Active Myofascial Trigger Point Therapy

[quorthon]

i would agree with a colleague that has posted about the waste of time on so calles "trigger point" therapy...I would add that it may be harmfull sometimes, not just waste of time....As primary clinicians (which means we are interfering in diagnostic processes,not just treat) we should ask ourselves where the trigger points are coming from....There is a huge literature which supports that the mechanisms of REFERRED PAIN from a variety of tissues (somatic,neural, even visceral!) can generate trigger points in a quite bizzare fashion. If a therapist starts treating a area of hypertonicity (aka trigger point) he doesnt know if the pain is local or referred.....For example, cardiac (visceral) pain generates trigger points in pectoralis major or left shoulder, discogenic pain generates trigger points in quadratum lumborum or erector spinae or even more serious an underlying systemic disease can generate "innocent" trigger points manifesting as a PRIMARY musculoskeletal condition..It becoming clear that in the above situations (and many more examples ) we will treat just a CLINICAL SIGN (not even symptom!) of a primary condition...We cannot identify the true SOURCE of the problem....
Forgot to mention that even those who thinks that trigger points are effective treatment modality maybe should start reviewing their patients more in the LONG-TERM for potential benefits, which i really doubt...Any SHORT-TERM benefits may induced just by the benign NATURAL COURSE of many musculoskeletal dysfunctions...Only through exercises and self-mobilisations we can achieve guaranteed results!

[violablue]

i would agree with a colleague that has posted about the waste of time on so calles "trigger point" therapy...I would add that it may be harmfull sometimes, not just waste of time....As primary clinicians (which means we are interfering in diagnostic processes,not just treat) we should ask ourselves where the trigger points are coming from....There is a huge literature which supports that the mechanisms of REFERRED PAIN from a variety of tissues (somatic,neural, even visceral!) can generate trigger points in a quite bizzare fashion. If a therapist starts treating a area of hypertonicity (aka trigger point) he doesnt know if the pain is local or referred.....For example, cardiac (visceral) pain generates trigger points in pectoralis major or left shoulder, discogenic pain generates trigger points in quadratum lumborum or erector spinae or even more serious an underlying systemic disease can generate "innocent" trigger points manifesting as a PRIMARY musculoskeletal condition..It becoming clear that in the above situations (and many more examples ) we will treat just a CLINICAL SIGN (not even symptom!) of a primary condition...We cannot identify the true SOURCE of the problem....
Forgot to mention that even those who thinks that trigger points are effective treatment modality maybe should start reviewing their patients more in the LONG-TERM for potential benefits, which i really doubt...Any SHORT-TERM benefits may induced just by the benign NATURAL COURSE of many musculoskeletal dysfunctions...Only through exercises and self-mobilisations we can achieve guaranteed results!

Mmm...waste of time? Can't find true source? We're taught to assess, evaluate, and diagnose. Set up a prognosis and plan. Then treat. Always reassessing and revising as needed. The trigger point information is so rich and helpful, why just write it off with a swish of the arm? Why can't it work in conjunction with mobilizations and exercises?

After all, if you are stretching a muscle are you not working at bringing it to a non-restricted length? Trigger point release does the same thing for a muscle. So why paint the whole therapeutic method over with such a negative brush stroke?

I think we are taught enough about referral patterns to be able to have some idea of things without feeling we are pellmell bent on destruction-by-trigger-point of say a heart patient.

[f1progeny]

Hi everyone,

Have to say I agree with viola above. TrP cannot be seen as a stand-alone method of treating patients however i use them regularly in my treatment of a variety of conditions- to excellent effect. Attending courses in manual release of MTrP's and Dry-needling it was stressed that to try to treat the TrP's alone is not sufficient and in fact is just poor-practice.
In undergrad we did very little soft-tissue release but had large emphasis on manual mobs etc and i feel this did not prepare me for optimising patient treatment. For optimal out-comes in any case all elements of the joint, myofascial and neural restrictions need to be treated along with correction of postural/biomechanical issues and correct re-training of neuro-muscular control(among other things).

I think any clinician woth their salt should always be wary of referred pain especially visceral pain masquerading as a musculoskeletal condition but a detailed history and examination looking out for yellow/red flags should help confirm the diagnosis/need for onward referral.
The key is the diagnosis, I just find that for musculoskeletal conditions release of TrP's is a quick and effective way for restoring soft-tissue to normal length/function in preparation for rehabilitation.

I'm not even going to go into the treatment of myofascial pain using dry-needling/manual release of TrP's which in my experience is extremely effective - however again the clinician and patient need to be aware that unless causative factors are addressed the TrP's will continue to develop.

As for research chris-k mentioned people above but i feel there will be a growing body of evidence in support of treating TrP's over the next few years. Search Jan Dommerholt for a very interesting chapter on craniomandibular pain.

Hope this helps, it's certainly an area that needs more research but a promising one.

[enggrajshukla]

Hi every,

I am agree with all, Dealing with "trigger points " will provide only short term relief from altered patterns of recruitment of muscle , and elements of referred pain associated with hypertonicity. Tell me why it does not work with the exercise.

[quorthon]

Hi everyone,.

As for research chris-k mentioned people above but i feel there will be a growing body of evidence in support of treating TrP's over the next few years. Search Jan Dommerholt for a very interesting chapter on craniomandibular pain.

Hope this helps, it's certainly an area that needs more research but a promising one.

You should also check more critisizing references if you want to have a more objective opinion about Trps...Quintner for example has published many articles on the subject based on clinical cases which show that Trigger points is nothing but a MANIFESTATION of other dysfunctions....In my own little experience (if i was 60 years old i would only say HUGE) when u treating succesfully a patient, u often observe that Trps dont longer exist...For example on a discogenic situation on lumbar spine, when Trps are in erector spinae or gluteus muscles, and after treatment there is no "tenderness" over this area...