Points That Need More Than Pondering: Defining Myofascial Trigger Points

What is a Myofascial Trigger Point (MTrP), and why does it matter, especially in fibromyalgia?

Myofascial trigger points can mimic many things and cause pain, dysfunction, and shortening of the muscle affected by this knotted up muscle fiber in a taut band of muscle. Such things as paresthesias (numbness and tingling that can be local or radiate in a specific pattern), burning, and pain can result from a MTrP, which is entrapping a nerve. Circulation/temp changes can occur if a MTrP is located next to a blood vessel, and swelling can develop if the MTrP is located next to a blood or lymph vessel). (Helpful treatments are links following).

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Common Abbreviations©

MPS: myofascial pain syndrome
CMP: chronic myofascial pain
MTP: myofascial trigger point
TrP: trigger point

Myofascial Trigger Point©
A myofascial trigger point (TrP) is a self-sustaining, irritable area in the muscle that can be felt as a nodule in a taut band. This irritated spot causes the muscle to gradually shorten, interfering with the motion function of the muscle and causing weakness and pain. Trigger points differ from tender points in that generally they refer pain to other parts of the body and can usually be felt with the hand (palpated) unless the muscle is too rigid from intense muscle involvement, or the trigger point is in a deep muscle or under bone. The tender points of FM or myalgias associated with CFID do not restrict motion or cause localized muscle weakness. If they do, the patient should also be evaluated for the presence of CMP. Trigger points in CMP are well defined and often radiating—the pain radiates out to other parts of the body.

Active Trigger Point©
An active TrP is a myofascial trigger point that causes pain at rest. It is always tender, causes shortening of the muscle, weakens the muscle, and causes patient complaints of referred pain on direct compression. An active trigger point can elicit a visible local twitch response when adequately stimulated by compression or needle insertion. It can produce referred motor and autonomic phenomena, generally occurring in the TrP referral zone. An active TrP can also cause the referral zone to become tender.

Secondary Trigger Point©
A secondary TrP is one that develops in a second compensating muscle. A compensating muscle is one that is trying to make up for the malfunction of the muscle affected by primary trigger points. In other words, when a primary trigger point causes muscle dysfunction, the opposing muscles become stressed. These opposing muscles become overloaded because they are attempting to carry the entire load of the muscle work needed to perform a task. When staring at a computer screen your head starts to drift forward after a while, particularly if you spend hours there. You may have primary TrPs in muscles on the front of your neck, which may or may not be making their presence known. As your head starts drifting forward, putting less stress on the primary TrPs because of the slackening, the muscles on the backside of your neck are being stretched and stressed in an effort to keep your face from falling onto your keyboard. The sustained overstretching of these muscles causes secondary trigger points to develop in the muscles on the back of your neck. (This is an important reason to pay attention to posture as an aggravating factor, to be discussed in chapter 4.)

Satellite Trigger Point©
Chronic myofascial pain (CMP) from myofascial trigger points is a peripheral nerve to muscle problem. Acetylcholine (a neurotransmitter, a chemical that carries information from the peripheral nervous system to the central nervous system) has been found in excessive amounts. Fibromyalgia, CFID/ME, migraine, IBS, irritable bladder and several other common co-existing conditions have a strong central nervous system component. When any of these co-exist with chronic myofascial pain (CMP) from myofascial trigger points (TrPs), the peripheral message of painful trigger points to the brain keeps the brain in a hypersensitive state," causing a “wind up” phenomenon at the HPA-axis (dysfunctional in FM and thought to be dysfunction in CFID) is off an running.

End Comments:
Chronic myofascial pain (CMP) from myofascial trigger points is a peripheral nerve to muscle problem. Acetylcholine (a neurotransmitter, a chemical that carries information from the peripheral nervous system to the central nervous system) has been found in excessive amounts where nerve meets muscle. Biopsies show a histological difference in MTrP fiber and even differences between an active and latent MTrP. Because of development of new technology examiners can now easily locate MTrPs for treatment.

Fibromyalgia, CFID/ME, migraine, IBS, irritable bladder and several other common co-existing conditions have a strong central nervous system component. When any of these co-exist with chronic myofascial pain (CMP) from myofascial trigger points (TrPs), the peripheral message of painful trigger points to the brain keeps the brain in a hypersensitive state," causing a “wind up” phenomenon at the HPA-axis (dysfunctional in FM and thought to be dysfunction in CFID) is off an running.

Myofascial trigger points can mimic sciatica, pelvic floor pain, or costochondritis. They can also cause painful intercourse, impotence, vulvodynia, cavitational necrosis, TMJ/TMD, restless leg syndrome, PMS, and much more. They can be one of the main factors in migraine headaches, chronic sinusitis and a host of other conditions. They are NOT to be taken lightly, especially now with abounding and repeated research over more than a decade showing us that they are a main component in the pain of FM.

Myofascial Release http://www.myofascialrelease.com/fascia_massage/public/default.asp

Active Release Therapy (ART) http://www.qfac.com/pain_management/active_release_therapy.html

National Association of Myofascial Trigger Point Therapists http://www.myofascialtherapy.org

Recommended reading for self treatment:
Integrative Therapies for Fibromyalgia, Chronic Fatigue Syndrome and Myofascial Pain: The Mind-Body Connection by Celeste Cooper, RN and Jeff Miller, PhD. Healing Arts Press: Vermont, 2010. (Forward by Devin Starlanyl, author, researcher, endorsed by Dr. John Whiteside, myofascial and holistic specialist physician, Australia, and Bill Douglas, Best Selling author, teacher, and founder of many stress management programs with global recognition.)

Healing Arts Press (Publisher)
http://store.innertraditions.com/isbn/978-1-59477-323-5 (On Sale)

Amazon
http://www.amazon.com/Integrative-Therapies-Fibromyalgia-Syndrome-Myofascial/dp/1594773238/ref=sr_1_1?ie=UTF8&s=books&qid=1246252159&sr=8-1(available in Kindle)

Barnes and Nobel
http://search.barnesandnoble.com/Integrative-Therapies-for-Fibromyalgia-Chronic-Fatigue-Syndrome-and-Myofascial-Pain/Jeffrey-Miller/e/9781594773235?itm=1&USRI=Integrative%20Therapies%20for%20Fibromyalgia,%20Chronic%20Fatigue%20Syndrome,%20and%20Myofascial%20Pain:%20The%20Mind-Body

The Trigger Point Therapy Workbook, 2nd ed. By Clair Davies, NCTMB with Amber Davies, NCTMB. New Harbinger: Oakland, 2004. (Forward by Dr. David Simons)

http://www.triggerpointbook.com/triggerp.htm

Amazon
http://www.amazon.com/Trigger-Point-Therapy-Workbook-Self-Treatment/dp/1572243759/ref=sr_1_1?ie=UTF8&qid=1307195480&sr=8-1

Barnes and Nobel
http://www.barnesandnoble.com/w/trigger-point-therapy-workbook-2d-clair-davies/1006105335

I hope you found this information helpful.


"Though our bodies are weak our determination is unbreakable, standing tall, standing strong, standing united, committing to a cure."

Celeste http://TheseThree.com
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