What are they?
are extremely common, causing musculoskeletal pain and dysfunction. They may
develop in any voluntary skeletal muscle. There are two types of trigger points:
(1) latent trigger points cause stiffness, increased muscle tension
and decreased range of motion or flexibility of joints from muscle shortening
but do not cause spontaneous pain; and (2) active trigger points have
the same symptoms as latent trigger points but DO cause pain with compression.
A latent trigger point can become active if the muscle it is located in remains
shortened and if the TrP is continually irritated causing referred pain (pain
to surrounding and distant from the TrP).
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does a RMT know I have a TrP?
are identified by a palpable taut band or nodule and spot tenderness that
causes pain. Pain severity ranges from agonizing and incapacitation to a painless
restriction of joint motion and postural distortion. Unrecognized myofascial
trigger points contribute to conditions such as tension headaches, occipital
neuralgia and tennis elbow (medial epicondylitis).
are TrP's important to treat?
If left untreated,
and allowed to become chronic, trigger points are then harder to relieve and
cause increased pain. Also an active key trigger point can induce an active
satellite TrP in another muscle. When treated, the inactivated TrP can also
inactivate the satellite TrP. Two for one therapy!
did I get this TrP?
The common cause
of trigger point activation is from muscle overload that may be acute, repetitive
or sustained. Other causes are direct impact trauma and overwork muscle fatigue.
Direct causes include
acute trauma, overwork fatigue, radiculopathy, and gross trauma. Indirect
causes include emotional distress, joint dysfunction, arthritic joint,
and other trigger points.
may not be aware of the dysfunction of the trigger point, only the pain. The
dysfunction of increased muscle tension, decreased stretch range of motion
are not noticed or ignored. The pain complaint of active TrP's can be poorly
localized, regional, aching pain in the muscle and joint (subcutaneous tissue).
Active TrP's become
more common with age to our most active middle years. In later years of life
with decreased strenuous activity latent TrP's become a more common complaint
as stiffness and inflexibility. Active TrP's are less common in laborers and
increase with sedentary workers. TrP's are found mostly in postural muscles
of the neck, shoulder and pelvic girdle and mastication; scalenes in the neck,
levator scapulae and upper trapezius of the shoulder girdle and quadratus
lumborum of the low back being the most common.
Motor dysfunction: spasm
of other muscles (muscles that are prone to tightness, loss of co-ordination
of involved muscles, decreased work tolerance. Example: A TrP in the forearm
may present with hand weakness, decreased forearm muscle co-ordination and
Sleep disturbances: due
to pain, increased pain sensitivity the next day from a sleepless night, positioning
is critical do to maintaining shortened muscle position or compression of
Trp increasing pain
To fully remove
a Trp the therapist and patient must work together to treat not only the symptoms
but also the causative factors so that the TrP does not return or become chronic.
A typical treatment
- Inactivation of the TrP using digital pressure called an ischemic compression
held up to 90 seconds
- Address the cause of activation of the TrP
- Correct the perpetuating factors
- Aid the patient in restoring and maintaining normal muscle function
Centre is a multi-disciplinary health treatment centre located near the Oak
Bay Village of Victoria, BC, Canada.
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