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T2 MSK > Topic 2 - Myofascial Trigger Points > Flashcards

Topic 2 - Myofascial Trigger Points Flashcards

1
Q

A hyper-irritable spot in skeletal muscle that is associated with a hypersensitive, palpable nodule in a taut band. It is painful on compression and can give rise to characteristic referred pain, weakness and autonomic phenomena.

A

Myofascial Trigger Point

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2
Q

T/F - TrP pain is often described as sharp and superficial.

A

False - TrP pain is often described as DULL, ACHING and DEEP.

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3
Q

A trigger point develops when a group of __________ become stuck in a _________ position.

A

Sarcomeres
Shortened

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4
Q

The exact mechanism by which trigger points develop is not fully understood, however there are __ predominant theories that are believed to explain why they are present.

A

3

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5
Q

What are the 3 theories explaining trigger points?

A

1) Energy Crisis Hypothesis
2) Motor Endplate Dysfunction
3) Integrated Hypothesis

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6
Q

A trigger point theory in which excess calcium produces sustained maximal contraction of sarcomeres, which increases energy requirements, as well as compresses the local vasculature. May be induced by strain or trauma.

A

Energy Crisis Hypothesis

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7
Q

Increased energy demands + ischemia = ______ ______

A

Energy Crisis

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8
Q

A trigger point theory in which increased acetylcholine release by the presynaptic neuron causes an increased release of calcium, resulting in sustained maximal sarcomere contraction. May be a result of genetics or stress, which increases sympathetic nervous system firing.

A

Motor Endplate Dysfunction

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9
Q

A trigger point theory in which trauma/strain causes rupture of sarcoplasmic reticulum, resulting in uncontrolled release of calcium followed by sustained contraction (leading to energy crisis). ATP is depleted, therefore no re-uptake of calcium into sarcoplasmic reticulum. Hypoxia decreases local pH which stimulates nociceptors, causing pain and increased sympathetic nervous system firing.

A

Integrated Hypothesis

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10
Q

Chronic nociceptive activation can create _____________ in the central nervous system.

A

Sensitization

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11
Q

Contraction > Ischemia > Pain > SYNS > Ach > Ca+ > Contraction = ________ Hypothesis

A

Integrated

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12
Q

T/F - A TrP occurs through the entire motor unit.

A

False - A SPASM occurs through the entire motor unit.

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13
Q

Some reasons why _______ ______ can occur include:
- Acute overload
- Overwork fatigue
- Direct trauma
- Other TrPs
- Emotional/physiological stress
- Genetics
- Smoking

A

Trigger Points

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14
Q

Trigger point onset may be _____ or _______ depending on the cause.

A

Rapid
Gradual

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15
Q

T/F - Trigger points are extremely common and they are non-inflammatory.

A

True

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16
Q

T/F - Trigger points contribute to a high resting tone of a muscle, therefore they are considered a spasm.

A

False - Trigger points contribute to a high resting tone of a muscle, HOWEVER they are NOT considered a spasm.

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17
Q

A trigger point that is always tender and refers pain in a characteristic pattern, either at rest or in motion. It will weaken a muscle and prevent the full lengthening of it.

A

Active Trigger Point

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18
Q

Active trigger points can become ______, and can also elicit a _____ twitch response when stimulated or cause referred autonomic phenomena.

A

Latent
Local

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19
Q

A trigger point that is tender and causes referred pain only when it is compressed. It can shorten and weaken a muscle, elicit a local twitch response when stimulated or cause referred autonomic phenomena.

A

Latent Trigger Point

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20
Q

______ trigger points are more common than active trigger points, and may be present for years after their onset.

A

Latent

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21
Q

T/F - Latent trigger points can become active trigger points by minor over use, stretching or even chilling.

A

True

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22
Q

A trigger point that was activated by acute or chronic overload of the muscle in which it occurs.

A

Primary Trigger Point

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23
Q

A trigger point responsible for activating one or more satellite trigger points.

A

Key Trigger Point

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24
Q

A trigger point that was induced neurogenically or mechanically by a key trigger point and it may develop in the referral zone of the key trigger point.

A

Satellite Trigger Point

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25
Q

Satellite trigger points can occur in an overloaded _________ that is substituting for the muscle with the key trigger point.

A

Synergist

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26
Q

Satellite trigger points can occur in an __________ that is countering the tautness of the muscle with the key trigger point.

A

Antagonist

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27
Q

Pain that is felt at a distance, often entirely remote from its source. It may occur at rest, with movement or only when palpated.

A

Referred Pain

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28
Q

T/F - Inactivation of satellite trigger points will inactivate the key trigger point.

A

False - Inactivation of satellite trigger points WILL NOT inactivate the key trigger point.

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29
Q

A transient contraction of a group of muscle fibres in the taut band that contains the trigger point. It can look like a fasciculation or rippling of the muscle.

A

Local Twitch Response (LTR)

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30
Q

T/F - LTRs can only be found in active trigger points.

A

False - LTRs can be found in BOTH active AND LATENT trigger points.

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31
Q

A general pain response of the client. They may withdraw, wince or cry out in response to pressure over a trigger point.

A

Jump Sign

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32
Q

An area of tenderness similar to a trigger point, except it does not refer pain.

A

Tender Point (TOP)

33
Q

Disturbances of the autonomic nervous system that may accompany trigger points in particular muscles.

A

Referred Autonomic Phenomenon

34
Q

The 3 criteria for a TrP according to the CMTO Standards of Practice are:
- Local tenderness within a ____ ____ of muscle
- Local ______ response and/or the client reporting referral pain
- Tenderness or autonomic phenomenon pattern

A

Taut Band
Twitch

35
Q

Some ________ for trigger points include:
- Characteristic pattern of referred pain & tenderness
- Limited ROM
- Weakness
- Other symptoms like autonomic phenomenon & mood/sleep disturbance

A

Symptoms

36
Q

Limited ROM from a TrP is usually accompanied by pain as the muscle reaches ___ range. The client may complain of ________, especially in the morning or during periods of over activity.

A

End
Stiffness

37
Q

_________ from a trigger point is the nervous system’s way of adapting to limit the force of muscle contraction in order to prevent the pain threshold from being reached.

A

Weakness

38
Q

The following are all examples of referred _________ __________:
- Vasoconstriction
- Goosebumps/coldness
- Abnormal sweating
- Lacrimation
- Runny nose
- Altered proprioception/dizziness
- Tinnitus
- Ptosis
- Excessive salivation
- Blurred vision

A

Autonomic Phenomenon

39
Q

The following are all examples of ________ findings with a trigger point:
- Taut band within the affected muscle
- Local hardness (nodule)
- Generalized hardness
- Tender on palpation
- Referred pain and/or autonomic phenomenon
- Twitch response
- Limited ROM and/or weakness

A

Physical

40
Q

T/F - Trigger points are usually able to be fully resolved with treatment, though not necessarily in one treatment.

A

True

41
Q

Some factors influencing treatment of trigger points include:
- Length of ____ between onset and treatment
- __________ of mechanism of trigger point
- Perpetuating factors like self-care must be addressed

A

Time
Complexity

42
Q

Trigger points may move along the _______ chain (e.g. TrP in quadriceps can lead to TrPs in hamstrings).

A

Kinetic

43
Q

T/F - You must inform the client what to expect when the TrP treatment starts, as they have the right to know and consent to aspects of the massage that may be uncomfortable or painful.

A

True

44
Q

T/F - If the pain is too much for the client, insist they push through it or the TrP treatment will not be as effective.

A

False - If the pain is too much for the client, BE PREPARED TO MODIFY OR STOP the TrP treatment.

45
Q

A TrP treatment should never exceed __ out of 10 on a pain scale for the client.

A

7

46
Q

What are 3 ways that TrPs can be effectively treated?

A

1) Muscle Stripping
2) Specific Compressions
3) Post Isometric Relaxation (PIR)

47
Q

The following protocol outlines how to treat a _______ _____ safely and effectively:
- Prepare the tissue (e.g. deep moist heat, GST)
- Select a specific tool (e.g. olecranon, thumb)
- Perform technique through 3-5 barriers
- Follow up with more superficial/general techniques
- Stretch the muscle (30 sec x3)
- Heat the muscle

A

Trigger Point

48
Q

When muscle stripping, the muscle should be _______ and gently __________ without pain so that no residual slack is left in the tissue.

A

Relaxed
Lengthened

49
Q

When muscle stripping, use your thumb, reinforced fingers, a knuckle or olecranon to strip along the taut band with enough pressure to engage the restrictive _______.

A

Barrier

50
Q

T/F - Muscle stripping should be fast in order to release the tissue.

A

False - Muscle stripping should be SLOW in order to release the tissue.

51
Q

When muscle stripping, the muscle must be stripped from one __________ site to the other. This should be repeated __ to __ times.

A

Attachment
3-5

52
Q

A technique to treat TrPs that is also known as barrier release or ischemic compressions.

A

Specific Compressions

53
Q

T/F - With specific compressions, the muscle should be relaxed and gently lengthened to take up any residual slack in the muscle.

A

True

54
Q

When doing a specific compression, use a thumb, reinforced fingers, knuckle or olecranon and apply ________ directly on the TrP. Gradually increase until you feel __________ in the tissue, known as the first barrier.

A

Pressure
Resistance

55
Q

T/F - With specific compressions, as you release the barrier the referral pain that the client is feeling should diminish.

A

True

56
Q

T/F - With specific compressions, you don’t have to work through barriers.

A

False - With specific compressions, you DO have to work through 3-5 barriers.

57
Q

Be sure that the TrP doesn’t ___ ___ from under your thumb as you are compressing.

A

Slip Out

58
Q

A stretching technique that takes advantage of a muscle’s natural state of relaxation after a contraction. There are different versions of this technique and it may be used any time you would like to lengthen a muscle.

A

Post Isometric Relaxation (PIR)

59
Q

PIR is useful in treating TrPs when ______ treatment is too _______, or is contraindicated due to other conditions.

A

Direct
Painful

60
Q

When performing PIR, take the muscle into its ________ pain free position and slowly ________ then muscle to the point where you feel resistance, or the client reports tension.

A

Shortest
Lengthen

61
Q

T/F - With PIR, the client should contract their muscle using 50% of their strength.

A

False - With PIR, the client should contract their muscle using 10% of their strength.

62
Q

What type of muscle contraction is utilized with PIR, and how long should it be held for?

A

Isometric
10 sec

63
Q

Be sure that the client is _________ normally during the contraction with PIR. At the end of 10 seconds, have them ______ and relax the muscle of the ______.

A

Breathing
Inhale
Exhale

64
Q

T/F - With PIR, wait for the muscle to fully relax before moving to the next barrier.

A

True

65
Q

PIR should be repeated until an appropriate muscle length is achieved. This would be a minimum of __ times. The client will gently perform ______ ____ ROM at the involved joint once the stretch has been completed.

A

3 times
Active Free

66
Q

Use caution when positioning the cervical spine for trigger point treatments. _________ with lateral flexion and ___________ rotation may compress the vertebral artery. Perform a _____ test before the treatment if indicated.

A

Extension
Ipsilateral
VBA

67
Q

Trigger point pain may mimic ________ referral pain. Be ready to refer out if this is the case.

A

Visceral

68
Q

If the taut band you are feeling has a pulse, it is an ______, and not a taut band at all. Be aware of this especially when treating __________.

A

Artery
Temporalis

69
Q

Use care if there is calf pain reported. A ____ ____ __________ can cause TrP like pain in the calf. Do a _______ sign to rule this out before you start treatment.

A

Deep Vein Thrombosis (DVT)
Homan’s

70
Q

A modality that is available to health care practitioners with additional training. It involves inserting a thin, non-cutting needle into the trigger point, or superficial to it in order to reduce or eliminate it.

A

Dry Needling

71
Q

The 3 main mechanisms as the basis of ___ ________ are:
- Gate control mechanism
- Endogenous opioid cascade
- Local release of nitric oxide allows for increased perfusion

A

Dry Needling

72
Q

With the gate control mechanism and endogenous opioid cascade, we are modifying how the pain from the trigger point is perceived by the _____. The needle itself and the achey feeling it produces are sending sensory information up and blocking ______ pain signals from being felt.

A

Brain
Slower

73
Q

With the gate control mechanism and endogenous opioid cascade, the needles may trigger a release of _________ peptides that reduce or eliminate the pain felt in the brain.

A

Analgesic

74
Q

T/F - With local release of nitric oxide allowing for increased perfusion, it is possible to break the ischemia > pain > contraction cycle.

A

True

75
Q

A method of TrP release that involves spraying the affected muscle with a cooling spray that acts as an irritant, thereby blocking pain in the brain caused by the TrP, then applying a stretch to realign the muscle fibres and lengthen the shortened sarcomeres.

A

Spray and Stretch

76
Q

A method of TrP release that involves icing the the affected muscle with ice that acts as an irritant, thereby blocking pain in the brain caused by the TrP, then applying a stretch to realign the muscle fibres and lengthen the shortened sarcomeres.

A

Ice and Stretch

77
Q

A method of TrP release performed by a physician, as it is outside of our scope. Involves injecting the TrP with an analgesic or saline solution to eliminate it.

A

Trigger Point Injection

78
Q

A technique used to reset the tension on the muscle spindles by passively placing the muscle with the TrP in a shortened position where the pain on palpation greatly diminishes.

A

Positional Release

79
Q

How long is positional release typically held for?

A

90 sec

T2 MSK (12 decks)

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