After a good workout it isn’t unusual to have sore muscles. We groan and complain about them to anyone who will listen, secretly loving this feeling that lets us know we’re getting stronger. This type of soreness generally only lasts a few hours to a few days. Delayed onset muscle soreness, which will start one to two days following exercise, can last up to two weeks, depending on its severity. But, what if your pain last even longer than this?Muscle pain that lasts longer than two weeks could indicate an underlying problem such as a chronic muscle spasm. A seemingly mild ache can develop into a discomfort that may eventually affect your regular daily activities, your sleep and even your workouts.What starts as a small muscle spasm can form into something known as a myofascial trigger point. A trigger point is an area of muscle that feels like a small knot under the surface of your skin that is very tender when pressed, or causes pain when that particular muscle is used. Severity of pain can range from restriction of motion to agonizing, incapacitating pain. These trigger points can create something called referred pain. Referred pain is pain felt in an area which is remote from the actual site of injury. For example, I have had patients who complained of constant pain in the front of their shoulder and upper arm. After examination I found trigger points in the infraspinatus muscle, which is actually located in the back of the shoulder blade. Following several treatments of these trigger points my patients reported that the pain in the front of their shoulder and upper arm went away.Trigger points can occur in any muscle in the body and can refer pain to various locations. Once these trigger points have developed and have been causing pain they can be aggravated further by working out. The exact cause of myofascial trigger points is unclear. It is most widely believed that they are caused by injury and over training. The path to relief from these spasms begins with rest. It is then necessary to eliminate the trigger points and their source. Rehabilitation, which includes stretching and strengthening of the affected area, will prevent their return. Exercises that stretch the involved muscles are the key to sustained relief of myofascial pain and increasing muscular strength through exercise can significantly reduce the likelihood of developing trigger points. It is very important, however, that these exercises be performed correctly so as not to re-aggravate the condition. This is where you are at a great advantage, due to the availability of qualified personal trainers in the gym that can instruct you in appropriate strengthening and stretching mechanics.Myofascial trigger points are extremely common and become a distressing part of nearly everyone’s life at one time or another. To determine if you do indeed have trigger points that are causing your discomfort you will need the assistance of a professional who is familiar with myofascial trigger points. These include many chiropractors, medical doctors and massage therapists. Chiropractors and massage therapists do especially well at locating trigger points due to the hands-on nature of their practice. Using palpation, or feeling with their hands, they can confirm the presence of trigger points and also determine if there is associated referred pain. There are various methods to treat trigger points with more effective treatments being stretch and spray, injection therapy, and manual compression. The stretch and spray method uses a vapocoolant which is sprayed onto the skin in a specific pattern. Combined with the appropriate muscle stretch the spasm and/or pain reflex is inhibited which can relieve the trigger point. Injection therapy also has an inhibitory action on the trigger point, the effects of the local anesthetic used can decrease the pain. The actual needle itself can also offer counter-irritant effects on the spasm. Manual compression is applied using deep sustained pressure with the hands on the trigger point. Following release the area becomes flushed with blood, which helps bring nutrients to the area of injury and washes away toxins that were built up due to the spasm. Many patients become successful at treating trigger points at home once they understand why they occur and learn the appropriate techniques in relieving them. Proper treatment followed with good body mechanics and exercise can help return you to pre-injury status and get you back to enjoying your life and your workouts at their fullest.Henry T. Nguyen, D.C. Chiropractic Physician, practices at his offices located at4021 Central Avenue, Suite C, St. Petersburg, FL 33713(727) 327-0721 fax (727) 327-28751. McArdle WD, Katch FI, Katch VL: Essentials of Exercise Physiology. Philadelphia, Williams & Wilkins, 2000.2. Travell JG, Simons DG: Myofascial Pain and Dysfunction: The Trigger Point Manual. Vol1. Baltimore, Williams & Wilkins, 1983.

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