MASSAGE TRIGGER POINTS

TABLE 1: DIAGNOSTIC FEATURES OF MYOFASCIAL TRIGGER POINTS History

Regional aching pain

Onset can be related to acute, chronic or repetitive muscle overload Pain intensity usually related to movement or positioning but may become continuous when severe

Clinical diagnostic features

Painful limit to stretch range of motions

Palpable taunt band or hardness in a muscle Muscle shortening

Palpable tender nodule in the taunt band Myofascial pain produces specific regional pain complaints (not widespread total-body pain) Pressures on active trigger points reproduce usual or spontaneous pain

Pressure on latent trigger points produces no clinical symptoms Confirmatory findings

Local twitch response induced by snapping palpation or needle penetration of trigger points Endplate noise demonstrated by insertion of electromyographic needle into trigger point

Hindrance of locating trigger points

Excessive soft tissues

Intervening muscles or aponeuroses Tense and thick subcutaneous tissues Inadequate palpation skills

IN A CLINICAL SETTING, PHYSICAL EXAMINATION AND PALPATION IS THE ONLY METHOD OF DIAGNOSING PAIN

trigger point release pressure

treatment are: n to break the cycle of feedback n release the tension in the point n restore uniform sarcomere lengths in the affected muscle fibres. Release of tension can be achieved

actively or passively. Active release

The simplest form of active release is stretching. Slowly sustained stretches are much more effective at releasing trigger-point tightness than rapid brief stretches. This is because the sarcomere takes time to be released, due to the “stickiness” of its molecules. However, as soon as the muscle relaxes, the sarcomere has a tendency to return to its previous state. A series of contract–relax is more effective in re-setting the length. The patient stretches the muscles to extend the sarcomeres, then actively contracts the antagonist muscles to take up the slack. This also brings about reciprocal inhibition, which facilitates release of the muscle being elongated.

balloon finger pressure sarcomere

Passive release In passive release, the release movement is done for the patient. Trigger-point pressure is released by applying gentle persistent local pressure against the palpable tissue barrier in the trigger point. Figure 3 demonstrates the principle behind this treatment method. The “knot” is like a balloon which has a constant-volume structure. When compressed in a vertical dimension, there is an increase in the horizontal dimension. This is why finger pressure applied downward onto a trigger points tends to release the sarcomeres that are shortened. Massage techniques, such as compression friction massage and kneading, are particularly useful for de-activating trigger points. Practitioners can use the quality,

Figure 3: Releasing trigger-point pressure. An individual sarcomere is a constant- volume structure (like a balloon), so by compressing it in a vertical dimension it gets wider in the horizontal dimension. Downward pressure from a finger tends to lengthen sacromeres that are shortened and can therefore release the tension of a taut band (6).

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texture, temperature and colour of the tissue as a guide to best technique at any moment. The area to be treated must be warmed up with gentle stroking, progressing to kneading, or else muscle spasm may occur which can lead to an unsuccessful outcome. As the tissues become warmer and more elastic the practitioner is able to sink deeper into the muscles without hurting the patient and may then employ deeper strokes.

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