Trigger Points and Referral Pain: How a Physical Therapist Can Help Relieve and Prevent Discomfort
What Are Trigger Points?
This is one of our favorite diagnoses to treat here at Living Well!
Trigger points are sensitive, hyperirritable spots within a muscle that form due to muscle overuse, injury, or stress. They are commonly described as “knots” in the muscle tissue and can cause both local pain (at the site of the trigger point) and referred pain (pain felt in a different part of the body).
What Are Trigger Point Referral Patterns?
A referral pattern is the predictable path along which pain from a trigger point is felt. When pressure is applied to a trigger point, it often produces pain or discomfort not only at the site of the trigger but also in another area of the body that may seem unrelated. This happens because trigger points can irritate the nerves and create a pain signal that the brain perceives in a different location.
For example:
A trigger point in the upper trapezius muscle (in the shoulder) can cause pain that radiates into the side of the head or the jaw.
A trigger point in the gluteus medius (in the hip) can refer pain down the outer thigh or into the lower back.
A trigger point in the infraspinatus (a rotator cuff muscle) can cause pain in the shoulder and down the arm.
Why Do Trigger Points Refer Pain?
The nervous system creates these referral patterns due to the way muscles and nerves are interconnected. When a trigger point irritates a nerve, the brain may misinterpret the source of the pain signal, causing the discomfort to be felt in a distant location.
This is similar to how heart problems can cause referred pain in the arm or jaw — the brain receives the pain signal but struggles to pinpoint the exact origin.
Common Trigger Point Referral Patterns
Neck pain
Location of trigger point: Top of the shoulder
Muscle: Upper trapezius
Referral pattern: Headache at the temple, behind the eye, and down the side of the neck
Location of trigger point: Front of the neck
Muscle: sternocleidomastoid
Referral pattern: Headache at the forehead, eye, and jaw; dizziness or imbalance
2. Shoulder pain
Location of trigger point: Back of the shoulder blade
Muscle: infraspinatus
Referral pattern: Deep pain in the shoulder and down the arm
3. Hip pain
Location of trigger point: Side of the hip
Muscle: gluteal medius or gluteal minimus
Referral pattern: Pain down the outer thigh and into the knee
4. Back pain
Location of trigger point: Lower back
Muscle: quadratus lumborum or psoas
Referral pattern: Pain in the hip, gluteal region, and down the outer thigh
How Are Trigger Point Referral Patterns Treated?
Our Physical Therapists at Living Well can effectively treat trigger points and their referral patterns using several techniques:
Manual Therapy: Direct pressure (trigger point release) and massage to relax the muscle.
Dry Needling: Inserting thin needles into the trigger point to reduce muscle tension and improve blood flow.
Stretching and Mobility Work: Lengthening tight muscles to prevent recurrence of trigger points.
Strengthening Exercises: Building muscle support to reduce strain and prevent trigger points from forming.
Postural and Ergonomic Training: Improving posture and movement patterns to reduce muscle stress.
Why Understanding Referral Patterns Matters
Recognizing referral patterns allows physical therapists to treat the true source of the pain rather than just the symptoms. For example, treating arm pain caused by an infraspinatus trigger point is more effective than focusing solely on the arm itself.
If you’re experiencing unexplained pain, especially in areas distant from the source, our physical therapists at Living Well Physical Therapy can identify and treat the underlying trigger points to relieve your discomfort and restore function.