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

Check handout please

 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

Fibrositis (Gowers, Idiopathic myalgia (Gutstein-

1904) Good, 1940)
Fibromyositis Rheumatic myalgia (Good,
(Telling, 1911) 1941)
Myofasciitis (Albee,
1927) Myofascial Pain Syndrome
Myofibrositis
(Travell, 1948)
(Murray, 1929) Myodysneuria (Gutstein,
Perineuritis (Clayton 1955)
& Livingstone, 1930) Fibromyalgia (Yunus, 1977)
 Prevalence
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.

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.

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:

Radiculopathies pelvic pain and other urologic

joint dysfunction syndromes
disk pathology most pain syndromes
tendonitis nocturnal cramps
Craniomandibular dysfunction phantom pain
migraines etc.
tension-type headaches
carpal tunnel syndrome
computer-related disorders
whiplash associated disorders
spinal dysfunction
Etiology of MTrPs
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
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
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
Trigger Point Compression (Technique I)
 Manual Trigger Point Therapy
Manual stretching of the taut band
in muscle fiber direction
(Technique II)
 Manual Trigger Point Therapy
Myofascial Release
(Technique III)
 Manual Trigger Point Therapy

Intermuscular mobilisation
(Technique IV)
Thanks