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Branden Masengale

on 12 February 2013

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Trigger Points: Clinical
Applications By: Branden Masengale Myofascial Trigger Points {MTrPs} Defined: * First Described in 1942 by Dr. Janell Travell

* An area of hyperirritability located in a taut band of muscle

* Resembles a small pea or ropelike nodule that is painful upon palpation and REFERS pain, tenderness, and an involuntary response to a remote area. "Jump Sign" or "Jump Response" Can Also Include... * When the area is palpated the patient reacts with facial grimacing, a verbal response, or by jumping away from the examiner. Trigger Points Can Be Characterized As: * Active Trigger Points

* Latent Trigger Points * Those that cause pain (locally or referred) at rest or
with activity of the muscle containing the Trigger Point * Does not refer pain actively but may do so when pressure or strain is applied.

* According to Travell and Simons, a latent trigger point does not cause pain, but may cause restricted movement and weakness in the affected muscle. Common Causes * Trauma

* Overuse

* Mechanical Overload

* Postural Faults

* Psychological Stress * Disruption of the sarcoplasmic reticulum leading to excess calcium in the muscle Develop in muscle areas where energy supplies are diminished and metabolic activity is high Possible Mechanisms Ages Affected By
Trigger Points : Study: Development of Myofascial Trigger Points In Children ***Pressure Pain Threshold (PPT)
Using a Pressure Algometer * Concluded that there was increased
sensitivity in known TP areas in all
age groups tested (505 Children
Ages 4-11) Accepted Treatments
Trigger Points Spray and Stretch Therapeutic
Ultrasound Ishemic Pressure with Prolonged Stretch Electrical Stimulation Dry
Needling * Using a vapocoolant spray along
with passive stretching of the muscle Lewit and Simons:
* Demonstrated passive stretch alone
has same results Jaeger and Reeves
* Vapocoolant Spray could not produce
anesthesia because it could not reach
the depth of the desired tissue. ***Pain Pressure Threshold Study: Effect of Ultrasound on Trigger
Point Sensitivity Test Group: 5 min tx: 1.0 W/cm2 continuous 1 MHz

Control Group: 5 min tx: 0.1 W/cm2 continuous 1 MHz RESULTS: 44.4% increase in pressure scores for
the test group vs. 1.4% increase for
control group ***Pressure Pain Threshold
***VAS Scores Study: Effectiveness of a Home Program of
Ischemic Pressure Followed by Sustained Stretch Home use for pressure: Thera Cane Results: Control Group: Only Stretching Pressure with Stretch group showed significantly better results vs. control group. Studies Show: High Intensity: Greater VAS scores However... No mode produced a decrease
in TP sensitivity * Graff Radford et al An invasive procedure in which a
needle is inserted into the skin
and muscle directly at a trigger point * Typically used when
other forms fail 620 Potential Trigger Points Show up in similar places for everyone:
Makes trigger point maps accurate for everyone Hanten, W. P., Olson, S. L., Butts, N. L., & Nowicki, A. L. (2000). Effectiveness of a home program of ischemic pressure followed by sustained stretch for treatment of myofascial trigger points. Physical Therapy, 80(10), 997-1003. Retrieved from http://search.proquest.com/docview/223116103?accountid=131689

Han, T., Hong, C., Kuo, F., Hsieh, Y., Chou, L., & Kao, M. (2012). Mechanical pain sensitivity of deep tissues in children - possible development of myofascial trigger points in children. BMC Musculoskeletal Disorders, 13(1), 13-13. doi: http://dx.doi.org/10.1186/1471-2474-13-13

Srbely, J. Z., & Dickey, J. P. (2007). Randomized controlled study of the antinociceptive effect of ultrasound on trigger point sensitivity: Novel applications in myofascial therapy? Clinical Rehabilitation, 21(5), 411-7. doi: http://dx.doi.org/10.1177/0269215507073342

Travell JG, Simons DG. Myofascial Pain and Dysfunction: The Trigger Point Manual, The Upper Extremities. Baltimore, Md: Williams & Wilkins; 1983: 5-90 Sources Cited Any Questions:
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