What causes tender points?

shoulder pic copyWhat causes tender points?

In some cases it’s obvious what causes our tender points and pain. We fall or get into a car accident-these sorts of events leave little to doubt. But, it is difficult to pinpoint an exact injury when pain comes on slowly. Sometimes the pain seems to have come out of nowhere, or we even wake up in pain and assume we must have “slept wrong.” Sleeping does not cause pain unless there are underlying issues or we are sleeping in a terrible bed or with too many pillows.

So, what causes the pain and tender points in these situations?

At some point an event triggered the nerve endings in the fascia of the body. Fascia is the connective tissue surrounding everything from muscles to bones to internal organs. It serves many important functions, one of which is to hold these structures in place. For instance, fascia ensures our stomach does not actually end up in our throat when we ride roller coasters. Another vital function of the fascia is protection. It literally wraps around the organs, nerves, blood vessels, ligaments, tendons, muscles, etc. There are nerve receptors in the fascia that detect both how fast the body part is moving and nerve receptors that keep up with how long the part is. When the body part in question is being stretched quickly and not purposefully, the nerve receptor that detects speed sends a message to the spinal cord and brain that there is a threat and the structure may be harmed. The response message is sent out immediately to all muscles and fascia in the area to tighten and protect. This is a wonderful system that ensures our blood vessels, nerves and organs do not rupture easily. After the threat of injury is gone, the body stops sending the message of pending injury.

So why does the pain return or remain for months or years?

Remember the other nerve receptor that keeps up with how long the structure is? This one does not sense fast movement that is out of our control, nor the threat of injury. Those messages happened far too fast. But this nerve receptor did notice that the structure is now shorter. This acts to reset the “normal” length for this body part as being shorter than before. Now, every time this structure is moved beyond what used to be the normal length, the body reacts as if the threat of injury has increased and everything tightens up again causing pain and dysfunction.

Here’s an example of how this works in everyday life. Say you’re walking your dog and a squirrel runs by. The dog pulls on the leash and your arm is suddenly stretched out of your control. The first nerve receptor senses the brachial artery in your upper arm is in danger of being stretched too far causing a possible rupture. Since this would be a very dangerous situation, the nerve receptor in the fascia surrounding the artery sends a message of pending harm. The reflex quickly demands all muscles in the area to shorten around the artery and protect it. The biceps and several other muscles are recruited. There are also smooth muscle cells in the fascia that tighten around the artery directly to provide extra support. The other nerve receptor did not notice all this happen because it was too quick. All this receptor knows is that now the artery is in a shorter position than before. It assumes this is where it is supposed to be and resets this position as the new normal. Now every time the artery is lengthened, like reaching behind or out to the side, this second receptor will send a message reporting the danger of overstretching and being torn. This keeps the artery and surrounding muscles in a shortened and painful position until this receptor is once again reset back to the original length.

Fascial counterstrain is a treatment that resets these receptors in the fascia back to their original homeostasis, allowing the muscles to release this tension and spasm. It does this by shortening the structure (brachial artery in the example above) to take all input off the fascial receptors. This allows the metabolites in the injured area to drain and allows the receptor to “reboot,” effectively breaking the cycle of pain and tension.

Christine Wood About Christine Wood

Christine Wood, PT, DPT lives in Augusta County in the heart of Virginia’s beautiful Shenandoah Valley with her husband and children. With over 20 years of experience as a Physical Therapist, her hands have brought healing and pain relief to thousands of clients.