When a gun is fired the pain is usually in a different location to the trigger of the gun. When referring to muscles the term trigger point suggests that the muscle responsible for a painful area is not in the painful area. Sometimes the trigger point is on the front while the pain zone that the patient reports is on the back. Sometimes it is very close to the trigger while at other times it can be two feet away. The work of locating the trigger points and their corresponding pain zones can be attributed to Janet Travell, MD. Over the course of many years she carefully documented the effects of injecting each muscle with an irritant. The subsequent manual that she produced helps practitioners work backwards to locate the offending muscles by using the patients' reports of the painful 'target' areas.
A case in point.
A patient called me on Sunday night in desperation. He asked if there was any way he could be seen the following morning. I told him that I had a full schedule but if he was willing to come in at 7am I would see him. When he arrived he pointed to an area on his back close to the inside of his shoulder blase. He explained that the pain had been no less than 8 out of 10 for the last 3 days. He said that he knows "exactly" where the trouble is and has been rubbing it and pressing it the whole weekend. Finally he told me that before he called me on Sunday night he had taped the handle of a screwdriver to the door jamb and pushed himself onto the handle using the other side of the frame in order to get relief from that spot. I asked him to remove his shirt and show me the spot that hurts. When he took off his shirt I saw an open wound near his right shoulder blade. He had broken the skin with his efforts to relieve his pain. I cleaned and dressed his wound and explained to him that I will not be working on that area. His comment was, "but that is where the problem is". I explained about trigger points and showed him in the manual that the trigger muscle for pain near the shoulder blade is actually in the front of the neck. He was skeptical but agreed to a 15 minute treatment of ONLY one muscle group in the front of the neck on one side as a test. After about ten minutes he started giggling. I asked him what was funny and he said that he could hardly believe it but the pain was almost gone.
There are a couple of important things to note in this story. The first is that the patient was 100% sure that the 'problem' was located where the pain was located. This is completely natural since our experience usually tells us the same thing. For example, when we step on a nail or touch something hot the problem area is the area where the pain is felt. This makes pain from trigger points a lot more comples and usually many treatments are performed on the painful area before someone takes the time to look at referral from trigger points.
The second important thing to note is how far people are willing to go to relieve their pain. This man had broken the skin trying to get relief. I urge you please, if you have a persistent pain or tightness, to set up a consultation. I will do a thorough examination that will include an assessment of the trigger point referral pattern so that you don't have to resort to screwdriver handles to look for relief.