One cause of heartburn which is frequently overlooked is pain from muscle trigger points. These can mimic acid reflux and yet be entirely unresponsive to acid suppression drugs. When I suggest this to people, they are quite surprised that their ‘reflux’ or ‘hiatus hernia’ is actually nothing of the sort. I am able to demonstrate this to them by simply palpating the abdomen and after about 10 seconds of rubbing the tender area of muscle, the symptoms they have been complaining of start to appear.
The typical muscles which cause problems are those of the anterior abdominal wall, particularly the rectus abdominis sheath, the external obliques as well as the psoas muscle. Interestingly, trigger points in the psoas can be associated with nausea. The reason why trigger points causes the symptoms is not entirely clear and may be due to referred pain overloading the pain receptors in the spinal cord.
Sometimes, trigger points can cause a more generalised ‘irritable bowel’ type abdominal pain syndrome also.
So can one do anything about these trigger points? the good news is that one can. The first approach is to have physiotherapy with a therapist who is trained in myofascial release work. This is not widely practised amongst physios, but our group have teamed up with some excellent physiotherapists who have trained specifically in this type of treatment.
An alternative is to use hot water bottles to the affected areas to help relieve muscle tension. Some people respond well to acupuncture or acupressure.
Another approach is to inject the area with steroids. This can be very effective in some people who have long standing inflammation but it is not often used. If the trigger points can be clearly located and other approaches have not worked, this treatment is certainly something to consider.
Trigger points are often overlooked, and yet in some studies, up to three quarters of people who attend pain clinics have the source of the problem coming from these muscular causes.