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Understanding Trigger Points: Causes & Treatment

This document discusses the history, characteristics, terminology, causes, and treatment of trigger points. Trigger points are hyperirritable spots within muscles that can cause pain. They were first described in the 1800s and various terms were introduced over time. Trigger points may develop due to injury, repetitive movements, stress, or other trigger points. Treatment involves addressing contributing factors, somatic dysfunctions, stress management, fitness, and techniques like injection, stretching, and myofascial release.

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Stefan Vlad
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47 views16 pages

Understanding Trigger Points: Causes & Treatment

This document discusses the history, characteristics, terminology, causes, and treatment of trigger points. Trigger points are hyperirritable spots within muscles that can cause pain. They were first described in the 1800s and various terms were introduced over time. Trigger points may develop due to injury, repetitive movements, stress, or other trigger points. Treatment involves addressing contributing factors, somatic dysfunctions, stress management, fitness, and techniques like injection, stretching, and myofascial release.

Uploaded by

Stefan Vlad
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as PDF, TXT or read online on Scribd
  • Introduction to Trigger Points
  • History
  • Characteristics
  • Terminology
  • Potential Causes of Trigger Points
  • Neurophysiological Model
  • Osteopathic Model
  • Histological Changes
  • Physical Findings on Examination
  • Sternocleidomastoid Trigger Point Referral Pattern
  • Treatment Should Include the Following
  • Common Techniques & Approaches

Introduction to

Trigger Points
History

• 1800’s - Germans: “Muskel schmerzen”


• 1843 - Froriep: “Musckelschwiele”
• 1919 - Eversbusch “Muskelharten”
• 1938 - 1957 Good: “Myalgic spots”
• 1945 ? Travell: “Trigger points”
Characteristics
• May or may not be a palpable mass
• Hyperirritable locus within a muscle
• Pain on compression or irritation
• Tremor or fasciculation on compression or
irritation
• Refers pain with or without autonomic
phenomena
Terminology
• Active TP - A focus of hyperirritability in
a muscle or its fascia that is symptomatic
with respect to pain; it refers a pattern of
pain at rest and/or on motion that is
specific for the muscle.
Terminology
• Associated TP - A focus of
hyperirritability in a muscle or its fascia
that develops in response to
compensatory overload, shortened range,
or referred phenomena caused by trigger
point activity in another muscle.
AKA: Satellite and Secondary TP’s
Terminology

• Latent TP - A focus of hyperirritability in


muscle or its fascia that is clinically
quiescent with respect to spontaneous
pain; it is painful only when palpated.
Potential Causes of Trigger Points

• Acute/chronic injury or illness


• Excessive repetitive movements
• Chilling of the muscle
• Nervous tension or stress
• Tender point of long duration
• Active primary point causing secondary
TP
• Latent TP activated by any of the
previous
Neurophysiological Model
Facilitation
Nociceptive
Stimuli

Increased Sympathetic Increased Afferent Increased Efferent


Tone Input Output

Vasomotor Changes Decreased Activation Skeletal Muscle Contraction


Smooth Muscle Contraction Threshold Local Ischemia
Biochemical Alterations Increased Neural Biochemical Alterations
Stimulation

Propagation Propagation Propagation


of of of
Trigger Point(s) Trigger Point(s) Trigger Point(s)
Osteopathic Model

Contributing
Factors

Mental Fatique & Anxiety Genetics Physiologic State


Stress Management Fitness Level
Personality Posture
Histological Changes

• Fatty infiltration
• Increased number of nuclei
• Serous exudates
• PG, GAG deposits
Physical Findings on Examination

• Passive or active stretching of the affected muscle


increases pain.
• Stretch ROM of the affected muscle is restricted.
• Pain is increased when the affected muscle is strongly
contracted against a fixed resistance.
• Maximum contractile force of an affected muscle is
weakened.
Physical Findings on Examination

• Deep tenderness and dysesthesia is referred to


a zone away from the TP.
• Disturbances of non-sensory function are
sometimes induced in the pain reference zone.
• Muscle in the immediate vicinity of a TP feels
tense to palpation.
• There will be a point of maximum tenderness.
Physical Findings on Examination

• Digital pressure to an active TP elicits a “jump


sign”.
• Snapping palpation of the TP frequently evokes
a local twitch response.
• Moderate, sustained pressure of a TP causes or
intensifies pain in the TP reference zone.
• The skin of some patients may show
dermatographia in the area overlying an active
TP.
Sternocleidomastiod Trigger Point Referral Pattern
Treatment Should Include the Following:

• Address contributing factors


• Identify & normalize all somatic dysfunctions
• Stress management
• Improve level of physical fitness
• Improve overall state of health
Common Techniques &
Approaches
• Injection/Needling followed by Stretch
• Spray & Stretch or Ice application & Stretch
• Counterstrain followed by Stretch *(Combined
Technique)
• Functional/Positional Release
• Deep Digital Inhibition followed by Stretch
• Myofascial Release
• Muscle Energy
• HVLA (only effective if underlying osteoarticular
dysfunction is driving the Trigger point)

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