Expert: J.R. Strecker, B.S., D.C. - 6/18/2008

Question
Hello,

I have some questions regarding trigger points. I have several hard knots of muscle in my lower and mid back. I had a massage last week and the therapist commented that they had never seen so many knots.

My first question is: are these knots always trigger points that are causing my low back pain? Do trigger points sometimes not appear as knots? The pain radiates down my hip and buttocks only. My net research tells me that this usually means trigger points in my quadratus lumborum, but I am not a doc obviously.

I have been in a cycle of jog, pain for 2 days, jog, pain for 2 days, etc. I can't seem to stretch the pain away.

Also, does standard chiropractic training include trigger point therapy? Meaning, if I pick any local chiropractor, will he be able to help? Assuming that is it a trigger point issue...

I need to get this fixed, because the pain causes real problems and makes it difficult to stand up straight when it is "acting up". Thanks for your time!

Answer

Hello M.,

You’re right.  Trigger points, including ones of the quadratus lumborum can refer pain down your leg.  But there are other conditions that can do this.  

One of the most common causes of pain down the leg comes from the discs in the lumbar spine.  You do not necessarily have to herniate a disc to have symptoms go into your leg.  Instead, sometimes the discs will bulge a bit.  This is something I would speculate if you experience symptoms after you run and have trouble standing up straight.  For disc problems, a traction protocol is ideal along with McKenzie extension exercises, which can be seen here:
http://www.mckenziemdt.org/images/BronzeLady.gif
However, if your sciatic pain is coming from joint arthritis, these exercises may actually increase your symptoms.  So it’s always best to be evaluated by a knowledgeable doctor.

Disc herniations and bulges (excluding degenerative discs) are a bit more common in people that are in their 20s-40s.  After 40, radiation into the leg more commonly comes from the joints degenerating.  There are certain arthritic conditions, such as facet syndrome, that cause sciatic symptoms due to the remodeling of the bone.  Several years of improper biomechanics, wear and tear, and trauma to joints causes the bones to deposit calcium.  In the back of the lumbar spine, if the joints “jam” too hard for too many years, the calcium starts to deposit in the spaces where the nerves are.  If bone starts growing where there should be space for the nerve, then the bone puts pressure on the nerve and pain is felt in the buttock and/or leg.  For these types of conditions, flexion is much better for the lumbar spine (oppositely true for disc problems).  There are a variety of ways to be treated for this.  

One of the most common muscular causes for pain radiating to the legs is piriformis syndrome.  The piriformis muscle is a muscle in the buttock that is sometimes pierced by the sciatic nerve.  If the muscle is too tight, it can actually “choke” the sciatic nerve, causing radiating pain into the legs.

The above conditions are some of the most common conditions for pain that radiates into the leg.  Of course, there is no way for me to know which your is from an email alone, but I would recommend getting evaluated by a knowledgeable doctor.  If you’re looking for a chiropractor, you may find a variety out there.  I would recommend you to go see an orthopedic chiropractor.  You can find one located near you here:
http://www.ccodc.org/locate.php

So although some trigger points can cause your symptoms, they are not as common.  If you want to learn more, just do some Internet searching for the symptoms of disc bulge, facet syndrome, and piriformis syndrome.

I hope this helps a bit.  Best of luck!
Dr. J.R. Strecker, D.C.