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Trigger Points and Pain

Chiropractic Care and Trigger Points

Trigger points associated with lower back and leg pain are commonly found the iliotibial band (near the upper thigh), as well as in muscles near the hip and buttocks, including the psoas, gluteus maximus, and piriformis. Trigger points associated with neck, upper back, and arm pain are commonly found muscles near the upper back and neck such as the the shawl portion of the trapezius muscle, the rhomboid muscles, and the levator scapulae.

These chronic, persistent, localized muscle spasms are caused by postural inefficiencies, biomechanical faults, and stress. Any or all of these factors may be involved. Stress may be ongoing, depending on the person's circumstances, but posture and biomechanics can definitely be addressed and improved with chiropractic care.

Your chiropractor will analyze and identify biomechanical issues, particularly those involving spinal misalignments. A chiropractor will design treatment specifically tailored for your individual needs and, if needed, will help educate you regarding good postural habits and exercises that will be beneficial for many years to come.

Trigger points are persistent, localized muscle spasms that can cause a great deal of pain.1,2,3 Trigger points alone may be responsible for many cases of neck pain, upper back pain, and lower back pain. This relationship is fairly common knowledge among physicians who treat pain, including chiropractors, rheumatologists, and physiatrists (doctors of physical medicine).

What is not generally known is that trigger points may also be implicated in radiating pain into the arm and hand or radiating pain into the leg and foot. In fact, radiating pain due to trigger points may be mistaken for pain caused by a herniated disc, in either the neck or lower back. Trigger point pain affecting the wrist and hand may even be misdiagnosed as carpal tunnel syndrome. A patient in whom a correct diagnosis of trigger point pain is missed may lose much precious time and other resources, as she fruitlessly "tries" one doctor after another and needlessly undergoes all sorts of complex and costly testing.

The key to correctly identifying the source and cause of upper or lower extremity radiating pain is to be able to accurately characterize its nature. Radiating pain caused by trigger points is diffuse - the pain broadly covers a region. This diffuse pain is described as "scleratogenous", meaning that it is pain referred from connective tissue such as muscle and tendon. Radiating pain caused by a compressed spinal nerve (ultimately caused by a herniated disc, for example) is described as "radicular" or "dermatomal". This pain is confined to a specific area - the area that is supplied by a specific spinal nerve. For example, pain involving the thumb and index finger could be caused by compression of the C6 spinal nerve. Pain involving the outside of the foot and the little toe could be caused by compression of the S1 spinal nerve.

Scleratogenous pain is not specific. A person might complain of pain across the "shawl" portion of the upper back and traveling into the upper arm, experienced "all over" the upper arm. Another person might be experiencing pain across the gluteal region, hip, and upper thigh. Both of these patterns of radiating pain are likely due to several trigger points, localized to the respective areas.

Of course, an accurate diagnosis is necessary to be able to develop an effective treatment strategy. The good news is that although trigger points necessarily represent a chronic muscular process, they may be treated with very good to excellent outcomes using conservative protocols. Chiropractic care is the optimal method for managing trigger point pain. Chiropractic care is a drug-free approach which directly addresses the biomechanical causes of these persistent trigger points and their associated patterns of radiating pain. Chiropractic care improves mobility and restores function, helping to reduce and resolve chronic pain.

1Alonso-Blanco C, et al: Multiple active myofascial trigger points reproduce the overall spontaneous pain pattern in women with fibromyalgia and are related to widespread mechanical hypersensitivity. Clin J Pain Feb 28 2011 (Epub ahead of print)
2Bron C, et al: Treatment of myofascial trigger points in patients with chronic shoulder pain: a randomized, controlled trial. BMC Med 9:8, 2011 (January 24th)
3Renan-Ordine R, et al: Effectiveness of myofascial trigger point manual therapy combined with a self-stretching protocol for the management of plantar heel pain: a randomized controlled trial. J Orthop Sports Phys Ther 41(2):43-50, 2011

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Dr. Andrew Zomick & Dr. David Avallon

I have been coming to Stamford Sports and Spine for almost 10 years. I am active and have unfortunately been in a few car accidents. The care and treatment offered at Stamford Sports and Spine is world class and without them I would be living with an inordinate amount of pain and discomfort. Going to Stamford Sports and Spine has made my injuries manageable.


Very good team of therapists. Flexible and available schedule. They helped get my teenage athletes back on the field in half the time.


I was experiencing some pain in my right shoulder and numbness down my arm to my hand. The range of motion in my shoulder was limited and I could not participate in volleyball. Dr. Z came to our office offering a free chair massage and a chance to come in for an evaluation. I did this and we worked out a treatment plan that included therapy and adjustments. I noticed in the first few weeks the pain subsided greatly in my shoulder. The numbness in the arm and hand were present but noticeably better. After three weeks, the range of motion in my shoulder was back to normal and the pain was gone. Now after one month of therapy the numbness in the arm is extremely better and I do not notice the symptoms as often as I used to. Coming into the office has helped tremendously. I can now play volleyball pain-free.


After moving from London to the USA, two weeks into living in Stamford and having carried and unpacked a lot of heavy boxes my shoulder froze and I was in a great deal of constant pain. After finding Stamford Sports & Spine on the internet I made an appointment and the corrective programme S.S.S. put together for me meant that I immediately had some pain relief, and over the next few weeks the pain left completely. The programme is also ensuring that I am not only pain free but fully corrected so as this problem should not occur again. Very friendly staff and very detailed assessment programme that has ensured my full recovery.


From my first visit to Stamford Sports & Spine I was extremely impressed and pleased with their service. Everyone including staff and doctors were very knowledgeable with their chiropractic services. I learned a great deal about my symptoms and overall care more than I expected. I have visited a few other chiropractors but none were as thorough as Stamford Sports & Spine. I was experiencing severe pain in my shoulder and arm and after a few visits my pain decreased substantially. I really appreciate all the services from the adjustments, rollers and even exercise room. I would highly recommend this facility to everyone. The entire staff are friendly, professional and just simply great!


Everyone was incredibly professional and helpful.  The staff is friendly and goes beyond what was expected to meet my needs and education me about my condition.


Came in with severe and constant numbness and tingling in my legs and feet. The treatment worked quickly and resolved all of my symptoms. Thanks!


My arms were falling asleep every night and had numbness and tingling during the day. I no longer have any of those symptoms during the day and have very rare episodes of pain at night due to my treatment here at Stamford Sports & Spine


I came in for hip pain and stiff neck that also affected my right arm and hand. Using the relaxing rolling / traction bed and electrical muscle stimulation along with stretching and the adjustments my hip pain is gone. I can walk without sharp pains running up and down my legs. My neck range of motion has improved and my muscles are more flexible and less spastic.


I had severe neck pain which was aggravated by a recent move. I have been coming to be adjusted for a few weeks now and not only has it helped with the neck pain I had been experiencing, but it has also made me feel better overall. I feel like I am able to sit up straighter, and my muscles are looser and less tense. I no longer have the intense pain I had once been experiencing


When I came in my pain was a 10 out of 10. After just one week of care my pain went down to a 4 and has been improving ever since. The staff are very friendly and great educators. I learned a lot about my body and how to take better care of myself.


After a car accident,  I had to seek help for my upper back and neck pain. Slowly but surely I started to feel better, not immediately, but by keeping up with my visits with Dr. Q & Dr. Z. Now I can tell you that I feel leaps and bounds better, and am now looking forward to a pain-free summer.


I have been with Stamford Sports & Spine for more than a year now. I still remember how much pain I was in during my first session. I can now walk in and out without any aches or pains.


When I first started going to Stamford Sports & Spine, my back had been seizing up with alarming regularity. After just a few months of working with Dr. Z and Dr. Q, I feel much more confident in my daily activities and have even been able to return to the gym.


Thank you to Dr. Z, Dr. Q and the whole Stamford Sports & Spine team! For many years, I have been suffering from severe back pain that would sometimes keep me from going to work. The recurring pain would come and go and I couldn't figure out what I was doing to cause it. When I came to the office, Dr. Z took x-rays, did a complete examination and educated me as to what was happening and why. I began treatment and was given exercises to prevent these injuries from happening in the future. Since starting the treatment, I have seen a great improvement in my back. The pain is gone and I have an increased range of motion. Thanks again to the entire staff who are very friendly and always willing to accommodate my hectic schedule when I make appointments.


The strabismus in my eyes caused a vertical deviation in my eye placement.  This resulted in my head naturally tilting to the right and throwing my muscular structure in my neck and shoulders off.  I had accepted the tilt and tightness as a way of life and a natural dis-figuration of my spine.  I almost didn't sign on for initial treatment.  After 3 visits I have already noticed a difference in the position of my head, my posture and regular comfort levels.  There is still a ways to go to rid that area of  a lifetime of dysfunction, but what a relief to know it's treatable and already improving.


I found Dr. Z and Dr. Q earlier in the week after experiencing some back pain and sciatica. After the consultation and x-rays I began therapy. After just 2 treatments I felt much better and had a significant reduction in discomfort in the area of concern. I am looking forward to continuing my treatment in an effort for long term recovery and a return to my heavy exercise routine.


FANTASTIC. When I leave I feel like a whole new woman. I have been going there for my neck pain and headaches for about 1 year now; off and on and ever since I started treatment there my headaches have been reduced to one every few months instead of a few every month. The intensity of of my pain has also been reduced to almost nothing. The doctors seem to have a very friendly relationship with all of the patients and I feel very welcomed by the staff as well. Not to mention I love how they incorporate therapeutic massages into my treatment. I have since sent over many of my colleagues and family, who also share the same feelings. Thank you.


I had a great experience. My low back pain is completely gone. I found the staff extremely knowledgeable, accommodating and friendly. I would highly recommend them.

--Jay F.

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