Trigger Points in Physical Therapy

Characteristics of Trigger Points

• Patients with trigger points often report regional, persistent pain that results in a decreased range of motion of the affected muscle.
• The muscles most commonly affected are those used to maintain body posture, such as the neck, shoulders, and pelvic girdle muscles.
• Pain is usually constant and reproducible, but does not follow a dermatomal or nerve root distribution.

Symptoms of Myofascial Pain Syndrome

• Head and neck region: tension headache, tinnitus, temporomandibular joint pain, eye symptoms, and torticollis.
• Upper limb pain: referred pain, may resemble visceral pain or mimic tendonitis and bursitis.
• Lower extremities: pain in the quadriceps and calf muscles, leading to limited range of motion in the knee and ankle.

Types of Trigger Points

• Active Trigger Points: produce pain without digital compression, tender upon palpation, and impede muscle flexibility.
• Latent Trigger Points: silent, tender upon palpation, and may produce referred pain pattern only with ischemic compression.
• Satellite Trigger Points: develop in the same muscle or synergistic muscles, and usually resolve once the primary trigger point is resolved.
• Central Trigger Points: closely associated with dysfunctional endplates, located near the center of muscle fibers.
• Attachment Trigger Points: at the musculo-tendinous junction and/or osseous attachment of the muscle, causing enthesopathy.

Onset of Trigger Points

• Activation of myofascial trigger points is associated with micro-trauma, which can occur through repetitive motion or postural stresses.
• Patients may identify the cause of the dysfunction, especially if related to a sudden high-velocity movement or unusual activity.

Local Pain and Referred Pain Patterns

• Patients frequently complain of pain, burning sensation, and tenderness on the involved muscle.
• Myofascial trigger points refer pain to distal or proximal locations in specific patterns characteristic for each muscle, known as referred pain patterns (RPP).

Characteristics of Trigger Points

• Patients with trigger points often report regional, persistent pain that results in a decreased range of motion of the affected muscle.
• The muscles most commonly affected are those used to maintain body posture, such as the neck, shoulders, and pelvic girdle muscles.
• Pain is usually constant and reproducible, but does not follow a dermatomal or nerve root distribution.

Symptoms of Myofascial Pain Syndrome

• Head and neck region: tension headache, tinnitus, temporomandibular joint pain, eye symptoms, and torticollis.
• Upper limb pain: referred pain, may resemble visceral pain or mimic tendonitis and bursitis.
• Lower extremities: pain in the quadriceps and calf muscles, leading to limited range of motion in the knee and ankle.

Types of Trigger Points

• Active Trigger Points: produce pain without digital compression, tender upon palpation, and impede muscle flexibility.
• Latent Trigger Points: silent, tender upon palpation, and may produce referred pain pattern only with ischemic compression.
• Satellite Trigger Points: develop in the same muscle or synergistic muscles, and usually resolve once the primary trigger point is resolved.
• Central Trigger Points: closely associated with dysfunctional endplates, located near the center of muscle fibers.
• Attachment Trigger Points: at the musculo-tendinous junction and/or osseous attachment of the muscle, causing enthesopathy.

Onset of Trigger Points

• Activation of myofascial trigger points is associated with micro-trauma, which can occur through repetitive motion or postural stresses.
• Patients may identify the cause of the dysfunction, especially if related to a sudden high-velocity movement or unusual activity.

Local Pain and Referred Pain Patterns

• Patients frequently complain of pain, burning sensation, and tenderness on the involved muscle.
• Myofascial trigger points refer pain to distal or proximal locations in specific patterns characteristic for each muscle, known as referred pain patterns (RPP).

Learn about trigger points in physical therapy, including their effects on muscle range of motion and posture, and common affected muscles.