American
|
Home
Search
Pain referral
Trigger points
Cranial nerve
Spinal nerve
Historical
Infections are caused by an invasion of a microorganism, which are
bacterial, protozoal, ectoparasitic/endoparasitic or viral
in nature. While viruses are considered by most to be microorganisms or
pathogens several authors are of the opinion that viruses do not portray true
characteristics of an organism.
Potentially there are numerous infections, which can cause muscle pain and
aggravate trigger points. However, when these infections exist, they
are usually accompanied with additional symptoms such as fever, fatigue,
muscle weakness and possibly skin lesions, nausea, vomiting, diarrhea or
hemorrhage.
Low-grade viruses seem to be the most prevalent means of infection in
western society. However, viruses such as herpes (all types),
arbovirus (transmitted by ticks, mosquitoes and sand fleas), arenavirus
(transmitted by rodents and mosquitoes) viral stomatitis, mumps,
measles, and chicken pox viruses are among a few of the infectious
viruses that can result in trigger points. While all these infectious viruses
have somewhat different causes and symptoms, they all affect the muscles.
Drs. Travell & Simons placed significant emphasis on primary herpes simplex
being a perpetuating factor of myofascial pain syndrome TrP’s and stated
that its propensity for perpetuation was far more prevalent in perpetuating
TrP’s than that of secondary herpes simplex or even herpes zoster. Our
experience has been that while the secondary form of HS or genital herpes
does not seem to have the propensity to perpetuate or activate triggers in
comparison to primary herpes simplex, the post hepatic neuralgia experienced
with herpes zoster has the potential to be far more severe,
persistent and difficult to obtain amelioration than that of herpes simplex.
Herpes zoster (shingles) can be a devastating illness and the inescapable
neuralgia with secondary myalgia can frequently be so painful that the
individual can become suicidal. Elderly persons or those with a compromised
immune system in addition to severe psychological stress are at the greatest
risk for severity of pain and reoccurrence. Pain reoccurs on numerous
occasions, with the absence of lesions, occasionally for months or even
years after the initial eruptions.
While this condition usually affects the dorsal root ganglia of the thoracic
nerves, occasionally dermatomal distribution is noted in the lumbar
sacral region or with the eyes, ears and face from the ophthalmic or facial
cranial nerves (Ophthalmic herpes zoster, Ramsay Hunt’s syndrome or herpes
zoster oticus). According to the NIH, this virus is a form of chicken pox
and can be transmitted during the acute phase to individuals, whom have not
been previously infected by the chicken pox virus, if the vesicular dermatomal
eruptions are disturbed.
Soft tissue techniques applied by a person whom has never been exposed to
the pox virus may result in the contraction and possible transmission of this
virus during the acute phase. While gentle rubbing along the dermatomal
pathway can be beneficial in reducing postherpetic neuralgia, soft tissue
technique would be contraindicated during the acute stage. Dermatomal pain
usually precedes eruption for approximately 3 to 5 days. The lesions are active
for approximately five days to two weeks. Should the lesions be persistent for
over three weeks, consider possible metastatic disease.
Occasionally, this condition affects the viscera and can present chest pain or
symptoms consistent with pleurisy or appendicitis prior to the erythematous
eruptions. As peripheral nerve compression also causes a hyperesthesia of
dermatomes, palpation should be conducted with latex gloves. Herpes
simplex is also transmittable and the same precaution should be used when
working around or in the mouth or groin.
A few
other viral infections which cause muscle pain, weakness and fatigue are the
common cold, influenza, pneumonia, viral hepatitis, malaria, poliomyelitis,
upper respiratory infection, GI infections, viral meningitis, viral
encephalitis, small pox and HIV (acute retroviral syndrome). While
multiple sclerosis is considered an autoimmune disease, the true cause of
degeneration of the myelin sheath is unknown. However, numerous authors
attribute its causation to either a virus or retrovirus with frequent
correlations to herpes. Symptoms are dependent upon area affected. Symptoms may
be intermittent or when more progressive, persistent and degenerative. The
symptoms range from virtually no effect to fluctuations in mood to severely
depressed, weakness, tremors, hypertonicity with ischemic bands and triggers,
hyperreflexia, gait abnormalities with proprioceptive dysfunction, paralysis,
constipation and urinary incontinence. With cerebral involvement you may see
difficulty in speaking, swallowing, and visual disturbances. Like several other
forms of neurologic disease (neuropathy) heat is contraindicated. It is not
uncommon that following a very warm whirlpool that the symptoms are worsened,
such as a foot drop which may occur and take several days to ameliorate.
Bacteria
or germs are single cell organisms that while very small are approximately 100
times larger than a virion. Unlike viruses bacterial invasion are usually
responsive to antibiotics. However, there are certain forms of bacteria, which
are antibiotic resistant. These resistant strains are usually the product of an
individual being administered liberal and frequent doses of antibiotics thus
diminishing the effectiveness of these medications. Bacterial infections may be
localized or systemic. They may be recent in onset or acute, sub-acute or
chronic. Dependent upon the type of bacteria, the immune system of the individual,
and resistance to antibiotics, most superficial infections are easily managed. Chronic infections, especially those that are in the bloodstream have a tendency
to be antibiotic resistant and in low-levels more difficult to diagnose. Usually
cultures or elevated white counts are excellent diagnostic indicators for
infection. However, with chronic infections it is not uncommon to have a normal
or slightly elevated white blood cell count, which is misleading as it pertains
to the infection. This occurs due to the body releasing immature leukocytes thus
requiring more specialized testing than a CBC.
Localized infections can be spread through the use of soft tissue
manipulation and therefore massage would be contraindicated. Depending
upon the type of infection, whirlpools would also be contraindicated,
and if ordered by a physician, the water would have to have an antibacterial
agent added (i.e. burn patients). The CDC recommends cleaning of whirlpools and
equipment with a 20% chlorine solution. Obviously, to avoid cross
contamination frequent hand washing with an antibacterial soap is required. Viruses
cannot replicate outside of a host cell. Anaerobic bacteria require a warm,
moist environment. Aerobic bacteria require oxygen for replication.
A few
conditions caused by bacterial infections which result in muscle pain are
Legionnaire’s disease, streptococcal myositis, poststreptococcal arthralgia,
septic arthritis, oral abscess, anthrax, upper respiratory infection, urinary
tract infection, sinusitis, toxic shock syndrome, salpingitis, prostatitis,
endometriosis, bacterial meningitis, and encephalitis. A
Protozoan is a single cell organism, which can be microscopic or macroscopic in
nature. Some forms move freely throughout the body with the use of their tail
(flagella). They are parasitic in nature and significantly larger than bacteria
with some having the ability to eat, eliminate, and conduct respiration on their
own. The main two protozoa that are responsible for muscle pain are giardiasis
and amebiasis. Parasites
live in (endoparasitic) or on (ectoparasitic) another living creature. Some
bacteria, viruses and protozoa are essentially parasites. The worst offenders of
parasites causing muscle pain or TrPs are adult tapeworms and pinworms, which
can have severe and even life threatening side effects. While ectoparasites such
as fleas, scabies, mites, ticks, leaches, and lice frequently act as vectors; the manual medicine practitioner is usually more concerned with coming in contact with these
parasites than having to confront the disease process that they may cause. Drs.
Travell & Simons do reference Deer Tick Fever, Rocky Mountain spotted fever, and Lyme’s disease as perpetuating factors for TrPs. Fungal
infections usually do not present muscle pain, nor are they listed as a
perpetuating factor for TrP’s. However, several of them can be spread and are
noteworthy of consideration. Systemic Candidiasis can cause a multitude of
symptoms ranging from fatigue, confusion and lethargy to the direst of
consequences when progressive, if the individual has a suppressed immune
system. In healthy individuals bacteria normally keeps this fungal development in check. However, with
the persistent use of antibiotics there are not any bacteria to fight off its
progression. Persons with Diabetes Mellitus, women on birth control pills or
who are pregnant also have a propensity for systemic candidiasis. Prevalent
sites of localized candidiasis are the skin, nails, mouth, mucus membranes,
vagina, gastrointestinal tract, penis, and anus. These localized sites of
candidiasis infection, while extremely troublesome, can be managed with
medication, diet, and naturopathic or homeopathic remedies. as in most
cases involving a suppressed immune system, the ability to reduce psychological
stress is important.
Myofascial trigger point perpetuating factor: infections and infestations
© Copyright