Thoracic and Lumbar Trigger Points
A trigger point is the specific spot in the muscle that starts off the pain, or ‘triggers’ it. They are also referred to as ‘knots’ in the muscle, which are commonly targeted by massage techniques. They can be caused by an injury or a degenerative condition.
Most types of pain and stiffness in the thoracic (upper) back muscles occur in the Thoracic Paraspinal muscle group, which run lengthwise, parallel to the spine. As these muscles attach to the spinal vertebrae, they can cause problems with spinal misalignment and damage to the intervertebral discs. Due to the close proximity of these muscles with the spine and nerves, trigger points in these muscles can also induce pain that feels like it originates in the organs of the chest and abdomen, such as appendicitis, kidney stones, angina, and lung problems, creating a difficult diagnosis.
There can be as many as twelve muscle groups involved in lower back pain. A simple case of pain may only involve two or three muscle groups, but if left untreated, up to ten additional muscle groups may become involved. The four main muscle groups primarily contributing to lumbar (lower) back pain are the Quadratus Lumborum, the Gluteus Medius, the Ilio-Psoas and the Rectus Abdominis groups.
The Quadratus Lumborum contracts to help stabilise the spine, and to flex the trunk to either side. This muscle group can contain up to four trigger points that refer pain to the low back, groin, hip, and gluteal regions.
The Gluteus Medius muscle group attaches just under the pelvic bone, and runs diagonally downward to attach on the leg bone at the hip joint. This muscle functions to raise the leg to the side, and to stabilize the pelvis during walking. Trigger points in this muscle refer pain to the buttocks and along the belt-line.
The Ilio-Psoas muscle group contracts to stabilise the trunk on the hips, and to flex the trunk forward and/or lift the thigh. Though this muscle is in the front of the body, its trigger points refer pain to the low back, in a vertical pattern that runs parallel with the spine.
Finally, the Rectus Abdominis muscle group is in the stomach region. It contracts to flex or curl the trunk on the pelvis and helps stabilise the trunk during upright activities. Trigger points in this muscle group can refer pain to the belt-line, across the mid back, and at various places in the stomach region. Additionally, the trigger points may produce such diverse symptoms such as abdominal bloating, heartburn, nausea, and may even resemble the pain associated with appendicitis.
Botox (Botulinum Toxin A)
Patients that have easily identifiable trigger points, permanently contracted muscles, or headaches that are associated with muscle spasms are very good candidates for Botulinum Toxin A injections. Botox is the industry name for Botulinum Toxin type A, which is derived from a strain of bacteria called clostridium botulinum. When Botox is injected into a muscle, it blocks the signals sent from the brain which tell the muscle to contract. Botox targets the muscles involved by effectively disarming them and ensuring that they do not send panic signals throughout the body. The body believes that there is no pain being experienced. Botox can help to keep the muscle relaxed for anywhere from three to six months, after which it is hoped that the muscle will be able to contract normally without pain or spasms.
Botox injections are performed as an outpatient procedure at the London Pain Clinic, with patients free to leave as soon as the treatment has been administered. Initially, the treating doctor will spend time identifying the individual trigger points, sometimes with the help of a physiotherapist, and will mark the areas with a pen. The located areas will then be sterilised with a chlorhexidine antiseptic spray and a fast acting local anaesthetic will be will injected through a small cosmetic needle.
Botox can then be administered by one of three different ways, depending on the case. Usually, small cosmetic needles are preferred, but a Stimuplex nerve stimulator or ultrasound guidance are sometimes necessary if the trigger points are more difficult to access. 100 units of Botox are usually administered, but this can increase up to 200 units depending on the affected area.
One of the major advantages of Botox is that there is little or no recovery time, and most people feel fine and can return to their normal life immediately. The results of treatment should last around 3-6 months and the procedure can be repeated after this time.