Condition-Specific Massage Therapy
LWW:
Instructor Resources from Bucci, Celia. Condition-Specific Massage Therapy. © Lippincott Williams & Wilkins/Wolters Kluwer Health
Chapter 3 – Myofascial Trigger Points
Lecture Notes
(Lecture notes can be distributed to students as a guide to classroom discussion, and as a study guide)
What is a trigger point?
a spot that shows evidence of an excessive, prolonged response to stimuli.
may be found in epithelial tissue, connective tissue, nerves and muscles.
refer pain to a location distant from the nodule in predictable patterns.
What is a myofascial trigger point?
trigger points in muscles and fascia
palpated as a nodule within a taut band of muscle.
frequently found at the neuromuscular junction - the site of synaptic contact between the motor neuron and muscle fibers
dysfunction at the neuromuscular junction produces a sustained contraction of affected muscle fibers
sustained contraction initiates a cycle that perpetuates the contraction, shortening muscle fibers and reducing action potential
Categories of trigger points
Active trigger point causes symptoms with normal activities of daily living and at rest. The referred sensation elicited by compressing an active trigger point will likely replicate the client’s pain during daily life
Latent trigger point is painful only on compression, does not cause pain during activities of daily living or rest
Satellite trigger point develops within the referral area of an active trigger point, in an overloaded synergist, or in the antagonist of the muscle containing a trigger point.
Signs and symptoms
pain in a general area
rarely produce sharp or easily localized pain unless directly compressed
predictable pattern of referred pain
passive stretch may be painful
contraction may aggravate trigger point
palpable taut band in muscle
may be difficult for the client to relax a muscle containing a trigger point
muscle tension, hypertonicity, and spasm may develop in muscles containing trigger points
affected muscles may be short, tense, may fatigue quickly, and may not lengthen fully without pain
referred autonomic phenomena including dilation or constriction of blood vessels, changes in local temperature, sweating, goose bumps, and production of tears or saliva
trigger points in some muscles may cause dizziness, ringing in the ears, and problems maintaining balance
local twitch response – a quick flutter of muscle fibers
Limiting the function of the prime mover containing a trigger point can overload its synergists and antagonists, which may in turn cause trigger points in those muscles
Reflex inhibition caused by trigger points may lead to weakness in muscles that show no sign of atrophy
Causes and contributing factors
mechanical overload of a muscle, whether by acute incident or repetitive misuse
muscle shortened due to postural imbalance
chilling a muscle may activate a trigger point
compression of muscles by external forces
nerve compression may activate a trigger point
pathologies including organ insufficiency and inflammatory conditions
trauma, fatigue, and physical or emotional stress
conditions that affect metabolic, endocrine, or chemical homeostasis
vitamin deficiency
chronic bacterial or viral infections and some allergies
regular exposure to toxic chemicals or heavy metals
Contraindications and special considerations
infection
acute injury
reproducing symptoms
causing kick-back pain
hypermobile joints and overstretched muscles
deep friction if tissue is at risk for rupture, or client takes anti-inflammatory meds or anticoagulants
treating aggressively or attempting to resolve several trigger points in one session may cause kick-back pain
Health history
When did the symptoms begin?
Did you have an injury or surgery to this area?
Do you have a history of chronic infection, metabolic disorders, or other chronic pain health conditions?
Have you seen a health care provider for this condition? What was the diagnosis?
What tests were performed?
Where do you feel symptoms?
Describe your symptoms.
Describe your posture during sleep, work or other activities.
Do any movements make symptoms better or worse?
Are you taking any medications?
Postural assessment
imbalances in movement or patterns of compensation give clues about the location of trigger points
reduced mobility or a favoring one side
lower body: watch as client walks, climbs steps, sits, and stands from sitting; client may stand in a position
that keeps resistance off the affected muscles
upper body: watch as client opens the door, takes off coat, or picks up a pen; client may hold the joint in a position that keeps the injured muscle from stretching
notice if the client rotates the trunk to avoid rotating the head notice if client is able to perform activities without assistance or avoids lengthening or loading certain muscles
ROM assessment
Active ROM of the affected joint may be limited
Passive ROM of the affected joint may produce no symptoms when shortening the affected muscle, and may produce pain when lengthening the affected muscle
R ROM of the affected joint may reveal weakness in the affected muscle
Palpation
Muscle is relaxed and comfortably lengthened
Work slowly with full concentration – approx. 6 seconds per inch of tissue palpated
Locate taut band
Locate nodule within taut band
Assess referral pattern
Condition-specific massage
Work proximal muscles to increase circulation
Assess and treat local fascial restrictions
Soften peripheral tissues
Place affected muscle in pain-free, lengthened position
Palpate and accurately locate taut band and trigger point
Begin with slow repetitive muscle stripping along entire length of the taut band until pain diminishes
If trigger point is not relieved, apply direct compression
If compression does not alleviate trigger point, use soften, stretch, and heat affected muscle to calm the area and leave it until a subsequent session
Stretch each muscle in which trigger points are treated
PIR if indicated
Apply moist heat to affected muscles if indicated
Reassess muscle length