The Great Imposters Or Muscles That Mimic
Victoria L. Magown,
CMTPT, LMT and George S. Pellegrino, LMT, CMTPT
As we usher in a new millennium, one of our goals at MyoRehab
is to bring a better understanding of Myofascial Pain and Dysfunction
to the medical community and to our readers. To achieve that goal
we will publish a series of articles focusing on common pain syndromes
illustrating their connection to myofascial trigger points.
A myofascial trigger point is a hypersensitive spot in a muscle
that when stimulated, usually produces pain referred in a predictable
pattern away from the trigger point. These points also trigger contractions
in muscles that are called taut bands. These triggered taut bands
cause the dysfunction of the pelvic joints. When trigger points are
activated in these muscles, both the muscles and the joints need
to be treated.
We will also continue our seminars series for healthcare practitioners
who work with pain patients to foster a better understanding of the
concept that the location of pain is not usually the location of
the problem. It is our goal to provide a better understanding of
Myofascial Pain and Dysfunction and how this neuromuscular “dis-ease”
can mimic common diagnoses and health problems.
High on the list of the “Muscles That Mimic” is the gluteus minimus.
with our weight on one leg more than the other can cause trigger
points to develop in this muscle (Illustration A) causing pain in
the buttocks, thigh and calf. Standing with our weight shifted to
one side usually occurs when we’ve had an injury to the side we are
trying to shift the weight from.
Looking at this pain pattern, lay people and healthcare professionals
alike often assume this to be sciatica. Sciatica is the description
of a pain pattern and not a true diagnosis. The pain referral pattern
of the gluteus minimus qualifies this muscle to be dubbed one of
“The Great Imposters”.
On more than one occasion, a patient has come to us with severe
pain in the left side of chest and down into the left arm. After
appropriate testing by a physician for a possible heart problem is
found to be negative, the patient is referred to MyoRehab. Trigger
points in the pectoralis major muscle will cause pain in the chest
and refer pain down into the arm (Illustration B). Since this pain
referral pattern so closely “mimics” that of a heart attack, the
pectoralis major is a major star in our list of “Imposters”.
Appendicitis is a fairly common health problem at any age and
often attacks without warning. There are numerous documented cases
in which the appendix has been removed and found to be free of disease.
In those cases, the culprit might have been trigger points in the
lower rectus abdominis. As you can see from the pain pattern (Illustration
C) this “Imposter” causes pain in the lower abdominal area, “mimicking”
Trigger points in the lower rectus abdominis can be activated
in a motor vehicle accident by the lower part of a seatbelt or a
painful menstrual cycle. These points in the lower abdominals can
trigger diarrhea and symptoms mimicking diverticulitis or gynecological
Migraine headaches have become all too common in today’s stressful
lifestyle. Many people suffer from headaches on a daily, weekly or
monthly basis. Trigger points in the posterior cervical muscles (back
of the neck) are always involved in severe headaches such as migraines,
tension headaches, and post-traumatic headaches. When trigger
points in the upper trapezius are activated for instance, they “mimic
migraines” (Illustration D) causing predictable head and neck pain.
These muscles contract strongly and can compress the greater occipital
nerve causing not only muscle pain but nerve pain as well.
All sports injuries; Tennis Elbow, Jogger’s Heel, Shin Splints,
Bicipital Tendonitis, Bursitis, etc., have “Muscles That Mimic”.
The mimicking muscles are, in fact, often the cause of the pain portion
of the symptoms. When we use our muscles over and over playing
a sport, if those muscles are not adequately stretched back to their
normal resting length, they becomes tighter and tighter, developing
points that will trigger pain and contracture. A good example
would be the finger extensors and supinator (Not illustrated) which
are the “Muscles That Mimic” Tennis Elbow. Tennis Elbow is caused
by repetitive micro-trauma to these muscles which shorten them and
cause pain. The soleus, gastrocnemius and tibialis anterior muscles
(Not illustrated) in the calf are the “muscles that mimic” both Jogger’s
Heel and Shin Splints.
Throughout the coming years, our articles will address these and
many other muscles in more depth. We will give you examples of different
patients’ pain problems and the resulting dysfunction. We will stress
the importance of a specific home exercise program given after treatment
to retrain the muscle to stay at its full resting length, pain-free.
There are many “Muscles that Mimic”. Are you suffering from points
that trigger one of these “Great Imposters”? If no one can find the
source of your pain give us
a call at MyoRehab.