How to get rid of those painful muscle knots

Myofascial Trigger Points (MTrps) are clinically diagnosed as palpable taut bands in the muscle that are tender when pressed (muscle knots). Often, these points refer lightning pain in distant areas and pain with stretching. A local twitch response with needling confirms active MTrps. MTrps have been found in 147 different muscles. Headaches, rotator cuff pain, tennis elbow, carpal tunnel syndrome, repetitive strain injuries, sciatica, plantar fasciitis, frozen shoulder, back, neck, hip, pelvic, arm, hand, jaw, shoulder and leg pain can all result from MTrps. Biopsies show MTrps are larger and darker than normal muscle tissue fibers and have spontaneous electrical activity versus adjacent muscles with no trigger points.

MTrps come from excess Acetylcholine (Ach) in the muscle fibers. Ach helps our muscles and brain be alert and active, but too much leads to clumps of Ach causing the painful muscle knots. Acetylcholine Enzyme (AchE) is a molecule that eats up excess Ach to prevent the formation of MTrps.

ATP is cellular energy and is directly responsible for preventing excess Ach. So if your cells don't have the proper energy stores, Ach builds up causing muscle cramps. Gene mutations can also cause AchE deficiency. Psychological stress, physical stress, lack of sleep, pesticides, nicotine and psychedelic mushrooms cause these gene mutations and act against AchE.

Tight muscles are among the most common reasons we find MTrps. They physically compress nerves and cramp down on blood vessels, which reduces the ability of AchE and ATP and causes a lack of local oxygen. A study showed that sustained, low level muscle contractions during continuous typing for as little as 30 minutes commonly resulted in the formation of MTrPs. Office workers, musicians, dentists and anyone else with a job that requires repetitive low level muscle activity are at high risk for developing MTrps. Accidents and physical trauma also cause MTrps. A retrospective review found 80 percent of 1,096 subjects involved in low velocity collisions had trigger points.

A proper diet significantly changes the chemical imbalance that leads to MTrps. Avoiding caffeine, nicotine or highly acid foods can increase Ach. Not enough hemoglobin and iron in your blood can directly cause hypoxia or low oxygen, which contributes to MTrps.

Janet Travell, M.D., who pioneered the study of MTrps, found a strong correlation between vitamin deficiencies and MTrps. Insufficiencies of iron, calcium, magnesium, zinc, folic acid, B12, B6, C and D have shown in many studies to increase MTrps. Ask a qualified practitioner to help you identify which vitamins you might need to supplement with if you have MTrps. An estimated 16 percent of patients with MTrps have vitamin B deficiency and 90 percent have low vitamin D. Hypothyroidism and statin drugs also show strong correlation of perpetuating MTrps.

Lavender, lemon balm, kava kava, rosemary, skullcap, passionflower, rose, and valerian all contain the chemical linalool, which has been shown to inhibit the release of Ach. So try some herbs that contain these. However, I highly recommend against the ingestion of essential oils. Many Chinese herbs contain these products. THC from marijuana also contains linalool, although the herb's efficacy may be due to the THC plugging into the same receptor as Ach and not actually inhibiting Ach itself. Smoking of any type reduces oxygen and encourages painful MTrps.

Many case studies show patients who responded weakly to manual or needle therapies responded better when they added proper supplementation with the same treatments. Patients who continued supplementation showed no relapse.

Medical acupuncture, with either dry needling or wet needling and proper supplementation, diet and stretching routine is the most powerful way to reduce MTrps.

Needling physically stretches the muscle, and it causes a chemical reaction within the nerves in the muscles which breaks up those MTrps. Medical acupuncture is needling into designated points that are near nerves, blood vessels and lymphatic/connective tissue planes. Medical acupuncture stimulates the release of natural opioids and an "inflammatory soup," which is a myriad of cells and chemicals
that help increase blood circulation, decrease pain and chemical homeostasis. This chemical reaction lasts up to 72 hours and can cause permanent reversal of symptoms if treatment is continued for at least 7 sessions. Adding an electrical current to the acupuncture needle further enhances ATP production to decrease MTrps.

Dry needling is needling into any MTrp and getting a twitch response. Both acupuncturists and some trained physical therapists can administer dry needling. Physical therapists who have abbreviated training in dry needling (about 46 hours in Colorado) tend to simply "piston" or manipulate the needle and add electrical stimulation. The process takes roughly five minutes. Researchers discovered that the key to relief is allowing the needle to retain for at least 10 minutes.

Wet needling is using an injection needle to get a twitch response from a MTrp, and injecting saline, dextrose, B12, lidocaine, herbal anti-inflammatories and other substances (this is out of the scope of PTs).

At Evergreen Medical Acupuncture, when we see a patient with MTrps, we are able to provide both dry and wet needling, retain needles for 15-45 minutes, add electrical stimulation, cupping, add those "inflammatory soup" acupuncture points, and go over the patients blood tests and prescribe the right supplements and diet. Patients get better very fast using this approach.

When researching MTrps, the patients who performed the best were the group who did any of the above needling techniques with needle retention of 10+ minutes, plus a stretching routine, and proper supplementation. There is hope for those of you suffering from MTrps!