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Chronic Myofascial Pain -
Understanding Trigger Point Therapy
by Deborah Reid
T
rigger Point therapy was developed ment. As a result, they prescribe pain
by Janet Travell and David Simons, medications for masking the pain or
MD, and is used to treat myofascial perform injection therapy of Botox,
pain. They produced two large volumes cortisone, prescribe physical therapy, or
of trigger point therapy and it has been worse, surgery. These methods do not
around since the 1940’s, but few doc- treat the source of the pain - that being
tors even know what trigger points are. the trigger point. Many doctors have not
A classic trigger point is defined as been trained in trigger points and don’t
the presence of discrete focal tender- know how to treat them. If you have
ness located in a palpable taut band of pain, they prefer to prescribe physi-
skeletal muscle, which produces both cal therapy; however, physical therapy
referred regional pain and a local twitch does not treat the pain and trigger points
response. Trigger points help define directly. The physical therapist will have
myofascial pain syndromes. Acute trau- the patient perform exercises that often
ma or repetitive microtrauma may lead aggravate the trigger points and intensify
to the development of a trigger point. the pain.
Lack of exercise, prolonged poor posture, If TrPs (Trigger Points) are treated
vitamin deficiencies, sleep disturbances, immediately and vigorously by a trig-
and joint problems may all predispose ger point specialist (massage therapist),
to the development of microtrauma. Oc- and perpetuating factors (conditions that
cupational or recreational activities that aggravate and perpetuate the TrPs) are
produce repetitive stress on a specific eliminated or controlled, TrPs can often
muscle or muscle group commonly be eliminated quickly. Unfortunately, if
cause chronic stress in muscle fibers, a TrP is left untreated or muscle action is
leading to trigger points. Acute sports restricted to avoid pain, the TrP usually
injuries caused by acute sprain or repeti- becomes latent. A “latent” TrP doesn’t
tive stress (tennis elbow or golf shoulder), hurt at all, unless you press it. You might
surgical scars, and tissues under tension eye symptoms, and Torticollis. Upper not even know it’s there. It weakens
frequently found after spinal surgery and limb pain is often referred and pain in and prevents full lengthening of the af-
hip replacement may also predispose the shoulders may resemble visceral fected muscle. If the muscle is pushed to
a person to the development of trigger pain or mimic tendonitis and bursitis. In work in spite of the pain with physical
points. In the head and neck region, the lower extremities, trigger points may therapy, especially if perpetuating factors
myofascial pain syndrome with trigger involve pain in the quadriceps and calf exist, active TrPs may develop second-
points can manifest as tension headache, muscles and may lead to a limited range ary and satellite TrPs. TrPs seem to form
tinnitus, temporomandibular joint pain, of motion in the knee and ankle. Trigger throughout life as a response to many
point hypersensitivity in the gluteus maxi- things that happen to our bodies - over-
mus and gluteus medius often produces use, repetitive motion trauma, bruises,
intense pain in the low back region. With strains, joint problems, etc. Pain creates a
proper and timely intervention, these neuromuscular response, and the muscle
TrPs can be broken up and eliminated. around the pain site tightens, “guarding”
If chronic myofascial pain has persisted the hurt area.
for some time, you may have fibrotic An active TrP not only hurts when it
muscles and/or calcified areas at the is pressed but it “triggers” a referred pain
attachment points. This usually indicates pattern not at the site of the trigger-point
multiple perpetuating factors, and it will origin, but remote from it. The pain is
take longer work and a lot of patience to often described as spreading or radiat-
regain function. ing. A latent trigger point does not cause
Trigger points are often misdiag- spontaneous pain, but may restrict move-
nosed by doctors and mistaken for other ment or cause muscle weakness. This is
maladies as bursitis or nerve impinge- not a one-time fix and is an intervention
50 Broward County
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