Myofascial Trigger Points

Question 1

MTrPs definition

Answer 1

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

Question 2

Trigger point results in

Answer 2

altered flexibility, altered muscle function, altered prorioception

Question 3

Active TrPs

Answer 3

produces clinical complaints of pain and pattern of referred pain

Question 4

Latent MTrPs

Answer 4

result in motor dysfunction but are not initially painful and are more common than active MTrPs

Question 5

Associated MtrPs

Answer 5

develop in muscles secondary to compensations due to MTrPs located in other muscles

Question 6

Pathophysiology

Answer 6

1. Muscle spindle - dysfunctional proprioceptors
2. Hyp of neuropathic process - dys with nerve and nerve supply
3. Scar tissue hyp - presence of scar tissue
4. Dysfunctional endplates and energy crisis - (Travel) some time of trauma, adverse action from overstretching, overshortening, overloading

Question 7

Referred pain

Answer 7

results from associated effects of muscle guarding
Results from involvement of associated fascia
DO NOT confuse with other forms of referred pain

Question 8

Trigger point activation

Answer 8

Muscle activity
Visceral disease
Joint dysfunction
Emotional distress

Question 9

Clinical presentation

Answer 9

Pt pain complaints
Painful stretching
Muscle weakness
Referred pain
Presence of taut bands
Tender palpation of nodule (within bands)
Local twitch response

Question 10

Essential Criteria for Dx

Answer 10

Palpable taut band
Extremely tender nodule within the taut band
Pain recognition
Painful ROM

Question 11

Examination

Answer 11

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

Question 12

Trigger point vs muscle tightness

Answer 12

taut banc, LTR, tenderness, Nodule - trigger point

muscle tightness - consistent tightness uniform throughout

Question 13

Trigger point vs. tender point

Answer 13

Tender point - more tender than tissue around it, can have referred pain, no twitch
Trigger point - nodule, referred pain pattern, twitch reflex

Question 14

Intervention

Answer 14

Modalities
Spray and stretch
SCS
Myofascial release
STM
Muscle stretching
Muscle strengthening
Proprioceptive training

Question 15

Trigger point release

Answer 15

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

Question 16

Active Trigger Point

Answer 16

myofascial trigger pont that elicits a pain complaint

Always presents with tenderness, muscle ROM, and strength limitations

Question 17

Latent Trigger point

Answer 17

Trigger point that is noted only with palpation

Question 18

Local twitch response

Answer 18

Contraction of muscle fibers associated with a trigger point when stimulated (palpated)

Question 19

Pincer Palpation

Answer 19

Use of thumb and fingers to palpate/grasp tissue

Question 20

REferred pain

Answer 20

pain arising from a trigger point but felt away from the point
resentation is related to the site of origin

Question 21

Allows follow

Answer 21

inactivation of a trigger point with muscle stretching

Question 22

Taut band

Answer 22

groupng of tense muscle fibers of a trigger point extending the origin and insertion
Results from reflexive muscle contraction

Question 23

Trigger point pressure release

Answer 23

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

Question 24

SCS vs. MTrP

Answer 24

SCS = shortening
Consistent pressure and time = both, SCS 90 sec MTrP 45 sec and can oscillate
Both require assessment first –> ROM