Transcript The myofascial pain syndrome (MPS) - Home

The myofascial pain syndrome (MPS)
Features of MTrPs
Motor:
 disturbed motor function
 muscle weakness as a result of motor
inhibition
 muscle stiffness
 restricted range of motion
Features of MTrPs
Autonomic:
 vasoconstriction
 vasodilatation
Features of MTrPs
Sensory:
 local tenderness
 referral of pain to a distant site
 peripheral sensitization
 central sensitization
Definition and type of Terms
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Examples of the two directions in
which trigger point may referred
A .)Peripheral projection of pain from suboccipital and
infraspinatus trigger points( .
B .)Mostly central projection of pain from biceps brachii
trigger points with some pain in the region of the
distal tendinous attachment of the muscle .
Other Muscle Pain Terminology
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Fibrositis (Gowers,
1904)
Fibromyositis
(Telling, 1911)
Myofasciitis (Albee,
1927)
Myofibrositis
(Murray, 1929)
Perineuritis (Clayton
& Livingstone, 1930)
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Idiopathic myalgia (GutsteinGood, 1940)
Rheumatic myalgia (Good,
1941)
Myofascial Pain Syndrome
(Travell, 1948)
Myodysneuria (Gutstein,
1955)
Fibromyalgia (Yunus, 1977)
Prevalence
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Research has shown that MTrPs are commonly associated with facet
joint dysfunctions, disc herniation, osteoarthritis, migraine, tension
type headache, (Fybromyalgia), visceral disorders etc.
Dommerholt, J. and T. Issa, Differential diagnosis: myofascial pain, in Fibromyalgia syndrome; a practitioner's guide to
treatment, L. Chaitow, Editor. 2003, Churchill Livingstone: Edinburgh. p. 149-177.
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A survey of APS (American Pain Society)-members shows that
88.5% consider MPS as a legitimate diagnosis
Harden, R.N., et al., Signs and symptoms of the myofascial pain syndrome: a national survey of pain management
providers. Clin J Pain, 2000. 16(1): p. 64-72.
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80% of 1096 subjects involved in low-velocity activity developed
active trigger points (MTrP)
Schuller, E., W. Eisenmenger, and G. Beier, Whiplash injury in low speed car accidents. J Musculoskeletal Pain, 2000.
8(1/2): p. 55-67.
MTrPs have been identified with:
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Radiculopathies
joint dysfunction
disk pathology
tendonitis
Craniomandibular dysfunction
migraines
tension-type headaches
carpal tunnel syndrome
computer-related disorders
whiplash associated disorders
spinal dysfunction
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pelvic pain and other urologic
syndromes
most pain syndromes
nocturnal cramps
phantom pain
etc.
Etiology of MTrPs
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Acute Overuse
Direct Trauma
Persistent Muscular Contraction
(emotional or physical cause), i.e,:
poor posture, repetitive motions, stress
response
Prolonged Immobility
Systemic Biochemical Imbalance
Diagnostic Criteria
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taut band: the group of
tense muscle fibers
extending from a trigger
point to the muscle
attachments, the tension
being caused by
contraction knots that are
located in the trigger point
region
Diagnostic Criteria
spot tenderness within the taut band (nociceptive
input into the dorsal horn contributing to wind-up
and central sensitization)
local twitch response.
referred pain.
Jump sign.
Identification
Myofascial Trigger Points
are identified by
physical examination,
specifically by palpation
There are two palpation
techniques:
 Flat palpation
 Pincer palpation
dependent upon the muscle
Manual Trigger Point Therapy
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Trigger Point Techniques
Trigger Point Compression (Technique I)
Manual stretching of the taut band in muscle fibre direction (Technique II)
Release Techniques:
Myofascial Release (Technique III)
Intermuscular mobilisation (Technique IV)
Stretching Techniques:
Therapeutic stretching (Technique V)
Self stretching (Technique VI)
Manual Trigger Point Therapy
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Trigger Point Compression (Technique I)
Manual Trigger Point Therapy
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Manual stretching of the taut band
in muscle fiber direction
(Technique II)
Manual Trigger Point Therapy
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Myofascial Release
(Technique III)
Manual Trigger Point Therapy
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Intermuscular mobilisation
(Technique IV)
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