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Pain referral
Trigger points
Cranial nerve
Spinal nerve
Historical Skip to Trigger point definitions Skip to Other sites for trigger points Skip to Criteria and characteristics Skip to Four phases of trigger points Skip to Myofascial trigger point perpetuating factors
2. Scar tissue 3. Ligament 4. Periosteum Motor points are not trigger points. Motor points are located in close
approximation to the middle of the muscle. Trigger points are randomly
dispersed.
2. Distinct patterns of pain referral inherent to that muscle.
3. Diminished strength and lengthening ability of that muscle.
4. Taut, palpable band or nodule within muscle.
5. Extreme tenderness of palpable band or nodule within fibers.
6. Elicited twitch response when taut band is either stimulated
or snapped transversely.
7. Replication of pain pattern when trigger point is stimulated. 8. Asymptomatic relief results when treatment has been performed.
Phase 3: Latent Trigger Point - Palpable button like or nodular
mass within muscles, fascia, scar tissue, ligaments, and periosteum which have characteristics of a trigger point. When
snapped transversely it may replicate a referral pattern as if it were
active. However, without direct pressure, it does not produce a
subjective referred pain complaint or autonomic phenomena
during either activity or rest.
Phase 2: Active Trigger Point - Palpable button like or nodular
mass within muscles, fascia, scar tissue, ligaments, and periosteum which have characteristics of a trigger point. Produces
a subjective referred pain complaint or autonomic phenomena
during activity but reduced or eliminated through rest.
Phase 1: Active Trigger Point - Palpable button like nodular mass
within muscles, fascia, scar tissue, ligaments, and periosteum
which have characteristics of a trigger point. Produces a subjective
referred pain complaint or autonomic phenomena, which is
present constantly regardless of activity or rest. There are
several forms of neuropathy, myopathy, arthropathy or circulatory diseases,
which can cause myofascial triggers as a secondary effect of the disease. When
this occurs usually more than one region is affected and there are other
symptoms and signs associated with these complaints. However, these other
symptoms are frequently overlooked or not referenced due to the individual
considering them as clinically insignificant or dismissing them due to fatigue,
activity or aging process. It is the comprehensive examination that will
identify the obscure signs and symptoms, which frequently provide the insight
and understanding of a condition. Usually
muscle pain is described as deep,
aching or boring. Although there are a few triggers, which cause sharp, lancinating or electrical pain, such as the quadratus lumborum. However,
normally this sharp knife-like pain or loss of sensation along a dermatomal
pathway is due to neurologic involvement. Throbbing or pulsating pain usually is
vascular in nature. Metabolic or endocrine conditions, toxicity or an infection
may also generate triggers but is usually diffuse. Focal inflammation is
localized, such as a tendonitis or bursitis, just as a localized infection
usually is point specific and well defined. Malignant tumors or neoplasms are
usually asymptomatic in the initial onset. However, as the disease progresses it
is not uncommon for the individual to point to a specific region for pain. This
may also be the case if the disease has metastasized, with the generalized
characteristic pain associated with metastatic cancer, only occurring in the
final stages of the disease process. Depending upon the form of cancer, the
practitioner may be initially presented with only the pain complaint and
triggers that would support that complaint. Should there be excessive rebound
tenderness either in amount or duration, or a recent regeneration of the
original pain complaint following the treatment, the practitioner should
immediately refer for detailed diagnostics. The
somatic practitioner normally sees individuals whose trigger points are
perpetuated by sudden cooling of fatigued muscles, repetitive usage, post
exercise stiffness, mechanical overload, ergonomic factors or tension related
conditions. These psychological and/or physiological stressors that perpetuate
or activate triggers are very responsive to care providing the predisposing
issues are identified and significantly reduced. According to
Travell & Simons, the stimulus for trigger points may be divided into direct and
in-direct forms of activation. Direct stimuli are:
Mechanical
overload
Repetitive
usage resulting in fatigue
Sudden
cooling of fatigued muscles
Trauma Indirect stimuli
are: Other trigger
points which activate secondary or satellite triggers
Visceral disease
Arthropathy
Myopathy
Neuropathy
Infection
Metabolic
dysfunction
Endocrine
dysfunction
Toxicity
Emotional
distress
Below are links to detailed information about specific perpetuating and
activating factors for trigger points.
Psychological stress
Mechanical stress
Nutritional deficiencies
Metabolic and endocrine inadequacies
Visceral disease
Infections and infestations © Copyright
Myofascial trigger points
Clarifying and standardizing nomenclature
It is imperative to have an operational understanding of medical
conditions by standardizing nomenclature when possible.
Myogenic dysfunction has been poorly defined due to the
numerous names for the same conditions. While most of the
medical community still refers to Myofascial Pain Syndromes by
various names, which usually refer to the area or structure that
was affected, we prefer to use Myofascial Pain Syndrome instead of
Myofasciitis or Myositis. Unfortunately, there appears to be a
revising of nomenclature in definition from the first edition to the
second edition of Travell & Simons' Trigger Point Manuals.
Therefore, we will present you with versions from each in an
attempt to clarify.
Compare and contrast trigger point definitions
VOLUME 1 FIRST EDITION
MYOFASCIAL PAIN AND DYSFUNCTION
THE TRIGGER POINT MANUAL
By: Janet G. Travell, M.D.
David G. Simons, M.D.
VOLUME 1 SECOND EDITION
MYOFASCIAL PAIN AND DYSFUNCTION
THE TRIGGER POINT MANUAL
By: David G. Simons, M.D.
Janet G. Travell, M.D.
Lois S. Simons, P.T.
TRIGGER POINT: A focus of hyperirritability
in tissue that, when compressed, is locally tender and, if sufficiently
hypersensitive, gives rise to referred pain and tenderness, and sometimes to
referred autonomic phenomena and distortion of proprioception. Types
include myofascial, cutaneous, fascial, ligamentous and periosteal
trigger points.
TRIGGER POINT: See Myofascial Trigger Point
MYOFASCIAL TRIGGER POINT:
A hyperirritable spot, usually within a taut band of skeletal muscle
or in the muscle's fascia that is painful on compression and that
can give rise to characteristic referred pain, tenderness, and
autonomic phenomena. A myofascial trigger point is to be
distinguished from cutaneous, ligamentous, periosteal and non-
muscular fascial trigger points. Types include active, latent,
primary, associated, satellite and secondary.
MYOFASCIAL TRIGGER POINT
(Clinical definition of a central trigger point)
A hyperirritable spot in skeletal muscle that is associated with a
hypersensitive palpable nodule in a taut band. The spot is painful
on compression and can give rise to characteristic referred pain,
referred tenderness, motor dysfunction, and autonomic
phenomena. Types of myofascial trigger points include: active,
associated, attachment, central, key, latent, primary and satellite.
(Note especially the distinction between central and attachment
myofascial trigger points). Any myofascial trigger point is to be
distinguished from a cutaneous, ligamentous, periosteal, or any
other non-muscular trigger point.
MYOFASCIAL TRIGGER POINT (Etiological
definition of a central trigger point): A cluster of electrically active
loci each of which is associated with a contraction knot and a dysfunctional
motor endplate in skeletal muscle.
SECONDARY MYOFASCIAL TRIGGER POINT:
A hyperirritable spot in a muscle or its fascia that became active
because its muscle was overloaded as a synergist substituting for,
or as an antagonist countering the tautness of, the muscle that
contained the primary trigger point, to be distinguished from a
satellite trigger point.
SECONDARY TRIGGER POINT: Term previously
used, but rarely in this edition. Trigger points previously identified as
secondary trigger points are now classified as satellite trigger points. A
secondary trigger point was previously identified as one that developed in a
synergist or an antagonist of the muscle harboring the key trigger point.
SATELLITE MYOFASCIAL TRIGGER POINT:
A focus of hyperirritability in a muscle or its fascia that became
active because the muscle was located within the zone of reference
of another trigger point, to be distinguished from a secondary
trigger point.
SATELLITE MYOFASCIAL TRIGGER POINT:
A central myofascial trigger point that was induced neurogenically
or mechanically by the activity of a key trigger point.
Distinguishing the mechanism responsible for the key-satellite
relationship can rarely be resolved by examination alone. The
relationship usually is confirmed by simultaneous inactivation of
the satellite when the key trigger point is inactivated. A satellite
trigger point may develop in the zone of reference of the key trigger
point, in an overloaded synergist that is substituting for the
muscle harboring the key trigger point (key muscle), in an
antagonist countering the increased tension of the key muscle, or
in a muscle linked apparently only neurogenically to the key
trigger point. Previously, only a trigger point that developed in the
referred pain zone of another trigger point was identified as a
satellite trigger point.
Other sites for trigger points
1. Skin
Eight differential criteria and characteristics for identifying myofascial trigger points
1. Acute, chronic or persistent overloading of a muscle.
Four phases of trigger points
Phase 4: Muscle tissue that does not exhibit a palpable ropy or
button like nodular mass, which is characteristic of a trigger point
(TrP). However, the tissue may be hypertonic, indurated, effecting
range of motion, structural deviation, and hypersensitive to tactile
pressure.
Myofascial trigger point perpetuating factors