Physiotherapy defines myofascial pain, or trigger points, as very focused hyperirritability in muscles and fascia (a connective tissue) that when stimulated, can cause central nervous system modulation. They are characterized by focal tenderness, that can be widespread when palpated.
Qualities of trigger points
There are four (4) sub-types of trigger points we manage in our physiotherapy clinics:
Treating the primary or key trigger points do not treat the secondary satellite ones, which must be treated separately.
Potential Causes Of Trigger Points
Development or activation of trigger points can be caused by several factors, which includes muscle overloading, activation by other trigger points, disease, psychological stress, trauma, and imbalance in the human system.
They form only in the muscles and/or connective tissues such as fascia. They are a bundle of muscle fibers which can cause deep pain within muscles and joints when they pull the associated muscles. When our muscle fibers contract, it creates a byproduct of lactic acid, which the body will remove via natural circulation. In a trigger point, the tightened muscle fibres contract and this constricts localized capillaries, effectively storing the lactic acid in the bundles itself.
When trigger points become active in the muscles, there is very often weakness plus pain in the affected areas; this pain patterns have a specific neural pathway, which can be traced easily. However, because there are many trigger points that have pain patterns that overlap, the treatment of the trigger points often becomes very extensive to remove them, though our physiotherapy clients often report a sense of general wellbeing after each session of trigger point management.
Diagnosing Trigger Points
We diagnose them by clinical interviews to identify signs, followed by a physical examination of the signs, symptoms, pain patterns as well as using manual clinical palpations. For a trained physiotherapist, we can detect the taut bands and nodules within muscle fibers that causes a “all or nothing at all” twitch response – this is a primary sign. Pressing on the nodule will then cause localized or referred pain.
Some larger muscles such as the back and gluteal muscles have multiple trigger points.
Physiotherapy Treatment Of Myofascial Pain Trigger Points
Successful Physiotherapy Myofascial Pain Treatment Protocol
Includes identifying accurately the trigger points, and the execution and resolution of all the active and key trigger points. The muscles that contains inactive, latent ones need to be stretched and mobilized, as well as to mobilize the fascia of nearby structures.
The results of any manual therapy is directly related to the skill and experience level of the physiotherapist or hand therapist. If trigger points are pressed for too short time, they main be active still; if they are pressed too hard or too long, the trigger points becomes inflamed and bruised, causing longer pain in the area. This bruising may feel like the soreness related to post-exercise soreness, but it is not.
Should you do self-treatments for your myofascial pain?
patients wants to administer their own self-treatments in between
physiotherapy sessions, as they want immediate relief. It is possible,
and we can train you in managing the symptomatic relief of pain – you’d
need to have fair working knowledge of the anatomy and physiology of
your affected areas, and understand the risks. We also have trigger balls and foam rollers that can help reach those hard-to-reach knots available in our clinics.
The risks includes possible damage of soft tissues and other organs (e.g. too close to nerve bundles, organs such as kidneys (for the treatment of trigger point in the quadratus lumborum) or the underlying glands.
Where to next?