Dysfunction and Pain from Myofascial Trigger Points
Robin Christenson, MPT
As myofascial trigger points accumulate, muscles begin to shorten and can cause severe pain and dysfunction. For example, imagine a hammock between two trees. If you tie the fabric into a knot, the hammock becomes shorter. More knots will begin to add force to the trees and the hammock will be too short to be able to lie on. The hammock no longer is functional and can create damage from the additional stress placed on the trees. While active trigger points in and of themselves are painful, the shortening effect on the muscle creates a cascade of dysfunction.
Due to the close proximity of the pelvic muscles, trigger points even in one muscle can cause dysfunction in bowel and bladder function, sexual function, postural and spinal alignment and overall body motion. Pelvic muscle trigger points can greatly contribute to bladder and bowel dysfunction. The urethra is the “hose” that drains the bladder, like the neck of a balloon. If you are trying to empty the air out of a balloon, it is difficult if you are putting pressure around the neck. The urethra should be able to relax in order to allow the bladder to empty completely. If trigger points occur around the urethra, one might experience urinary urgency, frequency, incomplete emptying or even painful urination. Trigger points around the anus can create an extremely tight anal sphincter. This can make bowel movements difficult or painful, and can lead to constipation.
Painful bowel movements are common in people with tailbone pain. Why? If your pelvic muscles become shortened, they begin adding abnormal, uneven forces to the bones in which they attach. Several of the muscles that that attach to the coccyx (tailbone) can pull it out of place creating pain. Some of the muscles that attach to the coccyx also attach to the anal sphincter so when taking a bowel movement, trigger points are disturbed, pulling on the coccyx.
Just as the many of the pelvic muscles attach into the coccyx, there are also several muscle that attach into the sacrum. Abnormal forces to the sacrum can lead to hip, buttock, and low back pain and misalignment. As several nerves exit through the sacrum, trigger points that lead to sacral muscle pressure can squeeze and irritate nerves. Sciatica is a common result of trigger points that have formed a deep pelvic muscle called the piriformis. Trigger points in the piriformis can also irritate or entrap the pudendal nerve. Pudendal Nerve Entrapment can cause severe pain with sitting, painful bowel movements, urinary dysfunction and even vaginal pain.
Chronic trigger points and resultant shortening in the muscles around the vagina often lead to vulvodynia, vulvar vestibulitis and vaginismus (click the word for definitions). These conditions are most often associated with severe vaginal burning, vaginal pain and painful intercourse. As hypertonic or spasmed vaginal muscles have decreased blood flow, the muscles begin to weaken and atrophy (thin and lose mass). Vaginal atrophy can lead to vaginal tearing with penetration, decreased gland production of lubrication, and weakened pelvic muscles leading to urinary incontinence.
Do you see how all of these trigger points in the pelvic muscle can lead to multiple, interrelated dysfunctions? As asked in the age old question: what came first, the chicken or the egg, you may find yourself going in circles trying to figure out the actual cause of your pain. As many pelvic dysfunctions result in or are caused by pelvic floor hypertonicity, treatment of the pelvic muscles is essential in unraveling pelvic pain.