A Few Thoughts on Myofascial Trigger Points

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The concept of sore spots that can be leveraged for therapeutic purposes have been independently discovered and used as a treatment for musculoskeletal pain by different cultures in the middle east, Europe, Africa and Asia.

A Few Thoughts on Myofascial Trigger Points

The concept of sore spots that can be leveraged for therapeutic purposes have been independently discovered and used as a treatment for musculoskeletal pain by different cultures throughout the Middle East, 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 also 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). Trigger points were described by Janet Travell as early as 1946, 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).

Otzi “The Iceman” believed to be 5,300 years old had 61 tattoos corresponding with acupuncture points and myofascial trigger points. Adapted from (Kean et al., 2013).

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

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).

Early research into myofascial trigger points often focused on a localized pathology with a focus on local soft tissue, but these traditional narratives used in the past may be flawed. Instead, what we call a myofascial trigger point may represent neurogenic inflammation of the myofascial unit resulting from persistent nociceptive bombardment and sensitization of the peripheral and/or central nervous system (Sikdar et al., 2023).

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 one interesting hypothesis proposes that persistent nociceptive bombardment contributes to sensitization of the peripheral and central nervous system. Which can results in a lower threshold for depolarization and hyperalgesia in innervated tissue (Sikdar et al., 2023).

Myofascial Trigger Points: Examination and Treatment Considerations

What we currently know is that myofascial pain syndromes involving trigger points are classified as a form of secondary musculoskeletal pain (Fitzcharles et al., 2022). It has been demonstrated in a number of studies that patients do benefit from hands-on work aimed at myofascial trigger points, but this may not always be due to reasons we once were taught (Guzmán Pavón et al., 2022; Fernández-de-Las-Peñas et al., 2023). 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:

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 musculoskeletal pain.

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