The myofascial pain syndrome (MPS)

Features of MTrPs

Motor: disturbed motor function muscle weakness as a result of

motor inhibition muscle stiffness restricted range of motion

Autonomic: vasoconstriction vasodilatation

Features of MTrPs

Features of MTrPs

Sensory: local tenderness referral of pain to a distant site peripheral sensitization central sensitization

Definition and type of Terms

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Examples of the two directions in which trigger point may referred

A). Peripheral projection of pain from suboccipital and infraspinatus trigger points. (

B). Mostly central projection of pain from biceps brachii trigger points with some pain in the region of the distal tendinous attachment of the muscle.

Other Muscle Pain Terminology Fibrositis

(Gowers, 1904) Fibromyositis

(Telling, 1911) Myofasciitis

(Albee, 1927) Myofibrositis

(Murray, 1929) Perineuritis

(Clayton & Livingstone, 1930)

Idiopathic myalgia (Gutstein-Good, 1940)

Rheumatic myalgia (Good, 1941)

Myofascial Pain Syndrome (Travell, 1948)

Myodysneuria (Gutstein, 1955)

Fibromyalgia (Yunus, 1977)

Prevalence

Research has shown that MTrPs are commonly associated with facet joint dysfunctions, disc herniation, osteoarthritis, migraine, tension type headache, (Fybromyalgia), visceral disorders etc.Dommerholt, J. and T. Issa, Differential diagnosis: myofascial pain, in Fibromyalgia syndrome; a practitioner's guide to treatment, L. Chaitow, Editor. 2003, Churchill Livingstone: Edinburgh. p. 149-177.

A survey of APS (American Pain Society)-members shows that 88.5% consider MPS as a legitimate diagnosisHarden, R.N., et al., Signs and symptoms of the myofascial pain syndrome: a national survey of pain management providers. Clin J Pain, 2000. 16(1): p. 64-72.

80% of 1096 subjects involved in low-velocity activity developed active trigger points (MTrP)Schuller, E., W. Eisenmenger, and G. Beier, Whiplash injury in low speed car accidents. J Musculoskeletal Pain, 2000. 8(1/2): p. 55-67.

MTrPs have been identified with:

Radiculopathies joint dysfunction disk pathology tendonitis Craniomandibular

dysfunction migraines tension-type headaches carpal tunnel syndrome computer-related disorders whiplash associated

disorders spinal dysfunction

pelvic pain and other urologic syndromes

most pain syndromes nocturnal cramps phantom pain etc.

Etiology of MTrPs

Acute Overuse Direct Trauma Persistent Muscular Contraction

(emotional or physical cause), i.e,: poor posture, repetitive motions, stress response

Prolonged Immobility Systemic Biochemical Imbalance

Diagnostic Criteria taut band: the group of

tense muscle fibers extending from a trigger point to the muscle attachments, the tension being caused by contraction knots that are located in the trigger point region

Diagnostic Criteria

spot tenderness within the taut band (nociceptive input into the dorsal horn contributing to wind-up and central sensitization)

local twitch response.

referred pain.

Jump sign.

Identification

Myofascial Trigger Points are identified by physical examination, specifically by palpation

There are two palpation techniques:

Flat palpation Pincer palpationdependent upon the muscle

Manual Trigger Point Therapy

Trigger Point Techniques Trigger Point Compression (Technique I) Manual stretching of the taut band in muscle fibre direction (Technique II)

Release Techniques: Myofascial Release (Technique III) Intermuscular mobilisation (Technique IV)

Stretching Techniques: Therapeutic stretching (Technique V) Self stretching (Technique VI)

Manual Trigger Point Therapy

Trigger Point Compression (Technique I)

Manual Trigger Point Therapy

Manual stretching of the taut bandin muscle fiber direction(Technique II)

Manual Trigger Point Therapy

Myofascial Release (Technique III)

Manual Trigger Point Therapy

Intermuscular mobilisation (Technique IV)

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