During the deep conditioning phase, the intra- and inter- tissue mobility of the functional unit is improved, which may include specific muscle stretches, neurodynamic mobilizations, joint mobilizations, orthotics, and strengthening muscle Current approaches for management of MPS include pharmacological and nonpharmacological interventions.
Among the pharmacological approaches are anti-inflammatory, analgesic, and narcotic medications, topical creams, and trigger point injections, which are now safer and more effective. Non-pharmacological interventions include manual therapies, which continue to include post-isometric relaxation, counterstrain method 72 , trigger point compression, muscle energy techniques, and myotherapy 73 , along with other treatments like laser therapy 74 , dry needling, and massage 35 , According to Simons, stretching and strengthening of the affected muscles is important for any treatment While many of the manual treatment methods stay the same or are only slightly modified all include some form of mechanical pressure , it is the underlying theory as to why they are effective that continues to evolve with further study.
Modalities and manual treatments are often clinically effective for deactivating active MTrPs and desensitizing sensitized spinal segments, and are commonly employed as a first line of treatment before attempting more invasive therapies.
While a number of recent reviews and meta-analyses have focused on needling, the effectiveness of manual therapy should not be overlooked and may possibly be just as effective as needling Among the invasive therapies, the scientific articles report mixed results. Generally, dry needling, anesthetic injection, steroids, and botulinum toxin-A [BTA] of the trigger point have all been shown to provide pain relief 70 , 77 - Regardless of the method used, there is considerable agreement that elicitation of a LTR produces more immediate and long-lasting pain relief than no elicitation of LTR 81 - 86 , although some still believe that eliciting an LTR is not necessary for improvement.
Nevertheless, within minutes of a single induced LTR, Shah et al. While treatment options for soft tissue pain have not changed dramatically, researchers today have certainly discovered better ways of categorizing and analyzing the clinical data they collect and determining if a treatment is effective.
Gerber et al. Clinicians are shifting the focus from not only pain relief and increasing function, but to improving the patient's quality of life as well. Though many practitioners can attest to improvement in pain levels of MPS, it is measured using self-reports of pain levels pre- and post-treatment. To date, the number of randomized, placebo-controlled trials is few, and most of them have small numbers of participants.
Additionally, because they rely exclusively on self-reports, there remains uncertainty about the validity of the findings. Thus, while a variety of pharmacological and nonpharmacological treatments have shown efficacy, studies of proper size and quantitative outcome measures need to be performed. Data have been published suggesting that MPS is a pain syndrome that can be acute or chronic, and that it involves muscle and fascia. The MTrP remains central to its diagnosis, and possibly its successful treatment.
New methods of describing and imaging the MTrP as well as the milieu of the MTrP have suggested that there are a variety of objective findings associated with the syndrome and active MTrPs. Table 1 compares the contributions of Travell and Simons to the contemporary understanding of the MTrP. Earlier theories for the pathogenesis of MTrPs and MPS, including muscle overuse and mechanical difficulties, remain current and have been neither proven nor disproven.
Current data suggest that active MTrPs are associated with a high symptom burden and a negative impact on function, both physical and psychosocial. Investigators also demonstrated that dry needling provides symptom relief and change in the status of the trigger point 88 , although the mechanism by which this works has not yet been demonstrated. Many questions remain to be answered. For example, what is the etiology and pathophysiology of MPS?
Is the resolution of the MTrP required for clinical response? What is the mechanism by which the pain state begins, evolves, and persists? Though the presence of pro-inflammatory and noxious biochemicals has been established, what are the levels of anti-inflammatory substances, analgesic substances, and muscle metabolites in the local biochemical milieu of muscle with and without MTrPs?
How does a tender nodule progress to a myofascial pain syndrome? Which musculoskeletal tissues are involved, what are their properties, and how do these change in response to treatment? These are some of the questions researchers must address in the future. Proper treatment of MPS requires identification and targeting of the mechanisms and pathophysiology of perpetuating factors in order to obtain sustained relief.
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Jay P. Jacqueline V. Lynn H. National Center for Biotechnology Information , U. Author manuscript; available in PMC Jul 1. Gerber , MD. Author information Copyright and License information Disclaimer. Address correspondence to: JPS vog.
Copyright notice. The publisher's final edited version of this article is available at PM R. See other articles in PMC that cite the published article. Associated Data Supplementary Materials. Abstract The intent of this paper is to discuss the evolving role of the myofascial trigger point MTrP in myofascial pain syndrome MPS from both a historical and scientific perspective. Introduction Myofascial pain is a clinical problem that has generated interest and confusion for decades.
Open in a separate window. Figure 1. Historical Perspective Guillaume de Baillous of France was one of the first to write in detail about muscle pain disorders. A Contemporary Conundrum Although the MTrP is a common physical finding, it is often an overlooked component of non-articular musculoskeletal pain because its pathophysiology is not fully understood. The Role of Muscle Travell and Simons methodically developed a working model based primarily on muscle anatomy and function, which evolved over years of observation and empirical testing.
The Role of MTrPs There exists a spectrum of physical findings and symptoms involving the nodule and surrounding soft tissue. Figure 2. Figure 3. Sensitization Without Pain Latent MTrPs are not associated with spontaneous pain; however, they cause local and possibly referred pain upon deep palpation. Figure 4. Evaluation and Treatment The history of soft tissue pain treatments follows the clinical trends of those physicians and soft tissue specialists e.
Figure 5. Figure 6. Supplementary Material Click here to view. Footnotes Publisher's Disclaimer: This is a PDF file of an unedited manuscript that has been accepted for publication. Contributor Information Jay P. References 1. Prevalence of myofascial pain in general internal medicine practice. West J Med. Gerwin RD. Classification, epidemiology, and natural history of myofascial pain syndrome.
Curr Pain Headache Rep. Myofascial pain syndrome of the head and neck: a review of clinical characteristics of patients. Error analysis of ultrasonic tissue doppler velocity estimation techniques for quantification of velocity and strain. Stockman R. The cause, pathology, and treatment of chronic rheumatism. Edinburgh Med J. Froriep R. Ein Beitrag zur Pathologie und Therapie des Rheumatismus. Gowers WR. Lumbago: its lessons and analogues.
Br Med J. Schade H. Uber den Rheumatismus, insbesondere den Muskelrheumatismus myogelose. Myofascial pain and dysfunction : the trigger point manual. The myofascial genesis of pain. Postgraduate Medicine. Robert B. Myofascial pain syndromes and their evaluation.
Focused review: myofascial pain. Hong C. Pathophysiology of myofascial trigger point. J Formos Med Assoc. Signs and symptoms of the myofascial pain syndrome: a national survey of pain management providers.
Clin J Pain. Uncovering the biochemical milieu of myofascial trigger points using in vivo microdialysis: an application of muscle pain concepts to myofascial pain syndrome. J Bodyw Mov Ther. Lippincott Williams and Wilkins; Philadelphia: Electromyographical Kinesiology. Elsevier; Amsterdam: Static work load and occupational myalgia: a new explanation model.
Myofascial trigger point development from visual and postural stressors during computer work. J Electromyogr Kinesiol. Kaergaard A, Andersen JH. Occupational and environmental medicine. Morphologische Untersuchung an Trigger punkten. Manuelle Medizin. Morphology and histochemistry of myogelosis. Clinical Anatomy. Mense S. The pathogenesis of muscle pain.
Current Pain and Headache Reports. An in vivo microanalytical technique for measuring the local biochemical milieu of human skeletal muscle. J Appl Physiol Nov; 99 5 — The spinal cord connections of the myofascial trigger spots. Eur J Pain. Central modulation of pain evoked from myofascial trigger point. A systematic comparison between subjects with no pain and pain associated with active myofascial trigger points.
Variability of criteria used to diagnosis myofascial trigger point pain syndrome-evidence from a review of the literature. Myofascial trigger points show spontaneous needle EMG activity. Spine Phila Pa Oct 1; 18 13 — Wiederholt WC. Simons DG. Review of enigmatic MTrPs as a common cause of enigmatic musculoskeletal pain and dysfunction. Myofascial Pain Syndrome. Wolfe F. The fibromyalgia and myofascial pain syndromes: A preliminary study of tender points and trigger points in person wiht fibromyalgia, myofascial pain syndrome and no disease.
J Rheumatol. Dommerholt J, Huijbregts P. Myofascial trigger points : pathophysiology and evidence- informed diagnosis and management. Jones and Bartlett Publishers; Sudbury, Mass: Fascial components of the myofascial pain syndrome. Hyaluronan within fascia in the etiology of myofascial pain. Surg Radiol Anat. Quintner J, Cohen M. Clinical Journal of Pain. Srbely J. New trends in the treatment and management of myofascial pain syndrome. Capsaicin-induced central sensitization evokes segmental increases in trigger point sensitivity in humans.
J Pain. Objective sonographic measures for characterizing myofascial trigger points associated with cervical pain. Journal of ultrasound in medicine : official journal of the American Institute of Ultrasound in Medicine. Office-based elastographic technique for quantifying mechanical properties of skeletal muscle. Ultrasonic characterization of the upper trapezius muscle in patients with chronic neck pain.
Ultrasonic imaging. Understanding the vascular environment of myofascial trigger points using ultrasonic imaging and computational modeling. Conference proceedings Huguenin L. Myofascial trigger points: the current evidence. Physical Therapy in Sport. Audette J, Bailey A. California Humana Press; Integrative Pain Medicine. Genesis of pain in arthrosis. Revista Brasileira de Ortopedia. Woolf CJ. Central sensitization: uncovering the relation between pain and plasticity.
Functional reorganization in the rat dorsal horn during an experimental myositis. Sato A. Somatovisceral reflexes. J Manipulative Physiol Ther. Sperry M, Goshgarian H. Ultrastructural changes in the rat phrenic nucleus developing within 2 h after cervical spinal cord hemisection. Experimental Neurology. Mense S, Hoheisel U. Central nervous sequelae of local muscle pain. Journal of Musculoskeletal Pain. Cerebral processing of acute skin and muscle pain in humans.
J Neurophysiol. Injection of nerve growth factor into human masseter muscle evokes long-lasting mechanical allodynia and hyperalgesia. Sensitization of rat dorsal horn neurons by NGF-induced subthreshold potentials and low-frequency activation. A study employing intracellular recordings in vivo. Brain Research. Central sensitization, referred pain and deep tissue hyperalgesia in musculoskeletal pain. Proceedings of the 11th World Congress on Pain.
Melzack R, Wall PD. Pain mechanisms: a new theory. Willard F. Humana Press Inc; Totowa: Basic Mechanisms of Pain. Simons , D. Travell and Simons ' myofascial pain and dysfunction : the trigger point manual , vol. Upper half of body a.
Upper half of body. Williams and Wilkins, Upper Half of Body. Author : David G. It includes new drawings, a number of trigger point release techniques in addition to spray and stretch, and a new chapter on intercostal muscles and diaphragm. Author : Janet G. This book answers all possible questions regarding muscle pain - from local muscle soreness to the f ibromyalgia syndrome.
The unique concept behind the book is the combin ation of neuroanatomical and neurophysiological data with the clinical management of all diseases that exhibit muscle pain. Organized by chief complaint, each chapter follows a structured format that takes readers from overview and assessment, through a case history, to a planned program of rehabilitation, generalization to similar conditions, and a treatment protocol.
Author : Michael Hutson Publisher: Oxford University Press ISBN: Category: Musculoskeletal system Page: View: Read Now » Musculoskeletal medicine is now recognised as a distinct branch of medicine, incorporating the sub-specialities of manual medicine, orthopaedic medicine, and the neuromusculoskeletal component of osteopathic medicine. The editors of this volume have been active in promoting the discipline worldwide, and this new edition is the ideal reference for doctors and therapists wishing to expand and improve their skill base, or to further their careers and academic accomplishments, to the benefit of the patient.
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