pain presentation.
Cervicogenic headache is a specific term relating to a headache with neck/cervical origin. Cervico being cervical (neck) region, and genic meaning origin- not to be confused with a headache that has accompanying neck pain, as many headaches can present with neck pain as a symptom. In the case of cervicogenic headaches, the cervical spine is not the symptom, rather, it is the cause. While all neck pain accompanying a headache can respond favourably to care, and improve headache intensity, cervical treatments (exercise, muscle work, etc.) are key to relieving cervicogenic headaches, many of which are due to trigger points.
Even headaches following a concussion have been linked to trigger points and muscle tension in the cervical spine. With forces of a minimal 4.5g necessary for a mild neck muscular injury, concussions occur at 70-120g’s of force. This means that every concussion is associated with a neck injury (whiplash), of which, sustained muscle tension can is a leading complaint. Concussion research indicates that treatment of the neck with a chiropractor or physiotherapist can improve these headaches significantly.
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Physiologically, muscle trigger points are caused by a shortening and tightening of specific muscle fibres within a muscle itself. This shortening and tightening prevents any stretching or movement when the muscle as a whole becomes active, and through compressive forces it can present with pain in its referral zone, which may actually be located somewhere completely separate. For example, a trigger point in the back of the trapezius (behind the shoulder), can cause a headache, or a trigger point in the jaw muscles (lateral pterygoids), can produce horrible face pain and headaches – a common side effect of TMJ disorders.
Experiencing trigger point pain or headaches is quite common, and uncomfortable. From those who are very active, to those who are completely inactive, these headaches and body pain are very treatable, and respond quite well to care. If you’ve got pain you can’t quite get rid of, it may be time to seek help from a trained manual therapist to see if they can localize your pain and minimize your symptoms.