Trigger Points/ Tender Points Flashcards
What is a trigger point?
- Hyperirritable locus within a taut band of skeletal muscle located in the muscular tissue or its associated fascia
What are the 2 types of trigger points?
- Active (Pain without palpation)
- Latent (Clinically silet, but restricts, weakens muscle, and predisposes it to acute attacks of pain)
Upon who is trigger point mapping based?
JFK
Is a Trigger Point a primary or secondary condition?
Can be either
What are 4 direct causes of trigger points?
- Acute overload (a specific event or movement)
- Overwork/ overuse fatigue
- Direct trauma
- Chilling
What are the 2 causes of overwork fatigue?
- Repetitive contractions
- Sustained contractions
What are 4 indirect causes of trigger points?
- Overloaded synergistic muscles from primary muscle dysfunction
- Visceral disease
- Arthritic joints
- Emotional distress
How much do trigger points vary?
- Extremely variable due to activity
- Latent can turn into active
How do TrPs limit the movement of muscle?
- Develop guarding habits that limit movement
What type of autonomic changes may appear in the presence of Trigger Points?
- Diaphoresis
- Vascontriction
- Changes in proprioception
- Hair loss
- etc…
What are the 6 clinical signs used to diagnose a trigger point?
- Weakness and restriction in the stretch of an affected muscle
- A palpable taut band in the affected muscle
- Severe focal tenderness to digital pressure
- Twitch response following snapping or dry needling
- Reproduction of pain
- Elimination of symptoms targeting specific muscle
What is the goal of trigger point therapy?
- Inactivate trigger point decreasing referred pain
What are 3 methods of trigger point treatment?
- Manual technique
- Needling w/ or w/o medicaiton
- Dry needling
How much pressure should be applied through digital palpation to assess trigger points?
- Approximately 4 kg
How many tender points need to be present for a diagnosis of fibromyalgia?
- 11 of 18 sites
What are the 18 sites of tender points?
- Bilateral at suboccipital muscle insertions
- Bilateral anterior aspects of the intertransverse spaces at C5 - C7
- Bilateral trapezius at midpoints and upper boarders
- Bilateral medial supraspinaltus
- Bilateral second rib at the 2nd costochondral junctions lateral to junctions of upper surfaces
- Bilaterally 2 cm distal to humeral epicondyles
- Bilateral outer quadrants of buttocks in anterior fold of muscle
- Bilateral greater trochanter near trochanteric prominence
- Bilateral medial fat pad proximal to the joint line of knee
Are tender or trigger points exclusively muscle?
- Trigger points
Who developed the counterstrain/ positional release method?
- Jones
What is the theory behind positional release?
- Decreases sensitivity of the muscle spindle to stretch, which decreases the excitability of extrafusal muscle fibers
Does a trigger point or tender point illicit a local twitch response?
- Trigger points
Does a trigger point or tender point illicit a local tenderness on palpation?
- Both
Can a trigger point or tender point be singular?
Only a trigger point
Does a tender point or trigger point occur in specific locations?
Tender point
Does a trigger point or tender point cause a specific referred pain pattern?
Trigger point
Does a trigger point or tender point increase the body’s overall sensitivity to pain?
Tender point
What is the referred pain pattern of the SCM?
- Occiput/ occipital headaches
- Ear
- Eye
- Cheek
- Frontal area/ frontal headaches
- Throat
- Sternum
What are 3 autogenic symptoms of the SCM?
- Tinnitus
- Blurred vision
- Postural dizziness
What type of grip is used when performing TrP therapy on the SCM?
- Pincer
What should be avoided when performing TrP therapy on the SCM?
- The carotid artery and jugular vein
What are the stretch positions that follow TrP therapy of the SCM?
Clavicular head: Neck extension, side bending, and rotation to the opposite side
Sternal: Neck extension, side-bending to the opposite side, rotation to the same side of the stretched muscle
What is the positive stretch sign of the SCM?
- Pain at occipital base and upper c-spine of side opposite stretch
What muscle is usually involved in TrPs of the SCM?
- The scalenes
What postural imbalance is typically present if the Scalenes and TrPs develop trigger points?
T-spine/ forward neck posture
Besides posture, what else may lead to TrPs of the SCM?
- Whiplash injury
What occupations may lead to development of SCM trigger points?
- Those that require constant or repetitive forward neck bending
What sleeping modification can be made to prevent SCM TrPs?
- Pillow positioning
What is a common HEP for SCM TrPs?
- Maintain shoulder in depression (hold onto table
- Use MFS positions
What is the referred pain pattern for the Scalenes?
- Neck
- Pectoral region
- Medial border of scapula
- Front and back of arm
- Radial surface of the forearm
- Index finger and thumb
What grip is used for TrPs in the Scalenes?
- Thumb or four fingesr
- Palpated against transverse processes
What is the stretch for the Scalenes following TrP treatment?
- Neck side-bending with moderate extension
- Stabilize scapula by holding onto chair
What is the positive stretch sign for the scalenes?
- Pain on ipsilateral cervical spine
What are 3 mechanisms of injury for the Scalenes?
- Whiplash
- Over respiration
- Muscular imbalance between the SCM and scalenes causing forward neck posture
What is the referred pain pattern for the suboccipitals?
- Occipital headaches
- Deep headaches
- Pain behind the eye
What stretch technique is coupled with TrP of the suboccipitals?
- Suboccipital decompression technique
- Chin tuck with upper cervical traction
What is the positive stretch sign for the suboccipitals?
- There is none
What are 3 mechanisms of injury for the suboccipitals?
- Forward head posture with posterior rotation of the occiput
- Prone position for a prolonged period with hands support the head (watching TV or reading a book)
- Excessive use of binoculars or eye glasses that require adjustment may cause a short hyperextension of the neck
What is the referred pain pattern of the upper trapezius?
- Posterolateral neck
- Behind ear
- Temporal area/ temporal headaches
- To zygomatic arches
What is the stretch coupled with TrP therapy of the upper trapezius?
- Neck flexion
- Side-bending towards opposite side
- Slight rotation to ipsilateral side
What is the positive stretch sign of the upper trapezius?
- Pain at the opposite side during a stretch
What is the HEP stretch for the patient for an upper trapezius TrP?
- Pt sitting and holding ipsilateral shoulder in depression by gripping under the table with their hand
- Use other hand to flex, contralaterally sidebend, and ipsilaterally rotate the neck to the same side
What are 3 mechanisms of injury of the upper trapezius muscle?
- Stabilizing phone between head and shoulder
- Carrying heavy bags with strap over shoulder
- Armchairs or wheelchairs with high arm supports or no supports
