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Myofascial pain - Trigger Points

Since the late 1800's there has been clinical interest in pain of muscular origin. Muscular rheumatitis, myalgia, myofibrositis, myofascitis and myofascial pain dysfunction syndrome are synonymous terms developed over the years to describe such pain.

Today it is clearly recognized that myofascial pain is referred from trigger points. A trigger point is a hyperactive spot, usually within a taut band of skeletal muscle or its fascia, that is painful on compression and can give rise to characteristic patterns of referred pain. A trigger point may be "active"or "latent". "Active" trigger points refer pain at rest and/or on motion specific for the affected muscle. A "latent" trigger point is painful only on palpation.

To diagnose active myofascial TPs, one looks for:

• A history of sudden or gradual onset with overload of affected muscle.
• Characteristic patterns of pain referred from TPs. Patterns are specific to individual muscles.
• Weakness and restriction of range of motion of the affected muscle.
• A taut, palpable band in the affected muscle.
• Exquisite, focal tenderness to digital pressure on the TP in the band of taut muscle.
• Reproduction of the patient's pain complaint by pressure of the TP.
• Elimination of symptoms by therapy directed specifically to the affected muscles.

Physical therapy techniques used to treat myofascial trigger points are:

• The use of "spray & stretch", a vapo-collant, to inactivate the TP.
• Ischemic compression (sustained pressure) to the TP to inactivate it.
• Ultrasound alone or combined with electrical stimulation to inactivate the TP.
• Active range of motion following the inactivation to re-educate the muscles to their full length potential.
• Moist heat to relax the muscles and to minimize post-treatment soreness.
• Massage to improve mobility of the tissues.
• Identification of postures and activities that precipitate and perpetuate TPs and designing an exercise program to correct and minimize these factors.