1 and 2: Muscle Resting Tension; TrPs Overview

Question 1

What are the most common causes of mm hypertonicity?

Answer 1

• brain lesinos in UMN
• brainstem lesions
• basal ganglia lesions like Parkinson

Question 2

Define Stretch Weakness

Answer 2

Stretch weakness is a condition in which a muscle is elongated beyond physiological neutral but not beyond the normal ROM. Prolonged muscle elongation causes muscle spindle inhibition and the creation of additional sarcomeres. The increased muscle length also changes the length-tension curve. Stretch weakness is also known as positional weakness and is often associated with overuse and postural changes.

Question 3

Define Tightness Weakness

Answer 3

This is the most severe form of muscle tightness. It is often overlooked clinically. Overused muscle shortens over time, changing the muscle’s length-tension curve and becoming more readily activated and weaker after time.

There can be an increase in the non-contractile tissue and a decrease in elasticity. It can eventually cause ischemia and changes to muscle fibres, which further weakens the muscle.

It is important to distinguish between neuroflexive weakness (reciprocaal inhibition, fatigue, trigger point weakness, decrease in afferent information – i.e. ligament damage and swelling) and structural (structural lesion of nerve) weakness.

Question 4

Define muscle resting tension (MRT)

Answer 4

This passive tension is the CNS-independent component resulting from intrinsic molecular interactions of the actin and myosin filaments in sarcomeric units of skeletal muscle and myofibroblast cells.

Question 5

What’s a definition of Mass?

Answer 5

The property of matter that measures its resistance to acceleration. Measured in kilograms.

Question 6

What are four characterictics common to trigger points?

Answer 6

• referred pain (in characteristic patterns)
• tenderness on palpation
• weakness
• autonomic phenomena

Question 7

What happens physiologically when a trigger point develops?

Answer 7

a group of sarcomeres becomes stuck in a shortened position

Question 8

What are some common causes of trigger points?

Answer 8

• acute overload, such as heavy lifting or whiplash injuries
• overwork fatigue, such as sustaining a work position for a long time
• direct trauma from falls and contusions
• other TrPs
• emotional distress, or other stress factors that increase sympathetic nervous system activity

Question 9

What are some characteristics of an active TrP?

Answer 9

• always tender and refers pain in a characteristic pattern
• will weaken a muscle, and prevent full lengthening
• referred pain will be present either at rest or in motion
• can become latent
• can elicit a local twitch response when stimulated or cause referred autonomic phenomena

Question 10

What are some characteristics of a latent TrP?

Answer 10

• is tender and causes referred pain only when it is compressed
• they are more common than active TrPs and may be present for years after their onset
• can shorten and weaken a m
• can be reactivated (become an active TrP) by minor overuse, streching or even chilling (shivering)
• can elicit a local twitch resopnse when stimulated or cause referred autonomic phenomena

Question 11

What’s a Primary TrP?

Answer 11

a TrP that was activated by acute or chronic overload of the muscle in which it occurs

Question 12

What’s a Key TrP?

Answer 12

a TrP responsible for actiating one or more satellite TrPs

Question 13

What’s a Satellite TrP and where may they occur?

Answer 13

A TrP that was induced neurogenically or mechanically by a key TrP

• may develop in the referal zone of the key TrP
• in an overloaded synergist that is substituting for the muscle with the key TrP
• in an antagonist countering the tautness of the m that contained the key TrP

Question 14

What’s a Local Twitch Response (LTR)?

Answer 14

A transient contraction of a group of m fibres in the taut band that contains the TrP. It can look like a fasciculation, or rippling of the m.

• LTRs can be found in active and latent TrPs
• they are typically found when the TrP is palpable and sufficiently stimulated

Question 15

According the the CMTO Standards of Practice, a TrP is edentified by meeting at least 2 of these criteria:

Answer 15

• local tenderness within a taut band of m
• local twitch response and/or the patient reporting referral pain
• tenderness and/or autonomic phenomenon

Question 16

What are some examples of autonomic phenomena?

Answer 16

• ptosis (drooping eyelid)
• sweating or lacrimation (tearing)
• coryza (runny nose)
• excessive salivation
• goosebumps
• altered proprioception (dizziness)
• blurred ision
• tinnitus (ringing in the ears)

Question 17

What’s a discomfort statement?

Answer 17

It’s important to let the client know that there may be pain or discomfort when treating a TrP. Remember to:

• inform of likelihood of pain during tx
• establish pain scale and maybe don’t go beyond 7
• infom of possibility of residual pain after tx

Question 18

How many barriers should be worked through with a TrP tx?

Answer 18

3-5 barriers

Question 19

After coming out to more general techniques, what’s the last step in TrP tx?

Answer 19

always streching the m (3 x 30 secs) then applying heat

Question 20

How is muscle stripping conducted?

Answer 20

• m should be relaxed and gently lengthened without pain (no residual slack, but not stretched)
• strip, using specific tool, along taut band with enough pressure to engage restrictive barrier
  
  • move no faster than the tissue releases
• m must be stripped from one attachment to the other
• repeat 3-5x taking up slack in tissue and getting deeper to engage subsequent barriers

Question 21

How are Specific TrP Compressions conducted and what are the AKAs?

Answer 21

• aka Barrier Release aka Ischemic Compressions
• m should be relaxed and gently lengthened to take up residual slack
• using specific tool, apply presssure directly on thee TrP; increase pressure until resistance is felt (1st barrier)
• as barrier releases, referral pain felt by client should diminish, increase pressure to next barrier (and repeat through 3-5 barriers)

Question 22

What’s Post Isometric Relaxation (PIR) and how is it conducted?

Answer 22

Post Isometric Relaxation is a stretching technique that takes advantage of a m’s natural state of relaxation after a contraction. There are different versions of PIR, and it may be used any time you would like to lengthen a m. It is useful in tx TrPs when direct tx is too painful, or when other conditions contraindicate painful or direct tx.

• take m into its shortest pain free position and slowly lengthen m to point where resistance is felt or client reports tension (1st barrier)
• have client contract m using 10% of strength
• hold for 10 secs (isometrically as I resist)
• be sure client is breathing normally
• at end of 10 secs, client inhales and relaxes on exhale
• wait for m to relax, then move to next barrier
• repeat until appropriate m length is achieved (min 3x)
• have client gently perform AF ROM after stretch

Question 23

Describe the Energy Crisis Theory

Answer 23

Question 24

Describe what happens at the Dysfunctional Endplate Region in the Energy Crisis Theory of TrPs

Answer 24