Radiating pain is a very common presenting problem. Most frequently the pain affects an arm or a leg. Once serious underlying diseases have been ruled out, such as the arm or jaw pain from angina or a “heart attack”, the most frequent diagnosis would be of a “trapped nerve.”
There are certainly many cases where symptoms of pain, pins and needles or numbness result from pressure and irritation to a nerve, but sometimes the signs and symptoms don’t quite add up, and treatment doesn’t produce the expected improvement.
“Trigger points” are another very common yet much less well known cause of radiating pain. These malicious little nodules occur in muscles, feeling like small knotty lumps, they are not themselves painful unless a probing finger presses them to confess their guilt as the cause of symptoms.
These symptoms can be the same ones as caused by ‘trapped nerves”, pain, pins and needles or tingling and even some numbness; but in these cases it’s a set up, the nerve “was framed for a job they never done” (please read that quote in your best east end of London gangster voice).
Just to add an extra bit of spice to the story, trigger points can also cause symptoms that are frequently due to some other underlying condition. Examples include tinnitus (ringing in the ears) and/or dizziness from trigger points in neck muscles; period pains from trigger points in abdominal muscles; and disturbed heart rhythm from trigger points in chest muscles.
A full circle can then develop, with the symptoms produced by trigger points leading to the development of another problem. Disturbed heart rhythms increase the degree of turbulence in the flow of blood, which in turn can increase the risk of a heart attack when it affects the flow of blood to the heart muscle itself.
Muscles that contain active trigger points tend to complain when they are stretched, or asked to do any work, which sounds rather like someone I know very well! So the pattern of activities or positions that tend to trigger or aggravate symptoms, along with the areas of the body where symptoms are referred, help in the process of identifying trigger points as causes of symptoms.
Some years ago a women came to see me for help with the migraines that were making her life a misery. She suffered frequent headaches, and her eyes “went funny.” Her symptoms were made worse by stress and driving, which was rather unfortunate as she had a sales job covering a large part of the north of England. She had been given several different migraine medications with little effect on her symptoms.
Her lack of free head movement lead me to suspect a particular neck muscle, which when examined felt like a towrope that was in use. Treating the very tender trigger point in this muscle relieved her symptoms, and made me look like a magician.
The moral of the story?
The problem doesn’t need to be where the pain is, and the causing mechanism may not be the most obvious one.