cervical examination for myofacial pain

[davidc]

Does anyone know of a protocol for cervical examination, for patients suffering from MFPD , MYO FACIAL PAIN DYSFUNDTION, OR tmd/
This is to try rule out or assertain referred pain from neck, upper back, "trigger points"
thanks

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[thomas bibu]

hi dear,

well, I wonder whether there is a particular protocol of cervical examination for myofasical pain syndrome alone.

just thought of sharing a bit of information to avoid the so called "confusion" between fibromyalgia and myofasical pain syndrome.

C/Features********** Fibromyalgia********** MPS
Pain****************** Diffuse**************Local
Fatigue**************** Common***********Uncommon
AM. Stiffness************Common***********Uncommon
Tender points************Present************Absent
Trigger points************Absent************ Present
Ratio****************Women>Men**********Women=Men
Prognosis***************Chronic***********Resolves with treatment

I do agree that presently researchers are realizing that FMS and MPS not only occur together, they reinforce each other as well. gosh! its like adding fuel to fire regarding the confusion between the two

whatever wish to share a golden rule - "one should not try to strengthen a muscle that has a TrP (trigger point), because the muscle is already physiologically contracted. attempts at strengthening a muscle with TrPs will only cause the TrPs to worsen and may develop satellites."

do let me know if this was of any help to you.

cheers,

thomas

[bikelet]

What about eccentrically working a muscle with trigger points? Any thoughts on that?

[SagarNaik]

hi dear,

well, I wonder whether there is a particular protocol of cervical examination for myofasical pain syndrome alone.

just thought of sharing a bit of information to avoid the so called "confusion" between fibromyalgia and myofasical pain syndrome.

C/Features********** Fibromyalgia********** MPS
Pain****************** Diffuse**************Local
Fatigue**************** Common***********Uncommon
AM. Stiffness************Common***********Uncommon
Tender points************Present************Absent
Trigger points************Absent************ Present
Ratio****************Women>Men**********Women=Men
Prognosis***************Chronic***********Resolves with treatment

I do agree that presently researchers are realizing that FMS and MPS not only occur together, they reinforce each other as well. gosh! its like adding fuel to fire regarding the confusion between the two

whatever wish to share a golden rule - "one should not try to strengthen a muscle that has a TrP (trigger point), because the muscle is already physiologically contracted. attempts at strengthening a muscle with TrPs will only cause the TrPs to worsen and may develop satellites."

do let me know if this was of any help to you.

cheers,

thomas

Thanks for explaining the differences between the two conditions.

Only one concern:
If there is trigger point in Myofacial Pain Syndrome then will it not have tenderness too????

I would think there would be severe pain at the trigger point.

You have mentioned tenderness present in fibromayalgia which is diffuse in origin......???

I think you will get tenderness in conditions where pain can be localized means MPS as you mentioned pain is local....

Might be wrong, but this is what I think. Open for further discussion.

[thomas bibu]

hi sagar,

well, I really had problems the other day to format the text into three divisions
eg. C/features******Fibromyalgia*******MPS.

what I really meant is tenderness & not tender points. perhaps the reason why I made that mistake is because of the cut and paste technique, please excuse!

retrospectively with tenderness what I mean is not local but diffuse tenderness of the muscle (FM), unlike only on certain points or in other words trigger points (MPS).

hope it is clear now.

cheers,

thomas

[SagarNaik]

hi sagar,

well, I really had problems the other day to format the text into three divisions
eg. C/features******Fibromyalgia*******MPS.

what I really meant is tenderness & not tender points. perhaps the reason why I made that mistake is because of the cut and paste technique, please excuse!

retrospectively with tenderness what I mean is not local but diffuse tenderness of the muscle (FM), unlike only on certain points or in other words trigger points (MPS).

hope it is clear now.

cheers,

thomas

Thanks for clarifying.

I got confused because both Tenderness and Trigger Points were mentioned.

Still I think explanation for tenderness and trigger points in not too convincing.

As you have mentioned trigger points and tenderness are both same. When tenderness is local it is called trigger points. {This is what I interprete from your lines marked in red above.}

Both are different terms and can't be used interchangeably.

Definition of Trigger Point - Trigger points are described as hyperirritable spots in skeletal muscle that are associated with palpable nodules in taut bands of muscle fibers. (Wikipedia)

Compression of a trigger point may elicit local tenderness, referred pain, or local twitch response.

Definition of Tenderness - Pain or discomfort when an affected area is touched. (Wikipedia)

You might wanted to say same thing but the sentence reads to me the other way. So just wanted to make sure.

Cheers for PHYSICAL THERAPY,

[thomas bibu]

dear sagar,

thank you for defining trigger point and tenderness .

let me copy your definition and ask for your explanation on hyperirritable spots.

Definition of Trigger Point - Trigger points are described as hyperirritable spots in skeletal muscle that are associated with palpable nodules in taut bands of muscle fibers (Wikipedia).

well my question is how would you describe the hyperirritable spots??? please dont mention about the palpable nodules / taut bands - which I am sure as practicing PTs we are all aware of as associated signs, but only on "hyperirritable" spots,

preferably without using similar words like pain/tenderness/ache/soreness/twinge/hurt/sting/smarting/throbbing/pricking/burning/stinging/thorny/spiky etc.

looking forward to your reply.

cheers,

thomas

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[SagarNaik]

dear sagar,

thank you for defining trigger point and tenderness .

let me copy your definition and ask for your explanation on hyperirritable spots.

Definition of Trigger Point - Trigger points are described as hyperirritable spots in skeletal muscle that are associated with palpable nodules in taut bands of muscle fibers (Wikipedia).

well my question is how would you describe the hyperirritable spots??? please dont mention about the palpable nodules / taut bands - which I am sure as practicing PTs we are all aware of as associated signs, but only on "hyperirritable" spots,

preferably without using similar words like pain/tenderness/ache/soreness/twinge/hurt/sting/smarting/throbbing/pricking/burning/stinging/thorny/spiky etc.

looking forward to your reply.

cheers,

thomas

Let me put the classic difference between Trigger Point and Tender Point defined by American Academy of Family Physicians.

Active Trigger Point is tender to palpation with a referred pain pattern that is similar to the patient’s pain complaint. This referred pain is felt not at the site of the trigger-point origin, but remote from it. The pain is often described as spreading or radiating. Referred pain is an important characteristic of a trigger point. It differentiates a trigger point from a tender point, which is associated with pain at the site of palpation only.

For complete reading please find the attached article. I have highlighted difference for you so that it would be easy.

Waiting for your views.

[davidc]

trigger point is it fact or fantacy.
We treat "it".
Sure, maybe its a placebo effect. But if the outcome is a patient that feels better and functions better, and the risks of hurting the patient are minimal, why not continue well-established therapies and also continue to discover their physiologic basis.
But my original question is how to we EXAMINE the neck to gather enough info to make an educated , calculated diagnosis on what to base our treatment.
Is there a standard protocol anyone is using?
Can one do a cervical exam without including shoulder or upper back?
How can one rule out referred cervical pain?
With regard ro the trigger point my gut feeling is that the answer is chemical and Nano technology is the answer,
david

[thomas bibu]

hi bikelet, (if thats ur name)

at the outset I am sure you will agree that there is an ongoing debate over the correct treatment technique, techniques etc.

well, in my practice I go for a combination of soft tissue therapy, stress management and trigger point therapy and I often get good results.

as far as exercises I really dont prescribe much (concentric, eccentric etc), I just stick to normal free range of motion exercises if at all.

on the contrary really wish to know whether you get good results with eccentric exercises, would be grateful if you could elaborate.

thanx & cheers,

thomas