Myofascial Trigger Points Flashcards
MTrPs definition
hyperirritable spot in skeletal muscle associated with hypersensitive palpable nodule in a taut band
Paunful on compression and can give rise to referred pain, tenderness, motor dysfunction and autonomic phenomena
Trigger point results in
altered flexibility, altered muscle function, altered prorioception
Active TrPs
produces clinical complaints of pain and pattern of referred pain
Latent MTrPs
result in motor dysfunction but are not initially painful and are more common than active MTrPs
Associated MtrPs
develop in muscles secondary to compensations due to MTrPs located in other muscles
Pathophysiology
- Muscle spindle - dysfunctional proprioceptors
- Hyp of neuropathic process - dys with nerve and nerve supply
- Scar tissue hyp - presence of scar tissue
- Dysfunctional endplates and energy crisis - (Travel) some time of trauma, adverse action from overstretching, overshortening, overloading
Referred pain
results from associated effects of muscle guarding
Results from involvement of associated fascia
DO NOT confuse with other forms of referred pain
Trigger point activation
Muscle activity
Visceral disease
Joint dysfunction
Emotional distress
Clinical presentation
Pt pain complaints Painful stretching Muscle weakness Referred pain Presence of taut bands Tender palpation of nodule (within bands) Local twitch response
Essential Criteria for Dx
Palpable taut band
Extremely tender nodule within the taut band
Pain recognition
Painful ROM
Examination
History Identify mechanism of injury: bbiomechanics Identify referred pain pattern Assess ROM Assess strength Palpate for taut bands, nodules, LTR Other special tests and measures
Trigger point vs muscle tightness
taut banc, LTR, tenderness, Nodule - trigger point
muscle tightness - consistent tightness uniform throughout
Trigger point vs. tender point
Tender point - more tender than tissue around it, can have referred pain, no twitch
Trigger point - nodule, referred pain pattern, twitch reflex
Intervention
Modalities Spray and stretch SCS Myofascial release STM Muscle stretching Muscle strengthening Proprioceptive training
Trigger point release
Locate TrP
Passively lengthen muscle to non-painful stretch
Apply pressure to TrP to resistive barrier 9discomfort but no pain)
Sustain for 45 sec
Repeat, engaging new barrier
Active Trigger Point
myofascial trigger pont that elicits a pain complaint
Always presents with tenderness, muscle ROM, and strength limitations
Latent Trigger point
Trigger point that is noted only with palpation
Local twitch response
Contraction of muscle fibers associated with a trigger point when stimulated (palpated)
Pincer Palpation
Use of thumb and fingers to palpate/grasp tissue
REferred pain
pain arising from a trigger point but felt away from the point
resentation is related to the site of origin
Allows follow
inactivation of a trigger point with muscle stretching
Taut band
groupng of tense muscle fibers of a trigger point extending the origin and insertion
Results from reflexive muscle contraction
Trigger point pressure release
Inactivation of a trigger point via application of increasing, nonpainful pressure over a trigger point until tissue resistence is felt
Pressure is maintained until the resistive barrier is reduced
PRessure is then increased to the next barrier to help reduce or eliminate the trigger pont pressure
SCS vs. MTrP
SCS = shortening
Consistent pressure and time = both, SCS 90 sec MTrP 45 sec and can oscillate
Both require assessment first –> ROM
