Neck Muscle Stretching Techniques Quiz

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193 Questions

What are the aggravating factors of myofascial trigger points?

Placing the involved muscle in a shortened position for a prolonged period

What is a relieving factor for myofascial trigger points?

Short periods of light activity with movement

What technique should be performed after warm up of effleurage to palpate trigger points?

Petrissage

What is a confirmation that a trigger point is present during palpation?

The client experiences a local twitch response

What does 'effleurage' refer to in the context of palpating trigger points?

Gentle stroking movements on the skin

When should assisted effleurage towards the heart be performed?

After palpating trigger points

What is the referral pattern for the rectus femoris muscle?

Refers to lower anterior thigh & anterior knee region

What is the stretch position for the vastus lateralis muscle?

Supine: Leg off table (knee fix w/hip ext)

What is the referral pattern for the semimembranosus muscle?

Referred pain from semitendinosus & semimembranous concentrates on lower buttocks & upper posterior thigh

What is the stretch position for the tibialis anterior muscle?

Supine: Hip flexion, hip abduction, slight internal rotation (knee to opposite shoulders)

What is the referral pattern for the gastrocnemius muscle?

Most common TP of this muscle. Refers pain from instep of foot, over posteromedial aspect of ankle & calf & back of lower thigh

Which technique involves applying pressure to a trigger point for 7-10 seconds at a time to create ischemia and then hyperemia?

Intermittent Ischemic Compression

What is the most clinically significant feature of a myofascial trigger point?

Referred pain

Which muscle group's trigger point referral pattern feels like deep head pain that radiates from occipital to temple, eye, and forehead?

Suboccipital muscles

What is the action of the trapezius muscles associated with?

Rotation of occiput & C1 & C2

Which technique involves using a rubber reflex hammer to tap onto the trigger point 10 times with a force equal to that of eliciting a tendon reflex jerk?

Which muscle's trigger point referred pain concentrates at the vertex of the head?

Splenius capitis

What is the primary action associated with the splenius cervicis muscle?

Extension

What is the purpose of the intermittent cold and stretch technique?

To ice the area and repeat with movement

Which muscle's trigger point referral pattern feels like an 'all over headache' from occipital to temple, eye, and forehead?

Suboccipital muscles

What may activate the trapezius muscles' trigger points?

Postural stress that overloads extension or rotation of head & neck.

What causes pain in clients with trigger points in splenius cervicis muscle?

Extension or rotation of head & neck due to postural stress.

What is the purpose of applying moderate pressure to a trigger point for 30 seconds?

To determine if pain is at a 4/10 scale.

Which muscle is responsible for pain concentrated at the inferior angle of the scapula and may extend to the back and down the medial arm and forearm to the ulnar aspect of the hand including 4th & 5th digit?

Latissimus dorsi

Which muscle causes pain that is projected up & down the posterior aspect of the arm & to the lateral epicondyle more than medial, with spill over into 4th & 5th digits up to Suprascapular region?

Forearm extensors

For pain penetrating deeply into the posterior deltoid region and may project to the dorsum of the forearm, which muscle is primarily responsible?

Infraspinatus

When a client complains of persistent deep, achy, lower back pain, which muscle is often responsible for this condition?

Quadratus lumborum

Which muscle is activated for swimmers when performing the 'crawl' stroke and can cause pain around the sacroiliac joint & lower buttock region?

Glute max

In cases where a client experiences limited movement, weakness & pain from elbow to hand and the lateral epicondyle is tender to touch, which muscle is likely causing this dysfunction?

Forearm extensors

If a client has trouble looking in blind spots while driving and has limited range of motion of neck rotation on the same side, which muscle may be causing these symptoms?

Levator Scapula

For pain that refers locally to the chest and anterior shoulder & may extend down medial side of arm to 4th & 5th digit, which muscle should be examined?

Pectoralis major

In cases where the pain is projected over CLAVICAL & down anteriolateral arm to first 3 digits, which muscle is most likely responsible?

Subclavius

Which muscle can mimic cardiac pain, especially when it occurs on the left and can cause sensation of chest constriction?

Pectoralis Major

If a client experiences pain that concentrates at the angle of the neck and along the vertebral border of the scapula, and may project to the posterior deltoid region, which muscle should be considered as the source of pain?

Levator Scapula

A client who complains of pain penetrating deeply into posterior deltoid region and may project to the dorsum of the forearm may have activation in which muscle?

Infraspinatus

Two types of passive stretch techniques are ______ and facilitated.

passive

______ is the ability to yield to a stretch.

Flexibility

______ is the ability to return to its resting length after stretch.

Elasticity

______ is assuming a new and greater length after a stretch.

Plasticity

The ______ causes the muscle to contract in response to a stretch.

stretch reflex

When the stretch is released, sarcomeres return to their ______ length.

resting

What is the ability of tissue to return to its original shape and size after a stretch?

Elasticity

What is the ability of tissue to assume a new, permanent length after a prolonged stretch?

Plasticity

What is the danger of increasing range of motion (ROM) too quickly during a stretch?

The tissue may become more fragile and susceptible to rupture.

When should stretching be indicated for a client?

When the client has limited range of motion restricted by adhesions, contractures, and scar formations.

What is the ability of tissue to yield to a stretch?

Plasticity

What is the primary goal of stretching according to the text?

To regain normal range of motion

What is the recommended duration for holding a passive stretch?

30 seconds or longer

What should the client feel during a passive stretch?

A mild pull of the tissues

What should be done before initiating a passive stretch?

Warm the structures using petrissage or hydrotherapy

What should be done after releasing a passive stretch?

Perform effleurage, petrissage, etc. to flush out the area

What is a contraindication for passive stretching?

All of the above

The primary goal of stretching is to ______ normal ROM.

regain

Prolonged immobilization leads to atrophy and ______ of tissues.

fragility

The ______ causes the muscle to contract in response to a stretch.

stretch reflex

______ is assuming a new and greater length after a stretch.

Creep

When the stretch is released, sarcomeres return to their ______ length.

original

______ is the ability of tissue to return to its resting length after stretch.

Elasticity

If the stress is held for prolonged periods of time, the collagen fibers begin to fail and tissue will assume a new lengthened position permanently. This is known as tissue ______.

plasticity

When limited ROM interferes with Activities of Daily Living (ADLs) and there is tissue shortened opposed by muscle weakness, it indicates the need for ______.

stretching

A significant change to the client's ROM can occur when tissue exhibits plasticity, leading to a new shape and size. However, the tissue may become more fragile and susceptible to rupture, reducing its ______.

stability

Overstretching can pose a danger if the ROM is increased too quickly, potentially resulting in the client injuring themselves with simple daily ______.

movements

Limited ROM restricted by adhesions, contractures, and scar formations are indications for ______.

stretching

Prolonged use of steroids can lead to thickening of soft tissues.

False

During passive stretching, the client should feel pain to ensure effectiveness.

False

Overstretching weak postural muscles can improve postural alignment.

False

Edematous tissue is strong and resilient.

False

The primary goal of passive stretching is to strengthen tissues.

False

Stretching exercises should never be combined with strengthening exercises.

False

If the stress on tissue is held for a prolonged period, the tissue will retain its original shape and size.

False

Overstretching can significantly reduce the stability of the tissue, making it more susceptible to rupture.

True

$ROM = \frac{1}{2}(\pi r^2)$

False

Stretching should be indicated when limited ROM interferes with Activities of Daily Living (ADLs) or when there is tissue shortening opposed by muscle weakness.

True

Elasticity refers to the ability of tissue to assume a new, permanent length after a prolonged stretch.

False

If the stress is held for prolonged periods of time, the collagen fibers begin to fail and tissue will assume a new lengthened position permanently. This is known as tissue ______.

plasticity

A significant change to the client's ROM can occur when tissue exhibits ______, leading to a new shape and size.

plasticity

When limited ROM interferes with Activities of Daily Living (ADLs) and there is tissue shortened opposed by muscle weakness, it indicates the need for ______.

stretching

The ______ causes the muscle to contract in response to a stretch.

stretch reflex

______ is the ability to yield to a stretch.

Elasticity

Prolonged immobilization leads to atrophy and ______ of tissues.

fragility

______ is the ability to yield to a stretch.

Flexibility

______ is assuming a new and greater length after a stretch.

Plasticity

The ______ causes the muscle to contract in response to a stretch.

stretch reflex

When the stretch is released, sarcomeres return to their ______ length.

resting

Overstretching can pose a danger if the ROM is increased too quickly, potentially resulting in the client injuring themselves with simple daily ______.

activities

Limited ROM restricted by adhesions, contractures and scar formations are indications for ______.

stretching

When limited ROM interferes with Activities of Daily Living (ADLs) and there is tissue shortened opposed by muscle weakness, it indicates the need for ______.

stretching

Prolonged immobilization leads to atrophy and ______ of tissues.

fragility

______ is the ability of tissue to return to its resting length after stretch.

Elasticity

______ is assuming a new and greater length after a stretch.

Creep

The ______ causes the muscle to contract in response to a stretch.

Myotatic reflex

Stretching is indicated when limited range of motion (ROM) interferes with activities of daily living (ADLs).

True

The primary goal of stretching is to increase muscle strength.

False

Prolonged immobilization leads to tissue atrophy and fragility.

True

Overstretching weak postural muscles can improve muscular imbalances.

False

Acute sharp pain with movement is a contraindication for passive stretching.

True

Tissue creep refers to the ability of tissue to return to its resting length after a stretch.

False

Prolonged immobilization leads to tissue atrophy and ________.

fragility

A significant change to the client's ROM can occur when tissue exhibits __________, leading to a new shape and size.

plasticity

The _________ causes the muscle to contract in response to a stretch.

stretch reflex

If the stress is held for prolonged periods of time, the collagen fibers begin to fail and tissue will assume a new lengthened position permanently. This is known as tissue __________.

creep

When the stretch is released, sarcomeres return to their _________ length.

resting

When limited ROM interferes with Activities of Daily Living (ADLs) and there is tissue shortened opposed by muscle weakness, it indicates the need for __________.

stretching

Deep moist heat applied for 20 minutes on the site of the treated trigger point is recommended later that day to minimize ______.

pain

As a general guideline, it can take anywhere from ______ treatments to fully resolve a trigger point.

3-10

Elimination of trigger points largely depends on the removal of ______ factors.

perpetuating

Ice area to create ______ (referral pain pattern) – repeat with movement.

ischemia

Using a rubber reflex hammer, slowly direct a ______ onto the trigger point 10x.

tap

The patient is urged to restrict any ______ activities after the treatment.

aggravating

The purpose of performing a Myo-fascial Trigger point technique is to release trigger points and relieve ______.

pain

Flat palpation is used for broad, flatter, hard to pick up muscles like ______.

supraspinatus, infraspinatus, QL

Local Twitch Response (LTR) is a fasciculation contraction of muscle fibers in the taut band lasting for about ______ seconds.

1-2

The pain felt by the patient associated with the TrP is seemingly unrelated to the location of the TrP, making it ______ and predictable in skeletal muscle.

reproducible

In trigger point therapy, the client should expect to feel a sensation of ______ when pressure is applied to tender nodules.

pain

Referred pain is the most clinically significant feature of a TrP, which can be elicited from both active and latent ______.

trigger points

Trigger point release using Ischemic Compression involves holding pressure on a tender nodule for 30 seconds to 2 minutes, until the muscle fibers ______ under your fingers.

release

Warm the tissue with effleurage and specific petrissage, and also may warm with ______ heat before trigger point release.

deep moist

The jump sign occurs if a body part moves as a result of palpation of the trigger point, such as hip hikes or shoulder ______.

moves

Pincer palpation is used for muscles that are easy to pick up, like the upper trapezius, gastrocnemius, latissimus, sternocleidomastoid, and the lateral border of ______ major.

pectoralis

Getting a clear description of where the patient's ______ is felt can be diagnostically significant to identifying which TrP is contributing to their problem.

pain

TrP's can produce ______ without producing pain (latent trigger points).

dysfunction

Decreased range of motion and strength due to muscle fatigue and ______ (Without muscle atrophy or neurological deficit).

hypertonicity

An initial ______ overloads muscle fibres giving rise to the trigger point.

trauma

Prolonged emotional stress such as ______ can lead to gradual onset of trigger points.

depression

Strenuous use of the muscle and ______ on the TrP are aggravating factors for trigger points.

pressure

Slow steady gentle ______ stretch can provide relief from trigger points.

passive

Limited ROM interferes with ______ and indicates the need for stretching.

activities of daily living

Prolonged immobilization leads to ______ of tissues.

atrophy

Before initiating a passive stretch, ______ of effleurage should be performed to palpate trigger points.

warm up

What is the main precaution to take when dealing with active trigger points?

Stretch the muscle with trigger points conservatively

What is a major contraindication for trigger point therapy?

Applying heat directly to an acute injury

What are the effects of Trigger Point Therapy?

Reduce pain and sympathetic nervous system firing

How can trigger points be identified based on patient symptoms?

Pain at night directly indicates the location of the trigger point

What is a key factor in identifying taut band attachments related to trigger points?

'Kick-back' pain is felt in the area of taut band attachments

What symptom indicates that a patient may have a trigger point contributing to their problem?

'Kick-back' pain felt in areas other than the exact TrP location

What is the primary purpose of performing a myofascial trigger point technique?

To relieve muscle tension and pain

What is the recommended duration for holding pressure on a tender trigger point nodule during ischemic compression?

30 seconds to 2 minutes

Which palpation technique is recommended for broad, flatter muscles that are harder to pick up, such as the supraspinatus and infraspinatus?

Flat palpation

What is the most clinically significant feature of a myofascial trigger point?

Referred pain

Which muscle is likely responsible for a client's pain projected over the clavicle and down the anteriolateral arm to the first 3 digits?

Pectoralis major

What is the purpose of performing a series of effleurage strokes before initiating a passive stretch?

To identify any trigger points in the muscle

What is the danger of increasing range of motion (ROM) too quickly during a stretch?

The tissue may become more fragile and susceptible to rupture

What is the primary goal of stretching?

To improve flexibility and range of motion

Which muscle's trigger point referral pattern feels like an 'all over headache' from the occipital to the temple, eye, and forehead?

Trapezius

What is the ability of tissue to assume a new, permanent length after a prolonged stretch?

Plasticity

What technique can be used if the client is unable to manage the pain for 2 minutes?

Intermittent Ischemic Compression

What should be done after the trigger point treatment to minimize pain?

Apply deep moist heat for 20 minutes

How frequently should trigger point treatments be performed as a general guideline?

2-3 half hour sessions per week

What is the recommended technique to apply to a trigger point using a rubber reflex hammer?

Tap the trigger point 10 times with a force equal to eliciting a tendon reflex jerk

What is the primary goal of the exercises that may be given as homecare to the client?

To correct postural imbalances

What is the relationship between the time since the acute onset of pain and the number of treatments required to fully resolve the trigger point?

The longer the period, the more treatments required

Which of the following is NOT a typical symptom associated with trigger points?

Muscle atrophy

What is the primary purpose of getting a clear description of the patient's pain pattern?

To identify which trigger point is contributing to the problem

Which of the following is NOT a characteristic of trigger point pain?

Radiating nerve pain

Which of the following is a common aggravating factor for trigger points?

Exposure to a cold draft

What is the primary goal of passive stretching in trigger point therapy?

To release trigger points and relieve pain

Which of the following is a common relieving factor for trigger points?

Slow, steady, gentle passive stretch

What is the significance of identifying limitations in range of motion?

It is a fundamental characteristic of trigger points

Which of the following is a common cause of sudden onset or acute activation of trigger points?

Wrenching movements or traumatic events

What is the purpose of applying deep moist heat after trigger point therapy?

To minimize post-treatment soreness

Which of the following is a technique used in trigger point therapy?

All of the above

If a patient stretches or loads the muscle with a trigger point, they are likely to feel discomfort in the region of the taut band attachments.

True

Vigorous ischemic compressions can be safely done on active trigger points without causing any additional pain.

False

Heat can be directly applied proximal to an acute injury, such as to the forearm with a wrist sprain.

False

The main goal of trigger point therapy is to decrease local circulation in the affected area.

False

A prolonged chilling of muscles, like from a draft window, is considered a precaution in trigger point therapy.

True

Myofascial Trigger Point Techniques can help increase the length of muscles with trigger points.

True

Flat palpation is used for muscles that are easy to pick up, such as the upper trapezius and sternocleidomastoid.

False

The primary goal of stretching is to increase muscle strength.

False

Edematous tissue is strong and resilient.

False

If a client experiences pain that concentrates at the angle of the neck and along the vertebral border of the scapula, and may project to the posterior deltoid region, the supraspinatus muscle is likely the source of the pain.

False

The primary purpose of performing a myofascial trigger point technique is to increase muscle strength.

False

Deep moist heat applied for 20 minutes on the site of the treated trigger point is recommended later that day to minimize inflammation.

True

If a client has trouble looking in blind spots while driving and has limited range of motion of neck rotation on the same side, the sternocleidomastoid muscle may be causing these symptoms.

True

Acute sharp pain with movement is a contraindication for passive stretching.

True

Tissue creep refers to the ability of tissue to assume a new and greater length after a stretch.

True

If the stress on tissue is held for a prolonged period, the tissue will retain its original shape and size.

False

Intermittent Ischemic Compression involves applying pressure to a trigger point for 20-25 seconds at a time.

False

The patient should engage in aggravating activities after trigger point treatment.

False

Deep moist heat should be applied for 20 minutes on the site of the treated trigger point to minimize pain later that day.

True

The longer the period between the acute onset of pain and the beginning of treatment, the fewer treatments will be required over a shorter period of time.

False

It can take anywhere from 5-15 treatments to fully resolve a trigger point.

False

Elimination of trigger points largely depends on factors other than removing perpetuating factors.

False

Trigger points rarely produce dysfunction without producing pain.

False

A clear description of the patient's pain pattern is important for identifying the contributing trigger point.

True

Passively stretching the muscle is an aggravating factor for trigger points.

True

Trigger point referral patterns are not significant in identifying the contributing muscle.

False

Limited range of motion is rarely the chief complaint for trigger points.

True

Weakness due to muscle fatigue and hypertonicity is not associated with trigger points.

False

Sudden onset or acute overload can be caused by emotional stress or a death of a loved one.

True

Cold, damp weather is a relieving factor for trigger points.

False

A slow, steady, gentle passive stretch is a relieving factor for trigger points.

True

Trigger points can cause various non-pain associated symptoms such as excessive lacrimation and nasal secretion.

True

Study Notes

Here are the study notes:

Trigger Points and Pain Patterns

  • Trigger points (TrP's) are areas of hyperirritable muscle tissue that can cause pain and stiffness in various parts of the body
  • TrP's can be active or latent, and can cause referred pain, which is pain felt in a different area of the body than the TrP itself

Palpation and Identification of Trigger Points

  • Palpation involves feeling for taut bands and tender nodules in the muscle tissue
  • A local twitch response (LTR) can occur when a TrP is palpated, which is a rapid contraction of the muscle fibers
  • Jump sign: a body part may move or jerk when a TrP is palpated
  • Referred pain: pain felt in a different area of the body than the TrP itself

Trigger Point Release Technique

  • Identify a TrP and explain the procedure to the client
  • Warm the tissue with effleurage and specific petrissage
  • Apply ischemic compression to the TrP, holding for 30 seconds to 2 minutes
  • Release the pressure and flush the area with petrissage and effleurage
  • Passive stretching of the affected muscle

Trigger Point Therapy

  • Increase local circulation
  • Reduce pain and sympathetic nervous system firing
  • Treat TrPs
  • Increase length of muscle
  • Decrease hypertonicity of muscle

Contraindications and Precautions

  • Avoid vigorous techniques on active TrPs
  • Avoid full stretch of muscle with TrPs when hypermobility is present
  • Avoid prolonged chilling of muscle
  • Avoid vigorous ischemic compressions done too quickly
  • Avoid heat directly proximal to an acute injury

Alternative Trigger Point Techniques

  • Intermittent ischemic compression
  • Intermittent cold and stretch
  • Percussion and stretch

Post-Treatment and Prognosis

  • Restrict aggravating activities after treatment
  • Apply deep moist heat to the TrP
  • Identify and reduce lifestyle factors contributing to TrP activity
  • Exercises may be given as homecare to correct postural imbalances
  • Prognosis: number of treatments required depends on the duration of pain and the removal of perpetuating factors### Myofascial Trigger Point Techniques
  • Decreased range of motion, pain, and autonomic and proprioceptive symptoms are indications for myofascial trigger point techniques
  • Precautions for myofascial trigger point techniques:
    • Avoid vigorous techniques on active trigger points to prevent "kick-back" pain
    • Avoid full stretch of muscle with trigger points when hypermobility is present
    • Prolonged chilling of muscle should be avoided
  • Contraindications for myofascial trigger point techniques:
    • Vigorous ischemic compressions done too quickly
    • Heat directly proximal to an acute injury
    • Locally if there is a strain or sprain
    • Vigorous ischemic compressions within the same treatment as friction technique

Effects of Trigger Point Therapy

  • Increases local circulation
  • Reduces pain and sympathetic nervous system firing
  • Treats trigger points
  • Increases length of muscle
  • Decreases hypertonicity of muscle

Trigger Point Technique Procedure

  • Identify trigger points through palpation and client history
  • Prepare the client by explaining the procedure and goals
  • Warm the tissue with effleurage and petrissage
  • Apply ischemic compression and hold for 30 seconds to 2 minutes
  • Flush out the area with effleurage and petrissage after compression
  • Stretch the affected muscle and hold for 30 seconds

Palpation

  • Use flat palpation for broad, flatter muscles
  • Use pincer palpation for muscles that are easy to pick up
  • Identify taut bands and tender nodules to locate trigger points
  • Use a local twitch response to confirm the presence of a trigger point

Determining if there is a Trigger Point

  • Identify a taut band
  • Palpate to localize the tender nodule
  • Use a local twitch response to confirm the presence of a trigger point
  • Identify the referred pain pattern associated with the trigger point

Passive Stretching Technique Procedure

  • Explain the goals and procedure to the client
  • Position the client comfortably and in a stable position
  • Free the area of restrictions
  • Warm structures using petrissage or hydrotherapy
  • Stabilize the proximal segment of the joint and move the distal segment
  • Move the body segment in a slow, smooth, and gentle manner to the point of tissue resistance
  • Remind the client to breathe comfortably
  • Hold the stretch for 30 seconds or longer
  • Release the stretch slowly to prevent recoil of tissues
  • Allow for a rest period before stretching again
  • Flush out after stretch with effleurage and petrissage

Precautions and Contraindications for Stretching

  • Precautions:

    • Do not passively force a joint beyond its normal ROM
    • Extra care should be taken with suspected or known osteoporosis
    • Prolonged use of steroids causes thinning of soft tissues
    • Prolonged immobilization leads to atrophy and tissue fragility
    • Strengthening exercises should be coupled with stretching
    • Post-stretching, the client should feel muscle soreness lasting no more than 24 hours
    • Edematous tissue is fragile
    • Overstretching weak postural muscles can increase muscular imbalances
  • Contraindications:

    • When a bony formation limits ROM
    • Recent fracture
    • Muscles in spasm
    • Acute inflammation or infection
    • Acute sharp pain with movement
    • Severe contusion or tissue trauma
    • Hypermobility
    • Paralysis or severe numbness### Drawing the Pain Pattern
  • Identifying the location of the patient's pain is crucial in determining which trigger point (TrP) is contributing to their problem.

  • Pain often travels to other areas, and understanding the referral patterns of TrPs is essential.

  • Pain is typically described as an achiness and stiffness, and it's essential to differentiate it from radiating nerve pain.

  • Determining the activities and postures that aggravate and relieve the pain is vital.

  • Limited range of motion (ROM) is a fundamental characteristic of TrPs, identified by pain that develops as the muscle approaches full stretch ROM.

Limited Range of Motion

  • Observing the patient's posture and examining for limitations in ROM is crucial.
  • Watching the patient's spontaneous posture and movements while walking and sitting can provide valuable insights.
  • Limited ROM is often worse in the morning and recurs after periods of over-activity of the affected muscle(s).
  • This is due to the abnormal tension of the taut band.

Weakness

  • Decreased ROM and strength are due to muscle fatigue and hypertonicity, without muscle atrophy or neurological deficit.

Other Non-pain Associated Symptoms

  • Excessive lacrimation/tearing
  • Nasal secretion/runny nose
  • Pilomotor activity/hairs up
  • Changes in sweat patterns/sweating
  • Postural dizziness
  • Spatial disorientation
  • Altered perception of the weight of lifted objects
  • Sleep disturbances, which can increase pain sensitivity the next day

Motor Function Interruption

  • Includes spasm of other muscles, weakness of the involved muscle, loss of coordination, and decreased work tolerance.

Sudden Onset/Acute Overload

  • Sudden onset can occur due to an initial trauma that overloads muscle fibers, giving rise to the trigger point.
  • Pain develops within 12-24 hours post-trauma of the muscle(s) involved.
  • Examples of sudden onset events include wrenching movements, automobile accidents, falls, fractures, joint sprains, dislocations, direct blows to the muscle, episodes of excessive or unusual exercise, and intramuscular injections at the site of a latent TrP.

Gradual Onset/Overload

  • Gradual onset can take from hours to days to become a triggering factor in TrP activation.
  • Factors contributing to gradual onset include sustained postural overload, repetitive activities at work, prolonged emotional stress, other TrPs, immobilization in the shortened position, joint or nerve damage, and pathology.

Aggravating Factors

  • Strenuous use of the muscle
  • Passively stretching the muscle
  • Pressure on the TrP
  • Placing the involved muscle in a shortened position for a prolonged period
  • Sustained or repeated contraction of the involved muscle
  • Cold, damp weather
  • Viral infections
  • Periods of marked nervous tension
  • Exposure to a cold draft

Relieving Factors

  • Slow, steady, gentle passive stretching
  • Indications for stretching include limited ROM, restricted by adhesions, contractures, and scar formations, when limited ROM interferes with Activities of Daily Living (ADLs), and when there is tissue shortened opposed by muscle weakness.

Precautions and Contraindications

  • Precautions include avoiding passive force beyond normal ROM, taking extra care with suspected or known osteoporosis, and being cautious with prolonged use of steroids and immobilization.
  • Contraindications include when a bony formation limits ROM, recent fracture, muscles in spasm, acute inflammation or infection, acute sharp pain with movement, severe contusion, and hypermobility.

Myofascial Trigger Point Technique

  • Procedure involves identifying trigger points, treating trigger points, and increasing local circulation.
  • Avoid vigorous techniques on active trigger points, and do not use full stretch of muscle with trigger points when hypermobility is present.
  • Contraindications include vigorous ischemic compressions done too quickly, heat directly proximal to an acute injury, and locally if there is a strain or sprain.

Effects of Trigger Point Therapy

  • Increase local circulation
  • Reduce pain and sympathetic nervous system firing
  • Treat trigger point
  • Increase length of muscle
  • Decrease hypertonicity of muscle

Alternate Trigger Point Techniques

  • Intermittent ischemic compression
  • Intermittent cold and stretch
  • Percussion and stretch

Post Treatment

  • The patient should restrict any aggravating activities after treatment.
  • Deep moist heat applied for 20 minutes on the site of the treated trigger point is recommended later that day to minimize pain.
  • Lifestyle factors contributing to the trigger point activity should be identified and reduced if possible.
  • Exercises may be given as homecare to correct postural imbalances.

Prognosis

  • The longer the period between the acute onset of pain and the beginning of treatment, the greater the number of treatments required over a longer period.
  • It can take anywhere from 3-10 treatments to fully resolve a TrP.
  • Elimination of trigger points largely depends on the removal of perpetuating factors.

Test your knowledge of neck muscle stretching techniques and their associated referral patterns. This quiz covers stretches for muscles like Splenius Capitus, Splenius Cervicis, and Levator Scapula, as well as common client complaints and limitations in range of motion.

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