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  1. Trigger Points & Myofascial Pain Syndrome
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  4. The Complete Guide to Trigger Points & Myofascial Pain ()

You will know when you have found one as it will be very sensitive to the touch. By sensing this tenderness, you are given an opportunity to become aware of it and to consider its cause. Muscles involved in past surgeries tend to have painful trigger points as do muscles located around the joints. Some points, particularly those between the shoulder blades, will be instinctively located, while others may require a bit of detective work on your part.

Gentle stretching of your muscles on a regular basis will provide you with the clues you need to help yourself. A point on the right side of your body has a corresponding point on the left side. Pressure applied to this side will usually give the most relief. For best results, however, pay equal attention to points on both sides of your body. Trigger points can affect movement by keeping muscles short and stiff, which reduces range of motion.

They can maintain spasms in other muscles. They prevent muscles from relaxing, causing them to tire quickly, recover slowly from exertion, and contract excessively when they work. They can also keep muscles out of balance to the extent that they partially disarticulate joints, causing them to catch or pop when you move. Trigger points can make a muscle reluctant to do either. Stretching or contracting irritates trigger points and increases pain, making you less and less inclined to move.

Trigger point massage works extremely well for myofascial pain. Done correctly, it usually shows clear results within a week, often in just a day or two. Of course, one of the best ways to tackle nasty trigger points is to make an appointment with your massage therapist. But there are also many self-therapy tools on the market to help overcome the pain of trigger points.

The following trigger point massage tools can help alleviate and prevent discomfort throughout the body.

Trigger Points & Myofascial Pain Syndrome

In addition to its small, portable size, it also features circular ridges that provide extra pressure for deeper, more invigorating massage. The unique combination of ridges and small size make the roller ideal for precision targeting of sore muscles in the feet and arms. It lets you easily perform targeted, deep-pressure massage of sore muscles thanks to its unique design.

Each Thera Cane comes with a manual featuring 39 illustrated uses, stretches, and myofascial trigger point information. Clusters of trigger points are not uncommon in some of the larger muscles, such as the gluteus group gluteus maximus , gluteus medius , and gluteus minimus. Often there is a heat differential in the local area of a trigger point. A review of nine studies examining the reliability of trigger point diagnosis found that physical examination could not be recommended as reliable for the diagnosis of trigger points.

A review in Archives of Physical Medicine and Rehabilitation of two recent studies concludes they present findings that can reduce some of the controversy surrounding the cause and identification of myofascial trigger points MTPs. MRE is a modification of existing magnetic resonance imaging equipment to image stress produced by adjacent tissues with different degrees of tension.


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This report presents an MRE image of the taut band that shows the V-shaped signature of the increased tension compared with surrounding tissues. The findings suggest that MRE can quantitate asymmetries in muscle tone that could previously only be identified subjectively by examination. In the study by Shah and associates, they have shown the feasibility of continuous, in vivo recovery of small molecules from soft tissue without harmful effects.

With this technique, they have been able to investigate the biochemistry of muscle in subjects with myofascial trigger points and to contrast this with that of the noninvolved muscle. The main innovation of Travell's work was the introduction of the myofascial pain syndrome concept myofascial referring to the fascia that surrounds and permeates muscle.

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This is described as a focal hyperirritability in muscle that can strongly modulate central nervous system functions. Travell and followers distinguish this from fibromyalgia , which is characterized by widespread pain and tenderness and is described as a central augmentation of nociception giving rise to deep tissue tenderness that includes muscles.

Studies estimate that in 75—95 percent of cases, myofascial pain is a primary cause of regional pain. Myofascial pain is associated with muscle tenderness that arises from trigger points, focal points of tenderness, a few millimeters in diameter, found at multiple sites in a muscle and the fascia of muscle tissue. Biopsy tests found that trigger points were hyperirritable and electrically active muscle spindles in general muscle tissue. The misdiagnosis of pain is the most important issue taken up by Travell and Simons.

Referred pain from trigger points mimics the symptoms of a very long list of common maladies, but physicians, in weighing all the possible causes for a given condition, rarely consider a myofascial source.

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The study of trigger points has not historically been part of medical education. Travell and Simons hold that most of the common everyday pain is caused by myofascial trigger points and that ignorance of that basic concept could inevitably lead to false diagnoses and the ultimate failure to deal effectively with pain. Therapists may use myotherapy deep pressure as in Bonnie Prudden 's approach, massage or tapotement as in Dr. Griner's approach , mechanical vibration , pulsed ultrasound , electrostimulation , [13] ischemic compression , trigger-point-injection see below , dry-needling , "spray-and-stretch" using a cooling spray vapocoolant , 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 [ citation needed ] , the pain felt days after overexerting muscles.

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The Complete Guide to Trigger Points & Myofascial Pain ()

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. Researchers of evidence-based medicine concluded as of that evidence for the usefulness of trigger points in the diagnosis of fibromyalgia is thin.

Injections without anesthetics, or dry needling , and injections including saline, local anesthetics such as procaine hydrochloride Novocain or articaine without vasoconstrictors like epinephrine, [17] steroids , and botulinum toxin provide more immediate relief and can be effective when other methods fail. In regards to injections with anesthetics, a low concentration, short acting local anesthetic such as procaine 0. High concentrations or long acting local anesthetics as well as epinephrine can cause muscle necrosis , while use of steroids can cause tissue damage. Despite the concerns about long acting agents, [1] a mixture of lidocaine and marcaine is often used.

This has the advantages of immediate anesthesia with lidocaine during injection to minimize injection pain while providing a longer duration of action with a lowered concentration of bupivacaine. In , a study by Czech physician Karl Lewit reported that dry needling had the same success rate as anesthetic injections for the treatment of trigger points.

He dubbed this the 'needle effect'. In the s and s, studies relevant to trigger points were done by J. Treatment, whether by self or by a professional, has some inherent dangers.

It may lead to damage of soft tissue and other organs. The trigger points in the upper quadratus lumborum , for instance, are very close to the kidneys and poorly administered treatment particularly injections may lead to kidney damage. Likewise, treating the masseter muscle may damage the salivary glands superficial to this muscle. Furthermore, some experts believe trigger points may develop as a protective measure against unstable joints.

Studies to date on the efficacy of dry needling for MTrPs and pain have been too small to be conclusive. The first written descriptions of trigger points are from the 16th century. The French physician Guillaume de Baillou described trigger points in the context of what is now called myofascial pain syndrome. The concept was popularized in the US in the middle of the 20th century by the American physician Janet G. From Wikipedia, the free encyclopedia. Not to be confused with the "tender points", used for fibromyalgia diagnosis.