Latent myofascial trigger points

Hi guys,

Can some one say the effect of Latent myofascial trigger points over a normal muscle, with regard to Strength, Endurance, and more importantly the pattern of soreness when compared to that of a normal muscle,
a read in the book travell and simons that the muscle that harbours a latent myosfascial trigger point will be weak and with poor endurance, but it is not backed up with adequate literature,

could you guys think about it and answer

thanks in advance

Hi,
This is an interesting subject. When I dry needle trigger points, I tend to do so only when a patient reports abnormal function. I agree that the literature has little to offer on the reported findings in Travell & Simons, and I cannot offer anything further with a specific evidence base. However, there is literature on feedback loops and muscle inhibition following pain or inflammation, which may be relevant to how trigger points actually influence muscle tension. Post needling muscle relaxation is frequently seen clinically, but I agree that this is anecdotal rather than scientific (at present).
Latent points are more difficult to deal with than active triggers, simply because they are latent and harder to find / treat.They may well have an effect on muscle behaviour, even if it is subtle. Would a large more active trigger overlap and mask a less active trigger, and the less active trigger only show up once the predominant point was successfully treated? Possibly, but again I have no proof.
The lack of comment on this topic is likely to be due to the fact that this is an evolving area, and your post was related to actual research info request.
Sorry I cannot help you further.
MrPhysio+

thank you for your post, i was wondering if i missed out in my literature search to find out the impact of latent trigger points in the muscle, now i get a better picture of the current trend with regard to latent trigger points, ill have to think sleep over it probably and get back

thanks again!

Hi,
Try reading the book below if you can get a hold of it. It has focuses on muscle pain and has an indepth chapter on trigger points, with discussion backed by literature.

Mense S, Simons DG, 2001. Muscle Pain - understanding its nature, diagnosis and treatment. Lippincott Williams & Wilkins

Much of the research seems to come from older studies, and it's still not clear what the etiology of a trigger point is?

from memory, muscles with trigger points are more likely to fatigue demonstrated on surface EMG. There is also heightened responsiveness of the tissues adn acclerated fatigability, delayed recovery and relaxation of the muscle .

there isn't much literature on treatments of trigger points, so far most research have looked at ischaemic compression, which seems effective on its own or combined with other modalities. not much on PNF or MET techniques, or other manual therapies for it.

are you planning on doing research on MTrP?

Hi,
As you correctly state, the research quoted regarding most trigger point discussions is old. As a Private practitioner in a rural area, it is difficult for me to engage in research without funding, plus the time constraints of running my clinic. That said, I was most encouraged recently whilst discussing treatments at the Sports Medicine Australia conference in Fiji, including trigger point dry needling therapy, that others are also finding the technique very helpful. I did not present my experience, but started to get the itch to do so. I was previously involved in using Laser for tinnitus, but the problems related to setting up a double blinded trial for tinnitus has come up against funding and research institute availability problems.
It was nice of you to ask re the research, however. A paper by Lisa Heuggennin (the spelling may be incorrect) from Melbourne University investigated previous research in trigger point definitions. As I have recently moved house and business, much of my literature remains in storage boxes, so I cannot be more specific at present.
Trigger point treatments have potential, in my opin, to be applied to a broad range of conditions. Knee osteoarthritis and meniscal pain for example.
Thanks for your interst.
MrPhysio+

hello there guys,

yes i am doing a research on Latent Myofascial trigger points, in the recent edition of Travell and Simons he has stated under Latent trigger points that the muscle would be weak but the literature reference he has given is a study which had subjects with active myofascial trigger point, i was wondering if the reason for weakness had more to it and more over a research done on active trigger points cannot be accounted for latent trigger points as well...

can you people give more thoughts on this....

Hi
Firstly, the definition of a latent as against active trigger point needs to be fully and accurately defined. Is a latent point actually there until it is active, or is it simply suppressed by more active points around it? Are weaknesses described in the muscle caused by previous injury, inhibition from elsewhere etc? The answers are not known, to my knowledge. We may be seeing a relationship that is not causal. Can a true latent point, if it exists, be accurately found?
In general, I cannot answer your question. As stated previously, I am more concerned regarding the active points and their symptoms, rather than latent. I have not seen weaknesses that I associate with latent triggers, but that may be my failing.
MrPhysio+

It's possible that latent trigger points can become active or could it be that they are a stage of trigger points ie normal muscle > muscle tension and increased stiffness > latent trigger point > active trigger point.

if you are doing research it might be more clinically relevant to do it on active trigger points if you can find the participants because these are the ones that are symptomatic and more like to present to your clinic for treatment. latent trigger points should not be noticed by people normally. the prevalence of latent trigger points in a normal trigger point is pretty high (easier to find participants). if you palpate the upper trapezius, you'll probably find latent points in many. how much latent trigger points contribute to overall pain presentation of a patient is not really that clear. they cause pain when palpated, otherwise they are painless. however if there are microchanges in the muscle fibres, it may predispose the muscle to further damage or cause compensation at surrounding muscles.

what are you planning to research exactly or are u just looking for ideas? as far as treatment research is concerned, there is more literature on latent trigger points than active.

hello jthdude,

your final statement was quite catchy, did you say that there are more literature in terms of treatment of latent trigger points than active trigger points...., i would be very happy and glad if you would be kind enough to give me the references.

and as you rightly mentioned its easy to get patients with active trigger points and to my understanding about how it goes, its the latent trigger point that eventually flares up in to an active one and there after back to latent nodules again if not treated completely.....!

well i am interested to see how latent trigger points respond...as against a normal muscle,

and again pls do give me the references for the latent trigger points treatment....

Try Fernadez-de-la-penas in pub med, he has done plenty on MTrP.

Fryer and Hodgson (2005). the effect of manual pressure release on myofascial trigger points in the upper trapezius. Journal of Bodywork and Movement therapies.

Blanco RC et al. 2006. Change in active mouth opening following a single treatmetn of latent myofascial trigger points in the masseter muscle....journal of bodywork and movement therapies.

also try of interest for you would be
Lucas et al (2004). latent trigger points: their effects in muscle activation and movement efficiency. journal of bodywork and movement therapies.

try these for starters. if you find any others please let me know especially if there are articles that report ineffective treatments. hope these help you on your way.

Have a look first over the definition of Latent Myofascial trigger point.

A latent myofascial trigger point is a focus of hyper irritability in a muscle or its fascia that is clinically quiescent with respect to spontaneous pain; it is painful only when palpated. A latent trigger point may have all the characteristics of an active trigger point, from which it is to be distinguished.

So it is quite clear from the definition that latent trigger point may have all the characteristics of an active trigger point. An active trigger point causes pain. A latent trigger point is clinicaly silent with respect to pain, but may cause restriction of movement and weakness of the affected muscles. A latent trigger pooint may persist for years after recovering from injury; it produces the acute attack of pain, since minor over stretching, overuse or chilling of the muscle may suffice to reactivate it. Both active and latent trigger points cause dysfunction; only active trigger point cause pain. As activity becomes less strenous in the later years, individuals tend to exhibit chiefly the stiffness and restricted motion of latent TPs. Muscle strength becomes unreliable.e.g. things drop unexpectedly from patients grasp. Weakness of the muscle involved becomes evident when a maximum contraction efort produces less than normal strength. Weakness apparently is due to central inhibition that has developed to protect the muscle from a painful degree of contraction. The patient then substitute other muscles for the weak one., often unknowingly, e.g. carrying objects with non dominant, stronger arm. The weakness occurs without atrophy of muscles.

Have a look over some of the resources:

Myofascial Pain Syndromes by Dr Simon Strauss

Trigger Points (TrPs)

Comparison of the Local Tissue Milieu in Normal Muscle and Active and Latent Myofascial Trigger Points in the Upper Trapezius to the Local Tissue Milieu in a Normal Medial Gastrocnemius Muscle

Trigger point therapy

Latent myofascial trigger points in paraspinal muscles of patients with chronic pain

Trigger Point Wikipedia

Inter-therapist reliability in locating latent myofascial trigger points using palpation.

Myofascial trigger point Presentation

Repetitive Strain Injury and Myofascial Pain Syndrome

Differentiation of active and latent trigger points by thermography.

Trigger Points and Tender Points: Why the Difference Is Important to You

Myofascial Pain Syndromes and Trigger Point Injection Therapy

Comment on Gunn's ''Radiculopathy Model of Myofascial Trigger Points''

Trigger Points: Diagnosis and Management

Trigger point Therapy

National Association of Myofascial trigger points

Myofascial Barriers to Peak Athletic Performance

Myofascial trigger points, neck mobility and forward head posture in unilateral migraine

Trigger point Therapy

Repetitive Strain Injury and Myofascial Pain Syndrome

Trigger point Myofascial

Bodywork Therapies: Trigger Point / Myofascial Therapy

Enigmatic trigger often cause enigmatic musculoskeletal pain

Ultrasound Treatment of the Fibromyalgia Patients' Trigger Points Dr. Gina Honeyman-Lowe

Thanks for so many references. It´s a matter I use to work and it's one of my interests. If I have time next weekend I w'll post some references too.

Hello Guys,

thanks a lot for all your wonderful posts, i haven't been around for some time, but all the posts were really useful, i am working on it, i will get to you guys with useful info with regard to whats happening with my study

Sdkashif you are indeed a legend. Great selection of links there. Thanks very much!

Sweens