8 Myofascial Triggerpoints

Myofascial Trigger Points

Convergent Thinking and Myofascial Trigger points

The concept of sore spots that can be leveraged for therapeutic purposes have been independently discovered by several different cultures in Europe, Africa and Asia. One of the oldest examples on record is a 5,300 year old naturally preserved human body discovered in the Tyrolean Alps of Austria called Otzi “The Iceman”. This frozen body has 61 tattoos that correspond to myofascial trigger points and traditional acupuncture points that are commonly utilized to treat musculoskeletal pain. This 5300 year old preserved body gives insight into ancient medical practices, as it is believed that these tattoos represent an early form of therapeutic treatment similar to acupuncture used to treat low back and knee pain (Kean et al., 2013; Zink et al., 2019).

It is well documented in Asian cultures that traditional healers would therapeutically treat sore spots with manual therapy or acupuncture needles, one example is ASHI (ah yes!) points, a central tenant in acupuncture for over two thousand years. Many years later in the 1930’s Jonas Henrik Kellgren started the scientific investigation into these sore spots or what he called Referred Pain from Muscle (Kellgren, 1938). This was then followed up by years of research and documentation by Janet Travell and David Simons, the result of their cumulative work was the textbook – Travell, Simons and Simons’ Myofascial Pain and Dysfunction (now in its 3rd edition).

Myofascial Trigger point Pathophysiology: Sore Spots Exist, But Their Etiology is Still Not Well Understood.

Early research into myofascial trigger points often focused on a physiological dysfunction involving local soft tissue, but recently clinicians have spoken out against these traditional narratives to say that the explanations used in the past of this observable phenomenon are flawed in reasoning. They posit that what we call a myofascial trigger point may represent a form of nociplastic pain where there are neuroplastic changes of the peripheral or central nervous system (Quintner et al., 2015).

Moving forward as a profession we ought to acknowledge that there is uncertainty about myofascial trigger points and update the way we communicate with patients and other healthcare providers. One issue is that ascribing a patient’s pain solely to myofascial trigger points or other tissue-driven pain problem is often an oversimplification of a complex process. When it comes to myofascial trigger points there are several competing hypothesis, including, but not limited to:

  • Cinderella Hypothesis – low-level, continuous muscle contractions overload tissues and makes “Cinderella” fibers susceptible to calcium dysregulation and subsequently sarcomere contracture (Bron et al., 2012).
  • Integrated Hypothesis – the zone around a myofascial trigger points seems to be in an ischemic state resulting in a shortage of glucose and oxygen for metabolism and subsequent contracted sarcomeres in skeletal muscle (Gerwin et al., 2004; Gerwin et al., 2020).
  • Neurogenic Inflammation – the release of inflammatory substances from the nerve axon, results in a lower threshold for depolarization and hyperalgesia in innervated tissue (Quintner et al., 2015).
  • Central Sensitization – several studies support the hypothesis that persistent nociceptive input from myofascial trigger points contributes to the development of central sensitization and/or changes in the dorsal horn. In contrast, preliminary evidence suggests that central sensitization can also promote myofascial trigger points activity (Fernández-de-las-Peñas et al., 2014).

International Consensus on Diagnostic Criteria and Clinical Considerations of Myofascial Trigger Points

In an effort to establish standard terminology an international panel of 60 clinicians and researchers was recently consulted to establish a consensus for identification of a myofascial trigger point. The panel agreed on two palpatory and one symptom criteria: a taut band, a hypersensitive spot, and referred pain (Fernández-de-Las-Peñas & Dommerholt, 2018).

Myofascial Trigger Points: Examination and Treatment Considerations

It has been demonstrated in a number of studies that patients benefit from hands-on work aimed at myofascial trigger points, but this may not always be due to reasons we once were taught. Even if some of the traditional narratives around myofascial trigger points may be flawed, myofascial trigger points describe an observable phenomenon that may be help clinicians investigate common pain patterns, such as:
• Temporomandibular Disorders (Moayedi et al., 2020)
• Facial Pain (Gerwin, 2020)
• Neck Pain (Morikawa et al., 2017; Castaldo et al., 2019)
• Migraine Headaches (Landgraf et al., 2018)
• Tension-Type Headache (Fernández-De-Las-Peñas & Arendt-Nielsen, 2017; Palacios-Ceña et al., 2018)
• Carpal Tunnel Syndrome (Meder et al., 2017)
• Low Back Pain (Takamoto et al., 2015; Kodama et al., 2019)
• Chronic Pelvic Pain (Fuentes-Márquez et al., 2019)

Key Takeaways

Myofascial Trigger Points: What Are They, Really?

From a clinical perspective, myofascial trigger points describe an observable phenomenon that may help clinicians investigate common pain patterns. There is still no consensus on the etiology of these sore spots and what role they play in the generation and propagation of myofascial pain syndrome.

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