Myofascial Trigger Points

What do you do?  This is one of the most common questions I am asked and apparently a million dollar question!  One of my patients this week suggested that I tell people that I do Trigger Point Therapy as a lot of people can identify with this.  I hesitate to "market" this, as it is only one part of the range of treatment techniques I use.  However, I thought it was a a really good idea to explain this component of my treatments by explaining the accepted definition of a myofascial trigger point.

Definition of a myofascial trigger point (TrPs) - basically the spots in your muscles that are really tender when you have treatment, but you feel them release, are called myofascial TrPs.  There are however some common clinical features that are associated with the diagnosis of mysofascial TrPs.  These include;

Palpable Band - A cord-like band of fibres is palpable in the involved muscle. 

Spot Tenderness - a VERY tender and VERY small spot is usually found
in a palpable band. 

Jump Sign - placing pressure on the spot of tenderness causes the patient to physically react to the pain with a spontaneous exclamation or movement (or sometimes know who you are!!)

Pain recognition - pressure on TrP induces at least some of the pain of which the patient complains, and the patient recognizes it as his or her pain.  This pain can be felt in a referred zone, for example, pressure on the glut medius can cause pain down the leg. This finding by definition identifies an active TrP.

Twitch Response - the local twitch response is a transient contraction of the fibres of the taut band associated with a TrP when palpated.

Elicited Referred Pain and Tenderness - active TrPs refer pain in a pattern characteristic of that muscle and the pain is usually not where the TrP is, but is referred to a distance. This is often a surprise to patients, that the site of the pain is not where the problem is.

Restricted Range of Motion - stretching to full range of motion of the affected muscle can be restricted by pain. This restriction eases when the palpable taut bands are released through inactivation of associated TrPs. 

Muscle weakness - clinically, the patient is unable to achieve full normal strength on static testing, as compared to testing of a contralateral uninvolved muscle.  Also, the involved muscle is more likely to fatigue quickly.

The key to any successful treatment of TrPs is to figure out why they are there in the first place AND, do not treat TrPs in one particular muscle in isolation.......because the knee bone is connected to the...thigh bone, and the thigh bone is connected to the......keep singing!

In health



Reference - "UPDATE OF Myofascial Pain from Trigger Points" By Professor David Simons

Travell, Janet; Simons David; Simons Lois (1999). Myofascial Pain and Dysfunction: The Trigger Point Manual (2 vol. set, 2nd Ed.). USA: Lippincott Williams & Williams. 

Maybe good, maybe bad

“You know, its all about the way we choose to see things......

There was once a farmer who owned a very beautiful horse.  One day, the horse decided to run away and his neighbour said to him, 'What a terrible thing to happen to you – such a great loss’.  The farmer replied dryly, ‘You never know, maybe good, maybe bad.’

The next day, the horse came back with another horse by his side and the farmer’s neighbor said, what great good fortune, now you have two horses.’  The farmer’s reply was the same, ‘You never know, maybe good, maybe bad’.

The next day the farmer’s son fell off the new horse and broke his leg, to which the neighbor said, ‘That’s bad!’ and of course the farmer gave his usual reply.

Soon after this, war broke out in the land and all the young men were conscripted into the army, except the farmer’s son who couldn’t go because of his leg.  The neighbor said, ‘What a great piece of luck,’ and the farmer replied, ‘You never know…..’

There is so much truth in the statement, ‘You never know.’  The reality is for most of us is that we don’t know where each event is leading.

Our predicament is such that life happens around us and events are not always in our control.  We also know that the only thing we can control is ourselves and the way we perceive and receive life.  If we could see into the future we would probably view everything very differently.”

This is an exert from a book which I love called “The dance between joy and pain”. Dr Mansukh Patel and Rita Goswami RGN who embarked on a series of extraordinary journeys involving 3000 miles of walking and 150 000 miles of air travel, 31 countries….the most inspiring of places to the most disturbing…..Jerusalem, Assisi, Auschwitz and Dachau, from the slums of India to the penthouses in New York.

Nobody goes through life without experiencing pain and joy………..we all just have to keep learning how to dance!!!

In health