Trigger Points and Plantar Fasciitis

Yesterday I attended a fitness workshop from Perform Better. Perform Better is known for their hands on training seminars. Top profesionals in the industry provide education and training for physical therapists, trainers and coaches.

I learned about functional training for the shoulder, strength and power training for speed development and restoring fundamental movements with corrective exercises. The first half of the day is lecture. The second half is hands on drills and exercises.

Lee Burton, PhD, ATC, CSCS took us through screening to look for asymmetries. Asymmetries can be caused from muscle imbalances or postural problems. Participating in a repetitive sport can cause imbalances. Some muscles are weaker and others are stronger. For example: hamstrings may be stronger than the quadraceps in runners. We have to learn how to recruit the proper muscles in the right order. Burton’s screening used the squat, the hurdle step (stepping up and over a hurdle), and lying leg lift. These tests tell us what muscles aren’t being recruited properly to do the exercise. Inefficient movements cause compensations which move the joints in an unnatural manner. The body will always sacrifice quality for quantity. Movement patterns follow the path of least resistance.

The lying leg lift identified a compensation pattern. The lying leg lift testing procedure: Lie down in a supine position, lift one leg as high as you can and bring it back down. When I raised my left leg, a twist occurred in my right hip and my right quadracep externally rotated slightly. When I raised my right leg, I was able to lift it without any compensation on the left. I have been struggling with plantar fasciitis on my left foot.

The question is why? Why the left and not the right and left? I am compensating and I may have some referred pain. This referred pain may be coming from a trigger point in my soleus muscle.

Why is Pain Referred?

With certain muscles, the reality of referred pain can often be demonstrated by simply pressing on a trigger point that is bad enough to reproduce part of its referred pain pattern. It’s a little harder to explain why pain is referred at all.

Research on pain referral is difficult because the mechanisms of the human nervous system are so unimaginably small. The tiny electrochemical impulses in the nerves can be detected and measured to some extent, but not with accuracy or great discrimination.

In addition, there are ethical limits on how far you can go in pain experiments, whether with animals or humans. Nevertheless, scientists have made a number of suppositions about how pain can be displaced from its cause.

The easiest theory to accept regarding referred pain is that the signals simply get mixed in your neurological wiring. Sensory inputs from several sources are known to converge into single neurons (nerve cells) at the spinal level, where they are integrated and modified before being transmitted to the brain.

Under these circumstances, it may be possible for one electrical signal to influence another, resulting in mistaken impressions about where the signals are coming from.

The Functional Advantage of Referred Pain

On the surface, this looks like bad design, but the displacement of pain seems too consistent to be accidental. Referred pain occurs in very predictable patterns in everyone, with only small variations. This predictability implies that there may be some functional advantage to the referral of pain.

It’s notable that referred pain occurs very often in or near a joint, where pain is more likely to make you modify the activities or conditions that have created the problem.

Trigger point self-massage can help. Many massage therapists are familiar with the “trigger point” technique. Whether you are massaging yourself or getting a professional massage, using trigger points to release taut muscles can bring relief.

Sources:
Claire Davies
Lee Burton, PhD, ATC, CSCS