Friday, September 3, 2010

Defining Myofascial Trigger Points (MTrPs)

Myofascial trigger points can mimic many things and cause pain, dysfunction, and shortening of the muscle affected by this knotted up muscle fiber in a taut band of muscle. Such things as paresthesias (numbness and tingling), burning, or a needles and pins sensation if the TrP is entrapping the a nerve, circulation/temp changes (if located next to a blood vessel) and swelling (if located next to a blood or lymph vessel) may also be present. (Helpful treatment links following).

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Common Abbreviations ©

MPS: myofascial pain syndrome
CMP: chronic myofascial pain
MTP: myofascial trigger point
TrP: trigger point

Myofascial Trigger Point ©

A myofascial trigger point (TrP) is a self-sustaining, irritable area in the muscle that can be felt as a nodule in a taut band. This irritated spot causes the muscle to gradually shorten, interfering with the motion function of the muscle and causing weakness and pain. Trigger points differ from tender points in that generally they refer pain to other parts of the body and can usually be felt with the hand (palpated) unless the muscle is too rigid from intense muscle involvement, or the trigger point is in a deep muscle or under bone. The tender points of FM or myalgias associated with CFID do not restrict motion or cause localized muscle weakness. If they do, the patient should also be evaluated for the presence of CMP. Trigger points in CMP are well defined and often radiating—the pain radiates out to other parts of the body.

Active Trigger Point ©

An active TrP is a myofascial trigger point that causes pain at rest. It is always tender, causes shortening of the muscle, weakens the muscle, and causes patient complaints of referred pain on direct compression. An active trigger point can elicit a visible local twitch response when adequately stimulated by compression or needle insertion. It can produce referred motor and autonomic phenomena, generally occurring in the TrP referral zone. An active TrP can also cause the referral zone to become tender.

Secondary Trigger Point ©

A secondary TrP is one that develops in a second compensating muscle. A compensating muscle is one that is trying to make up for the malfunction of the muscle affected by primary trigger points. In other words, when a primary trigger point causes muscle dysfunction, the opposing muscles become stressed. These opposing muscles become overloaded because they are attempting to carry the entire load of the muscle work needed to perform a task. When staring at a computer screen your head starts to drift forward after a while, particularly if you spend hours there. You may have primary TrPs in muscles on the front of your neck, which may or may not be making their presence known. As your head starts drifting forward, putting less stress on the primary TrPs because of the slackening, the muscles on the backside of your neck are being stretched and stressed in an effort to keep your face from falling onto your keyboard. The sustained overstretching of these muscles causes secondary trigger points to develop in the muscles on the back of your neck. (This is an important reason to pay attention to posture as an
aggravating factor, to be discussed in chapter 4.)

Satellite Trigger Point ©

A satellite trigger point is a type of secondary TrP that develops in a muscle
of the primary trigger point’s referred pain area.

Latent Trigger Point ©

This type of trigger point is painful only when there is pressure on it. A latent TrP can restrict muscle movement and cause stiffness and weakness that persist for years after apparent recovery. Unless restricted motion or weakness causes you to start rubbing around to find the source, a latent TrP may go unnoticed. When you stumble upon a sore, hypersensitive nodule in a muscle that does not refer pain anywhere, you have found a latent trigger point. Now you have discovered the source of your restricted motion and weakness. Dormant latent TrPs can be reactivated by overstretching, overuse, or injury. Treat TrPs when you discover them, because some seemingly minor event, such as chilling, can cause a latent TrP to transition to an active trigger point. Once the TrP transitions from latent to active it will be painful all the time and can cause referred pain. Treatment is discussed in chapter 4.

End Notes:

Chronic myofascial pain (CMP) from myofascial trigger points is a peripheral nerve to muscle problem. Fibromyalgia, CFID/ME, migraine, IBS, irritable bladder and several other common co-existing conditions have a strong central nervous system component. When any of these co-exist with chronic myofascial pain (CMP) from myofascial trigger points (TrPs), the peripheral message of painful trigger points to the brain keeps the brain in a hypersensitive state," causing a “wind up” phenomenon at the HPA-axis (dysfunctional in FM and thought to be dysfunction in CFID) is off an running.

The good news is there are specialized myofascial physical therapists and chiropractors trained in techniques specifically designed for treatment of the myofascia. They can do a proper assessment and offer treatments such as myofascial release and active release therapy (ART) and active release therapy (ART). There are also specially trained myofascial massage therapist trained specifically in the work of Travell and Simmons.

Myofascial Release

Active Release Therapy (ART):

National Association of Myofascial Trigger Point Therapists

(Signature line appended, March 2018)
In healing,
Celeste Cooper, RN / Author, Freelancer, Advocate

Think adversity?-See opportunity!


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