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.

Learn about trigger points as described by Drs.Janet Travell and David Simons in 1992, which are highly irritable localized spots in skeletal muscles. Understand the characteristics and variations of trigger points, including their tenderness to pressure and sizes.