DEAR DR. GOTT: I find your column interesting and useful, but I am often frustrated by some of your answers when they concern muscle or joint pain. In your column about tennis elbow, you left out a very likely cause of the problem, but you seemed to disregard it or are unaware of it.
Trigger points may well cause this person’s tennis elbow and, while the pain could be coming from the forearm as you suggested, it could also be coming from the triceps. The trigger points can be caused by trauma or overuse of the muscle; but physical therapy, heat and massage treatments will not cure them, just provide short-term relief. Trigger points are small knots in the muscle that can cause constant pulling at the tendon, resulting in tendonitis. If you don’t release the trigger point, you won’t cure the problem. Physical therapy, heat and massage may relax the trigger point, but it will tighten up shortly after treatment and the pain will return.
Trigger points can cause referred pain in just about any part of the body, including joints, cause headaches and often lead to the misdiagnosis of ailments like plantar fasciitis and carpal-tunnel syndrome. It is time to let the public know more about this condition and how to treat it.
DEAR READER: Trigger points are essentially sensitive areas in the muscles. Chronic pain in these areas is referred to as myofascial pain syndrome. A trigger point or points can cause pain, referred pain, muscle weakness, referred tenderness and more. They are not to be confused with tender points, which are associated with fibromyalgia. Tender points do not cause referred pain, and more than one occurs symmetrically in the body.
In 2008, the results of a study appeared in the Journal of Alternative and Complementary Medicine suggesting that acupuncture and myofascial trigger therapy were both beneficial in treating pain disorders. Myofascial trigger therapy has been around since the 1800s, and acupuncture precedes that by about 2,000 years.
As for my not mentioning trigger points as a cause of tennis elbow, I must admit that I had not thought about it. For that reason, I have chosen to print your letter in the hope that it may help others.
Readers who are interested in learning more about pain can order my Health Reports “Managing Chronic Pain” and “Fibromyalgia” by sending a self-addressed stamped No. 10 envelope and a $2 check or money order per report to Newsletter, P.O. Box 167, Wickliffe, OH 44092-0167. Be sure to mention the title(s) or print an order form off my website’s direct link at www.AskDrGottMD.com/order_form.pdf.
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