11 Lumbar Myofascial Pain Flashcards
A muscle with morphological changes consistent with frank tearing of muscle fibers?
Muscle strain
A painful, involuntary muscle contraction?
Myospasm
Muscle of fascia with palpable fibrotic tissue
Fibrositis/myofibrositis
a hyperirritable nodule, usually within a taut band of skeletal muscle or in the muscle’s fascia, that is painful to compression, reproduces the patient’s familiar pain and that may give rise to characteristic referred pain, tenderness, and autonomic phenomena.
MFTP
lumbar muscle pain that is associated with muscle tenderness that reproduces the patient’s familiar pain but without palpatory evidence of discrete myofascial MFTP’s
Regional myofascial pain syndrome
- strain, spasm, myofibrosis and. Fibromyalgia has been ruled out
What are some additional symptoms that can be part of the complex picture of regional myofascial pain?
- non-restorative sleep
- chronic fatigue
- mood disorders
- chronic headache
- morning stiffness
- IBS
What is the prevalence of MFTP?
30% in LBP presenting to PCP and 85% of patients in tertiary clinic
What are some autonomic phenomenon that can be related to MFTP?
- vasoconstriction (blanching)
- coldness
- sweating
- pilomotor response
- vasodilation
- hypersecretion
Symptoms of MFTP that can sometimes mimic radicular symptoms
Referred pain, numbness or paresthesia
Although they will not be in a dermatomal pattern and the pain is dull and achy feather than sharp and superficial as in radicular pain
What are the three clinical criteria for diagnosing MFTP?
- presence of a palpable taut band within a
skeletal muscle - hypersensitive spot within the taut band
- Reproduction of the patient’s familiar pain
- Reproduction of a referred pain sensation with stimulation of the spot
Deep pressure or sustained pressure may be required to
reproduce the referral which might not express itself until
after _____ delay
10-15 second
Snapping/plucking palpation of a taut band in MFTP will sometimes produce what?
Local twitch response
Low sensitivity but high specificity
Other than the 4 main diagnostic criteria for MFTP, what other 4 findings may be present?
- local twitch response
- jump sign
- muscle weakness or tightness
- pain with stretching or contraction muscle
What is a latent trigger point?
patient reports no spontaneous symptoms,
but the practitioner can find a trigger point.
What are active trigger points?
cause symptoms that the
patient is already complaining about.
What are satellite trigger points?
Trigger points harbored in the referral area of primary trigger point that will recur until primary trigger point is eradicated
What are some perpetuating and precipitating factors of MFP and MFTP
- trauma
- emotional stress
- immobilization
- joint dysfunction
- nutritional inadequacies
What are some common treatment for MFTP?
- massage
- ischemic compression
- PIR
- dry needling or cupping
- laser therapy
- TENS (transcutaneous electrical nerve stimulation)
- pin and stretch
- acupuncture
- Botox
What are two post treatment interventions that should be immediately done?
- move muscle through complete ROM 3 times
- moist heat
- some recommend increasing water intake
What are some home treatments for MFTP?
- home stretch
- intermittent pressure of ball or roller
- avoid sustained stretched or shortened positions
- increase acitivity
- manage stress
- address nutrition
- modify/address perpetuating factors
Where does a QL MFTP refer pain to?
- SI
- Ischial tuberosity
- hip
- can therefore mimic lesions in those areas
What sleeping recommendation could be made for QL MFTP?
Sleeping on side with pillow between knees because supine can cause excess lordosis and QL shortening
What is the referral pattern for iliopsoas MFTP?
- anterior thigh
* mimics femoral nerve
What is the referral pattern for glute med?
- sacrum/LS junction
- hip
- ischial tuberosity
- SI
- iliac crest
- posterior thigh
