Trigger Points Definition

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Questions and Answers

What is a common characteristic of tender points in myofascial trigger points?

Referred pain to a different area of the body

Visible swelling at the site of palpation

Localized pain at the site of palpation only (correct)

Complete absence of pain

Which is a key feature of trigger points in muscles?

Local twitch response (correct)

Decreased muscle tone

Soft, spongy feeling upon palpation

Visible redness on the skin surface

What is suggested as the most reliable etiologic theory for myofascial trigger points?

Infection as the primary cause

Random occurrence without any specific cause

Combined hypothesis involving motor end-plate depolarization and prolonged muscle contractions (correct)

External temperature changes triggering muscle spasms

How is cross-fiber palpation used to detect taut bands or nodules?

By trapping the MTrP between fingertips and underlying bone Signup and view all the answers

Where do tender points associated with myofascial trigger points cause pain?

At the site of palpation only Signup and view all the answers

How many trigger points are found in the upper trapezius muscle?

2 Signup and view all the answers

What distinguishes myofascial pain from neuropathic pain?

Characteristic patterns of pain referral Signup and view all the answers

What is the purpose of pincer palpation during trigger point examination?

To detect taut bands or nodules Signup and view all the answers

What does the examiner look for when palpating along a taut band?

An enlarged point or a 'focus' of the contraction Signup and view all the answers

What type of pain are myofascial trigger points directly linked to?

Musculoskeletal and mechanical muscular pain Signup and view all the answers

Which muscles may require 'pincer palpation' during trigger point examination?

Upper trapezius, pectoralis major, teres major, latissimus dorsi, triceps Signup and view all the answers

What is a trigger point according to Drs. Janet Travell and David Simons?

A tender and irritable spot within a muscle Signup and view all the answers

What is a possible consequence of muscle overuse according to the text?

Development of trigger points Signup and view all the answers

What percentage of MVIC is recommended for the isometric contraction in the Muscle energy technique (MET) of the integrated neuromuscular inhibition technique?

25-30% MVIC Signup and view all the answers

What is a characteristic symptom of taut bands in muscles according to the text?

"Jump sign" Signup and view all the answers

How does Strain-counterstrain (SCS) technique differ from Ischemic compression in the integrated neuromuscular inhibition technique?

It identifies the position of ease and maintains it for 20-30 seconds. Signup and view all the answers

How are trigger points described in terms of tenderness?

Exquisitely tender to pressure Signup and view all the answers

What is the common physical characteristic of trigger points?

Embedded within the muscle fibers Signup and view all the answers

What reaction do patients often have when trigger points are pressed?

They may wince from the pain Signup and view all the answers

How can trigger points contribute to pain over time?

From latent or inactive trigger points building up pain over time Signup and view all the answers

Which condition is characterized by widespread diffuse musculoskeletal pain and fatigue?

Fibromyalgia syndrome Signup and view all the answers

What is the main difference between acupuncture points and trigger points?

Acupuncture points are localized concentrations of 'energy', while trigger points are discrete nodular tetherings in myofascial tissues. Signup and view all the answers

Why is the cause of fibromyalgia still unknown?

The text does not provide a reason for the unknown cause Signup and view all the answers

What role do trigger points play in acupuncture treatment according to the text?

Having a trigger point at an acupuncture point increases pain relief efficacy Signup and view all the answers

Which statement accurately describes fibromyalgia?

'Fibromyalgia syndrome is characterized by widespread diffuse musculoskeletal pain and fatigue.' Signup and view all the answers

What distinguishes trigger points from acupuncture points in terms of their physical nature?

Trigger points are energy concentrations, while acupuncture points are tetherings in myofascial tissues. Signup and view all the answers

What is the main purpose of Ischemic compression in the integrated neuromuscular inhibition technique?

To maintain pressure until the patient reports discomfort. Signup and view all the answers

How long is the position of ease maintained in the Strain-counterstrain (SCS) technique within the integrated neuromuscular inhibition technique?

20-30 seconds Signup and view all the answers

How many times is each step typically repeated in the integrated neuromuscular inhibition technique?

Three times Signup and view all the answers

Study Notes

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.

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Description

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.