Trigger Points 101: When your Back Pain is Actually a Pain in the Butt

Those unfortunate to have experienced or continue to suffer from chronic lower back pain know that it’s as if it is sourceless yet all-encompassing. Its pain hovers like a ghost on the body, reaching its affecting limbs to other body parts, causing an ache here and a tense knot there. 

This shifting and evolving sense of pain can often be a signal that the pain might not be generated by the lower back after all, making it a victim of another bodily mechanism. This is when lower back pain is actually and literally a pain in the butt instead or various other possibilities not directly caused to the lower back. 


Photo courtesy of Oh Nut Co.

Photo courtesy of Oh Nut Co.

What are Trigger Points (TrP)?

Trigger Points or TrP are small, contracted knots in a muscle or muscle group that lead to what is called “referred pain.” They can feel like tiny hard nodules or tense muscle fibres, which often feel painful when pressed and more often than not, send immediate sensation radiating in the lower back.

According to The Pain Center, chronic musculoskeletal disorders may lead to the development of trigger points in other areas of the body as well. Myofascial trigger points are similar, but can occur in softer tissues like skin, ligaments, tendons and scar tissue.

Their cause is still unknown but research suggests that they may be due to direct or indirect injury; repetitive motion, even from exercise like running; and/or stress, especially if chronic. Many of these speculated causes also go hand-in-hand, such as when an injury causes chronic stress in the body and change in mechanism or posture that is repeated over time.

These knotted areas repeatedly send the signal of pain to the brain through the nervous system and,  if left untreated, can lead to chronic pain. They do not disappear without treatment over time although they can become less sensitive or flare up from time to time, due to provocation such as oerexertion, illness, stress, and fatigue.

Trigger points, like many other issues, do not resolve with band-aid solutions like taking NSAIDs, anti-inflammatory supplements like turmeric, or chiropractic adjustments. They are pain points that need their respective and direct treatment. Trigger points that cause lower back pain must be located and treated properly and thoroughly if you are ever going to achieve a relatively painless lower back.

What is Referred Pain?

Referred pain is the pain that is radiated as a dull, aching pain or even a sharp one when a trigger point is pressed or aggravated. Trigger points can also cause sensations of numbness (due to dysfunction it causes on the lower back and the SI joint), angling, weakness, or false heart pain.

What muscles(s) can cause dysfunction and pain in the lower back?

The immediate muscles connected to the lower back that can cause it pain are the following muscles, which are linked to illustrations of where they are and their area(s) of referred pain: Quadratus Lumborum (QL); Multifidus; Erector Spinae; Psoas; Gluteus Maximus; and Gluteus Medius. And then there are other muscles, which aren’t directly connected to the lower back but can still affect its function. These include Gluteus Minimus; Piriformis; Hamstrings; and Tensor fascia lata.

These direct and indirect groups are ones to keep in mind when searching for your particular trigger point to ease the tension and thus alleviate your back pain.


A Trigger Point (TrP) Treatment

  • Locate the trigger point that is referring its tension to the lower back as pain. You can do this with a physical therapist, if you have access and have the means to have such support. Otherwise, take the time to massage or palpate the aforementioned muscles and muscle groups to test out tension to find the source of pain.

  • Perform ischemic compression on those points, which often involve a tennis ball. You can search for a guided video or instructions on your specific trigger point’s compression techniques. Perform this until no longer active or until eliminated if possible, which can be as little as a few days to months. I have experienced both ends of the spectrum; I found relief from QL-induced lower back pain within a few days versus needing months for releasing Psoas-related lower back pain. 

  • Perform specific stretching exercises for the involved muscle(s), which needs to be done during treatment phase and continued indefinitely for prevention. Ideally, stretches would be advised by a physical therapist but, again, there are options if you don’t have access for one. AthleanRX on YouTube has well-informed stretch therapy videos for various different muscles, including the QL. 

  • Correct any and all structural imbalances. Pronation/flat feet, short leg, pelvic tilt, poor posture, muscle imbalances. This tip is more directed towards those with access to physical therapy. If postural or muscle imbalances are not corrected, especially under the guide of a physical therapist, the affected muscle(s) will continue to be compressed and cause issues. For instance, my Psoas did not resolve full until I switched my running shoes to a pair that accommodates my pronation. You can take personal measures as well if you don’t ave the support of a physical therapist. Checking the soles of your shoes to see if they’re more worn on the inner or outer soles or neither is a great indicator as to whether you pronate and thus need different insoles for support. Being aware of hunching or “tech neck” is also one way to support the integrity of the spine, its connecting muscles like the erectors, and therefore the lower back.

  • Correct and nutritional deficiencies. Not even has access to healthcare, so this is for if you do have the privilege of having a primary care physician who can perform a basic chemical panel for you. Certain nutritional deficiencies, such as low magnesium, increase tension in the muscles as they don’t receive the proper nutrients for optimal function. Iron is also an issue, especially for people who menstruate, since it supports oxygenation throughout the body. Not all care providers check both Iron and Ferritin levels, the latter of which is the body’s iron storage, so ask if your labs include both to be safe. On the other hand, if you haven’t gotten lab testing done and are not confirmed for deficiencies, don’t supplement without the care of a physician. Vitamins and minerals can be overdosed. They also work together; for instance, an increase in Magnesium can affect your Calcium and vitamin D levels and vice versa. An increase in iron can affect vitamin C levels. Don’t be Dr. Google.

  • Drink more water. Your grandmother and her grandmother were right, you’re probably not drinking enough water. This is especially important for when you to ischemic compression and stretches as extra water is vital to continue the release of the body and flush out possible water retention caused by previous muscle trauma or strain for repair. 

  • And get enough sleep. Getting at least 7 hours of sleep is vital and more (at least 8 hours) for young adults and children. Pay attention to whether you wake up sore as well. A great way to support your body throughout the night is putting a pillow between your knees to keep your spine level if you sleep on your side. Sleeping on your back is also an optimal position, which yo can further support by putting a pillow underneath your knees. Try avoiding sleeping on your stomach, which is the least supportive position for your spine from the cervical to the lumbar regions. 


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ABOUT THE AUTHOR

Almila Kakinc-Dodd is the Founder, Editor-in-Chief of The Thirlby. She is also the author of the book The Thirlby: A Field Guide to a Vibrant Mind, Body, & Soul. She is currently pursuing her Master’s in Nursing as a Dean’s Scholar at Johns Hopkins University. Her background is in Anthropology & Literature, which she has further enriched through her Integrative Health Practitioner training at Duke University. She lives in the Washington, D.C. Metro Area, where she regularly contributes to various publications. She is a member of Democratic Socialists of America and urges others to join the movement.