The Great Imposters Or Muscles That Mimic

By

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. Standing 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” appendicitis.

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 disorders.

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.