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DxD Admin from Singapore asked a question

Does trigger point treatment work for a stiff neck?

Sport Medicine

I have this medical issue that has been bothering me for a year plus and I have approached ENT, Cardiologist, neurologist and ophthalmologist and all told me that I have a clean bill of health. I have done CT scan, echocardiogram, thyroid test, Holter monitoring, a few blood tests, tympanometry,  – all results were normal. I have been to A&E for 4 times because I felt like I was going to faint. On the first visit, I was diagnosed with vasovagal presyncope. On other visits, doctors could not find anything wrong with me.

In fact, I had consulted a psychiatrist, on the advice of my GP, for panic disorder. The anti-depressant prescribed to me has no effect on my dizziness. After a few consultations the psychiatrist opined that I may not be having panic disorder after all. Tapered off the medication and has been off it for about 2 months.

The problem is that I feel dizzy everyday. I notice that the dizziness happens when the side of my neck is painful. Sometimes my neck can become so stiff. Alot of other symptoms appeared other than a stiff and painful neck – palpitations, arm weakness, jaw pain and tinnitus.

I have read online about trigger points on the sternocleidomastoid (SCM) that can give rise to many weird symptoms – most of the symptoms I am experiencing. Pressing on my SCM,  can result in all the symptoms that I am experiencing.

I am thinking of getting treatment for these trigger points. I found a pain specialist who has expertise in this area of trigger points treatment.

But I would like to have some views from the doctors here about trigger points and my conditions. I am scheduled for MRI of my neck in September.  I have exhausted all avenues.

Appreciate some advice for this issue. I exercise often before this health issue and I don’t smoke nor drink. Just wanna get back to my normal healthy regime. Thank you in advance.

DOCTOR’S ANSWER (2)
Dr Dinesh Sirisena
Sport Medicine
Singapore
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Dr Dinesh Sirisena
Sport Medicine
Singapore
Answered on January 26th, 2018

Hi Archie81,

Very interesting question and symptoms that you are experiencing. I can sense your frustration in trying to resolve this problem from the numerous consultations and treatments you have sought.

From clinical practice, I have found that trigger points (TP) can be a challenge to treat at the best of times. When you are experiencing dizziness in addition – troublesome!

My take on TP is that it can cause different symptoms depending on where they occur and what other structures are overlying.

In the SCM, with the various nerve plexuses overlying and supplying this area, perhaps this is the reason for your associated symptoms. I have had some patients with TP in the traps or back neck muscles which are associated with migraines, headaches etc.

Have you considered acupuncture or acupressure? Sometimes it might help release the symptoms.

Equally, what are your sporting or work activities? Might these be contributing either from persistent activation/over-use of the SCM? Posture could be also a risk, especially if you use the computer or phone regularly.

Hopefully these are a few more things to consider when tackling your symptoms. BW

0 42 views 0 Doctors agree January 26th, 2018
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Dr Ethan
Singapore
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Dr Ethan
Singapore
Answered on January 26th, 2018

Hi Archie, welcome to the QnA.

My answer, to your question in brief is that it’s worth a shot (pun not intended).

From your details, you clearly fall into what doctors term “expert patients”. Ie. you’ve done a significant amount of online reading into your problem, and possible solutions. Not to mention, sought the advise of multiple specialists.

So please take my online reply for what it is – an extremely limited internet source (without the requisite examination, investigation results, specialist opinions and detailed questioning that a doctor seeing you in person would have).

The problem as I see it, is that your set of signs and symptoms is rather non-specific – Dizziness, stiffness, tinnitus and pain by themselves often have no clear cause.

They can each be a symptom of multiple disease, and together also don’t fit any one pattern for a particular condition (taking into account that you’ve already had most of them ruled out), especially in healthy patients.

This short post on “organic” vs “non-organic” disease (or functional symptoms) will further explain what I’m referencing, and why it can be difficult for patients such as yourself to find a satisfactory diagnosis and treatment.

I appreciate that it must be rather frustrating to be told “nothing’s wrong” after yet another imaging scan/blood test/specialist consult.

When “organic disease causes” are all ruled out, what’s left is often pesky diagnoses like musculoskeletal pain, nerve impingement, behavioural/functional/mental health type problems eg. somatic syndrome disorder – all of which can be difficult to treat.

I am thinking of getting treatment for these trigger points. I found a pain specialist who has expertise in this area of trigger points treatment. But I would like to have some views from the doctors here about trigger points and my conditions.

This wiki write-up on trigger points is a pretty good summary on the current state of things.

Do note that there are various trigger point treatments available, as covered under the management section of this other write-up.

From a scientific point of view, 2 things stand out:

  1. A review of previous studies has shown that treatment can be effective for some patients, but there needs to be larger studies to confirm findings.
  2. There are no reliable physical exams to diagnose the condition.

Putting 2 and 2 together, this means that empirical treatment may be worthwhile – ie as a doctor, I MAY NOT KNOW for sure if you have this problem, but I may give you treatment anyway since it’s been shown to be helpful in other patients with similar symptoms as yourself.

My final 2 cents, if the trigger point treatment fails, is that it may help to seek the advise of a rheumatologist. My rationale is that there are some uncommon autoimmune conditions that can cause weakness and stiffness. I wouldn’t be surprised if he found nothing wrong however, and referred you back to the pain doctor.

TLDR:

  1. Yes, I think trigger point treatment is worth a shot, if I were in your shoes. In Singapore, trigger point treatment is offered by pain doctors (usually anaesthetists) and Sport Medicine doctors.
  2. It may be worth consulting Rheumatology – but see what your Pain doctor says first.

Cheers

0 42 views 0 Doctors agree January 26th, 2018
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