Universitatea “Alexandru Ioan Cuza” din Iași

Facultatea de Educație Fizică și Sport

SPECIALIZARE: Kinetoterapie si Motricitate

Speciala

REFERAT

Trigger Points

Coordonator științific:

Perez Cenel Augusto

Student: Nistor Andrei

Anul universitar
2017-2018
Semestrul II
Trigger Point Symptoms & Referred Pain Patterns.

Myofascial trigger points, also known as trigger points, are described

as hyperirritable spots in the fascia surrounding skeletal muscle. They are associated with
palpable nodules in taut bands of muscle fibers.[1] They are a topic of ongoing controversy, as
there is limited data to inform a scientific understanding of the phenomenon. Accordingly, a
formal acceptance of myofascial "knots" as an identifiable source of pain is more common
among bodyworkers, physical therapists, chiropractors, and osteopathic practitioners.
Nonetheless, the concept of trigger points provides a framework which may be used to
help address certain musculoskeletal pain.

The trigger point model states that unexplained pain frequently radiates from these
points of local tenderness to broader areas, sometimes distant from the trigger point itself.
Practitioners claim to have identified reliable referred pain patterns which associate pain in
one location with trigger points elsewhere. There is variation in the methodology
for diagnosis of trigger points and a dearth of theory to explain how they arise and why they
produce specific patterns of referred pain.

Compression of a trigger point may elicit local tenderness, referred pain, or local
twitch response. The local twitch response is not the same as a muscle spasm. This is because
a muscle spasm refers to the entire muscle contracting whereas the local twitch response also
refers to the entire muscle but only involves a small twitch, no contraction.

Among physicians, various specialists might use trigger point therapy. These
include physiatrists (physicians specializing in physical medicine and rehabilitation), family
medicine, and orthopedics. Osteopathic as well as chiropractic schools also include trigger
points in their training. Other health professionals, such as athletic trainers, occupational
therapists, physiotherapists, acupuncturists, massage therapists and structural integrators are
also aware of these ideas and many of them make use of trigger points in their clinical work
as well.
Pain is a complex symptom experienced differently and individually.however, referred
pain is the defining symptom of a myofascial trigger point.

You may be used to the idea of referred pain of visceral origin: an example of this is
heart pain. A myocardial infarct (heart attack) is often not experienced as crushing chest pain,
but as pain in the left arm and hand, and in the left jaw. This type of pain is well documented,
and known to originate from the embryological dermomyotome; in this case, the heart tissue,
jaw tissue, and arm tissues all develop from the same dermomyotome.
Referred pain from a myofascial trigger point is somewhat different. It is a distinct and
discrete pattern or map of pain. This map is consistent, and has no racial or gender
differences, because stimulating an active trigger point generates the pain.

Patients describe referred pain in this map as having a deep and aching quality;
movement may sometimes exacerbate symptoms, making the pain sharper. An example of
this might be a headache. The patient often describes a pattern of pain, or ache, which can
sometimes be aggravated and made sharper by moving the head and neck. The intensity of
pain will vary according to the following factors (this list is not exhaustive):

Location (attachment points are more sensitive)

 Degree of trigger point irritability
 Active or latent trigger points
 Primary or satellite trigger points
 Site of trigger point (some areas are more sensitive)
 Associated tissue damage
 Location/host tissue stiffness or flexibility Ageing
 Chronicity of trigger point

Trigger Points Explained

What is trigger point therapy?

Most of us will suffer from stiff, achy muscles, and numerous musculoskeletal pain
conditions that are caused by "knots". Trigger point therapy uses a variety of techniques to
"deactivate" these painful knots and make them dissapear. Trigger point therapy is generally
simple to perform, both at home by yourself, with a partner, or by working with a trained
therapist.

For most musculoskeletal conditions, a combination of trigger point therapy together with
some simple lifestyle changes will produce very fast and lasting results.

So, what happens when you treat (massage) a trigger point? Well, by doing so you:

 numb and reduce the pain

 lessen the pain feedback pathways

 interrupt the pattern of pain and spasm

 stretch out tight muscles, which will indirectly affect other tissues

 open out the plastic-wrap-like myofascial bag that surrounds your muscles

 stimulate the blood supply helping to remove debris and toxins from the area

 encourage the release of powerful pain-killing endorphins

Pressing on trigger points:

 numbs and reduces pain in the treated area and in the area of the percieved pain;

 attenuates the pain feedback pathways;

 breaks the vicious cycle of pain and spasm;

 stretches tight structures, which will have an indirect effect on other tissues;

 opens out the plastic-wrap-like myofascial bag surrounding, investing, and supporting the
muscles;

 stimulates the blood supply, to clear away debris and toxins;

 increases the release of powerful pain-killing agents called endorphins;

affects the autonomic/automatic nervous system.

How do you know it is a trigger point?

You are looking for:

 Stiffness in the affected/host muscle

 Spot tenderness (exquisite pain)

 A palpable taut nodule or band

 Presence of referred pain

 Reproduction of the symptoms (accurate)

 Possible loss of skin elasticity in the region of the trigger point

 The affected area may be moister or warmer (or colder) than the surrounding tissues, and
may feel a little like sandpaper.

What bits of your hands should you feel them with?

 Finger pads: remember to cut your fingernails (shorter is better).

 Flat fingers: use the fingertips to slide around the skin across muscle fibers (see fig. a)
 Pincer: pinch or grip the belly of the muscle between the thumb and the other fingers,
rolling muscle fibers back and forth. (see fig. b)

 Flat-hand palpation: useful in the abdominal region (viscera).

 Elbow: allows a stronger and shorter lever, which can be a distinct advantage (not always
practical, and can be difficult to get used to).

If you plan to treat yourself at home through self-help, hands-on treatments, you should
schedule no more than one session a day, with a three or four day gap in-between. If you are
using balls, rollers or pressure tools on the other hand, then you can usually increase the
frequency of treatment up to up to six times a day (based on a 10-15 minute treatment
session).

If you are receiving treatment from therapist, you should also expect "home-work". Your
therapist will provide you with a suitable treatment plan for you to follow between visits.

About You and Your Pain

 Over 25% of adults suffer from musculoskeletal disorders (MSD's), and this number is
growing exponentially as we live longer, work longer, and adapt to changing lifestyles such as
increased use of mobile and tech devices.

Whilst most MSD's will heal over time without treatment, the process is usually slow
and debilitating. In some cases, a lack of early intervention and treatment can lead to more
serious symptoms, and temporary or permanent disability.

Sadly, the majority of MSD sufferers will take little or no remedial action, most often
because the costs of manual therapy can be prohibitive.

The good news is that the vast majority of MSD's can be effectively treated, especially
when action is taken early.

Physical muscle treatment

Therapists may use myotherapy ,pulsed ultrasound, electrostimulation, ischemic

compression, trigger-point-injection (see below), dry-needling, "spray-and-stretch" using
a cooling spray , low-level laser therapy and stretching techniques that invoke reciprocal
inhibition within the musculoskeletal system. Practitioners may use elbows, feet or various
tools to direct pressure directly upon the trigger point, to avoid overuse of their hands.

A successful treatment protocol relies on identifying trigger points, resolving them

and, if all trigger points have been deactivated, elongating the structures affected along their
natural range of motion and length. In the case of muscles, which is where most treatment
occurs, this involves stretching the muscle using combinations of passive, active, active
isolated(AIS), muscle energy techniques (MET),and proprioceptive neuromuscular
facilitation (PNF) stretching to be effective. Fascia surrounding muscles should also be treated
to elongate and resolve strain patterns, otherwise muscles will simply be returned to positions
where trigger points are likely to re-develop.

The results of manual therapy are related to the skill level of the therapist. If trigger
points are pressed too short a time, they may activate or remain active; if pressed too long or
hard, they may be irritated or the muscle may be bruised, resulting in pain in the area treated.
This bruising may last for a 1–3 days after treatment, and may feel like, but is not similar
to, delayed onset muscle soreness (DOMS), the pain felt days after overexerting muscles. Pain
is also common after a massage if the practitioner uses pressure on unnoticed latent or active
trigger points, or is not skilled in myofascial trigger point therapy

Have a Chat with an Experienced Therapist

There are many types of painful injuries and dysfunction syndromes. In the majority
of cases, manual therapy including trigger point therapy, correctly applied, should help relieve
symptoms and accelerate the body's natural process of rehabilitation and recovery.

Use the directory section on this website to search and compare manual therapists,
exercise professionals and trigger point therapists in your area.