Trigger Points Definition

Trigger Points

• Trigger points are highly irritable localized spots of exquisite tenderness in a nodule in a palpable taut band of skeletal muscle.
• Characteristics of trigger points include referred pain, tender points, multiple tender spots, localized pain at the site of palpation, and a local twitch response.
• Trigger points can occur in any skeletal muscle and are often found in specific symmetrical locations.

Etiology of Trigger Points

• The exact etiology of trigger points is not well known.
• Studies suggest that injured or overloaded muscle fibers may lead to involuntary shortening, a loss of oxygen and nutrient supply, and an increased metabolic deficiency in local tissues.
• The combined hypothesis suggests that abnormal depolarization of motor end-plates and prolonged muscle contractions give rise to a localized "adenosine triphosphate energy crisis" associated with sensory and autonomic reflex arcs due to central sensitization.

Integrated Neuromuscular Inhibition Technique

• This technique consists of ischemic compression, strain-counterstrain, and muscle energy technique.
• Ischemic compression involves applying pressure to a specific trigger point using a pincher grip until the pain is reduced.
• Strain-counterstrain involves applying pressure to a trigger point until pain is felt, then maintaining the pressure until the position of ease is achieved.
• Muscle energy technique involves the affected muscle making an isometric contraction followed by stretching.

Self-Treatment

• The subject is positioned to lengthen the muscle that will be assessed to create a perceptible increase in its resistance to movement.
• Cross-fiber palpation is used to detect any taut bands or nodules using "flat palpation" or "pincer palpation".
• The examiner traps the MTrP between their fingertips and the underlying bone to detect any taut bands or nodules.

Trigger Point Examination

• The testing procedure can be repeated bilaterally to ensure the accuracy of the trigger point examination.
• The trapezius muscle contains seven trigger point locations on both sides of the paired trapezius, and at the upper trapezius, there are only two trigger points.

Definition of Trigger Points

• Trigger points are highly irritable localized spots of exquisite tenderness in a nodule in a palpable taut band of skeletal muscle.
• Trigger points can vary in size and have been described as "tiny lumps," "little peas," and "large lumps".
• The size of a trigger point nodule varies according to the size, shape, and type of muscle in which it is generated.

Myofascial Trigger Points and Pain

• Myofascial trigger points may be implicated in all types of musculoskeletal and mechanical muscular pain.
• Pain or symptoms may be directly due to active trigger points, or pain may "build up" over time from latent or inactive trigger points.
• Studies have confirmed a high prevalence of trigger points directly associated with myofascial pain, somatic dysfunction, psychological disturbance, and associated restricted daily functioning.

Acupuncture or Acupressure Points and Trigger Points

• Trigger points are not equivalent to acupuncture points, but may overlap.
• Acupuncture points are said to be localized concentrations of "energy" that develop along electromagnetic lines (meridians).
• Trigger points are discrete nodular tetherings in the myofascial tissues, which cause a specific and reproducible referred pain pattern when stimulated.

Fibromyalgia

• Fibromyalgia is a complex syndrome characterized by pain amplification, musculo-skeletal discomfort, and systemic symptoms.
• Fibromyalgia syndrome is characterized by widespread diffuse musculoskeletal pain and fatigue.
• The cause of the disorder is still unknown.