Common Causes of Pain

Myofascial Trigger Point Pain

What is it?

Myofascial Trigger Points are very tender, hyperirritable muscle fibers (often described as “muscle knots”) that are very tender when touched or pressed (“palpated”), and can cause a wide variety of symptoms

How does it occur?

Myofascial trigger points can develop for any number of reasons.  Common causes include overuse or repetitive strain, acute injury or trauma, poor posture, suboptimal body mechanics, stress or muscle tension, prolonged immobilization, inactivity, and/or underlying structural abnormalities (osteoarthritis, tendon disorder, nerve entrapments etc).  Most trigger points develop through one of the following circumstances:

  1. Sudden onset, no injury (“acute”):  During a routine activity such as exercising, walking, going up or down stairs, gardening, housekeeping etc, you suddenly develop symptoms such as pain, tightness, stiffness, heaviness, weakness or some other sensation in a body part (shoulder, elbow, hip, thigh, knee, calf, heel…).
  2. Delayed onset (“subacute”): Hours or days after a routine or new activity (yardwork, lifting weights, moving furniture, hiking…)
  3. Post-injury:  In the weeks or months after an injury, you may have persistent pain, stiffness, instability, weakness and/or any number of other symptoms.  Some patients struggle to explain their symptoms, and often say “it’s hard to describe”.  Many patients with chronic, lingering symptoms are told they have “scar tissue”, or made to feel it is all “in your head” — especially if diagnostic tests and imaging findings are unremarkable.


What are the symptoms?

Pain and stiffness and tightness are perhaps the most common symptoms. Other symptoms include weakness, stiffness, heaviness, numbness, tingling, burning, itching, instability, the subjective sense that your affected body part is swollen (even though it may not look swollen).  Patients often say “the pain moves around” or “it’s hard to describe” – which suggests that a trigger point is a factor.

How is it diagnosed?

A detailed history and physical exam, with an emphasis on palpation – touching and applying pressure with fingers to detect areas of tenderness, tightness, and restriction). Imaging studies such as radiographs (X-rays), ultrasound, and MRI may be obtained to rule out other causes… Importantly, Trigger Points often mimic traditional orthopedic diagnoses such as “tendinitis”, “bursitis”, and “arthritis”.  As a result, they are often overlooked – even by specialist physicians.

What standard treatments are available? 

Manual therapies (deep tissue massage, cupping), Dry Needling, and shockwave (none of which are covered by insurance); Trigger Point Injections (typically covered by insurance)

What advanced, non-surgical treatments are available? 

Therapeutic Needling is the term Dr. Mahooti coined to describe a minimally invasive procedural technique he developed that is like Dry Needling, but better. Therapeutic Needling is a low risk procedural technique that integrates principles from Trigger Point Injections, Dry Needling, and acupuncture.  He has performed upwards of 20,000 procedures, teaches the technique to physicians at numerous regional and national medical conferences, and is founder of the Therapeutic Needling Institute.

When should I schedule a consultation with Dr. Mahooti?

If you have any of the above symptoms that are persistent, have not responded to stretching,  massage and other traditional orthopedic treatments (anti-inflammatories, physical therapy, cortisone injections, and activity modification)