trigger points for low back pain_full_optBy Sara Calabro

Los Angeles Times recently called back pain “one of medicine’s most confounding problems.” It’s also one of the most expensive—not to mention, a significant contributor to prescription-drug addiction and misuse, and overall low quality of life for hundreds of millions of people.

Acupuncture can help shed light on this monumental problem for which mainstream medicine has very few answers.

Part of the reason back pain is so puzzling is that it potentially involves so many different structures and functions throughout the body. This applies to acupuncture in that there are multiple ways to address back pain depending on the location, accompanying symptoms, and style of acupuncture being used.

This article will focus exclusively on trigger-point acupuncture for low back pain.

Trigger-point acupuncture releases sensitive nodules in the skeletal musculature that cause referred pain—what we refer to in layman’s terms as “knots.” Rather than temporarily masking the pain that’s caused by trigger points, as medications do, acupuncture actually eliminates the source of the problem.

Which trigger points cause low back pain?

low back pain trigger pointsWith low back pain, the source can be trigger points in a number of different muscles.

Trigger points in the following muscles can refer pain to the low back: erector spinae longissimus, erector spinae iliocostalis, multifidi, rotatores, rectus abdominis, quadratus lumborum, iliopsoas, gluteus medius, gluteus maximus, levator ani, and piriformis.

The pain-referral patterns for some of these muscles are shown below, along with a composite pattern that can appear when multiple muscles are involved.

In Myofascial Pain and Dysfunction: The Trigger Point Manual, author Janet Travell, a Western physician who is credited with coining the term “trigger point,” says of low back pain, “Occasionally only one muscle will be responsible for the pain as presented, but it is much more common for several muscles to contribute to overlapping pain patterns….No two patients present exactly the same picture.”

If trigger points cause so many problems, why don’t we hear about them more?

The last part of Travell’s statement above—”No two patients present exactly the same picture”—is partly to blame for trigger points being so under-represented in medical literature and media, and rarely mentioned in discussions between doctors and patients.

Mainstream medicine is centered around a one-size-fits-all treatment model. The goal is to isolate symptoms according to where they occur in the body, and address them according to pre-determined treatment plans that can be replicated in patients with the same symptoms. Under this model, similar symptoms that stem from different causes present a dilemma.

Also holding back widespread acceptance of trigger points as a leading cause of low back pain is the fact that they don’t show up on conventional medical tests.

Healthcare today is heavily geared toward evidence-based practices and dependence on technology at the expense of physical-exam skills. When MRIs and CT scans turn up nothing, many doctors are at a loss for how to diagnose the patient—and bill the insurance company.

In addition to being under the influence of their profession’s increasing reliance on technology, most doctors simply were never taught this stuff.

Travell says, “The muscles in general and [trigger points] in particular receive little attention as a major source of pain and dysfunction in modern medical school teaching and in medical textbooks.”

The notion of treating sensitive spots on the body has been part of acupuncturists’ shtick for thousands of years; it’s called ashi needling. However, knowledge of the modern-day version of this practice, which is much more Western in its approach—isolating anatomical structures—is relatively scare among acupuncturists as well.

Acupuncture is premised on the interconnected nature of disease, the dynamic interplay between physical health and emotional/environmental factors. So the idea of treating low back pain by isolating the piriformis muscle, for example, runs counter to the way acupuncturists are conditioned to think. 

It is only fairly recently that trigger-point acupuncture is becoming better known within the acupuncture community. This has stirred up much debate over how trigger points align with the fundamental tenets of acupuncture theory.

Whether the Chinese knew about trigger points eons before Janet Travell did—opinions welcome in the comments and on Twitter and Facebook!—is of lesser importance than the bottom line: Trigger-point acupuncture relieves low back pain in a very high percentage of cases.

How does acupuncture get rid of trigger points?

Acupuncturists who address trigger points typically perform more palpation than those who work in other styles. They feel along the muscles, looking for taut bands of fibers that contain tender spots. When these spots are pressed, the patient may feel local and/or referred pain to another part of the body. Often, pressing these tender spots will recreate the low back pain.

Once the trigger point has been identified, the acupuncturist may needle directly into it or at the muscle-attachment site. The needling usually causes the muscle to twitch, allowing it to loosen and return to its normal resting state. 

Sometimes patients feel an immediate loosening and reduction in low back pain, but not always. Particularly with low back pain that is chronic, trigger points can be extensive throughout various muscles, requiring several treatments to achieve relief.

There is also the issue of perpetuating factors, meaning the things that are causing the muscles to retain trigger points. This can include emotional stress and tension, bad posture, repetitive strain, or an imbalance in any one of the body’s systems—with low back pain, often the Kidney or Bladder systems are affected.

Acupuncture has tools for addressing acute pain symptoms as well as these underlying factors; it is truly a holistic approach to treating low back pain. It also works preventatively, by reorienting the patient’s posture and encouraging his own healing mechanisms.

Ubiquitous problems warrant comprehensive solutions. For low back pain, acupuncture treatments that incorporate trigger-point release come closer than anything we know of yet.

Featured photo by Sara Calabro; trigger-point images from Myofascial Pain and Dysfunction: The Trigger Point Manual

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