Myofascial Triggerpoints in an Updated Pain Framework

myofascial triggerpoints

From a Clinical Perspective, Myofascial Trigger Points Describe a Phenomenon

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 2017).

These clinical findings may be help clinicians investigate common pain patterns, such as:
• Neck Pain (Morikawa et al. 2017)
• Migraine Headaches (Landgraf et al. 2017)
• Tension-Type Headache (Fernández-De-Las-Peñas & Arendt-Nielsen 2017)
• Carpal Tunnel Syndrome (Meder et al. 2017)
• Low Back Pain (Takamoto et al. 2015)
• Chronic Pelvic Pain (Fuentes-Márquez et al. 2017)

Sore Spots Exist, but Their Etiology is Still Not Well Understood.

It has been demonstrated that patients benefit from hands on work aimed at MTrPs, but this may not always be due to reasons we once were taught. One issue is that ascribing patient’s pain solely to MTrPs or other tissue-driven pain problem is often an oversimplification of a complex process. When it comes to MTrPs there are a number of 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).
  • Expanded Integrated Hypothesis - the zone around a MTrP seems to be in an ischemic state resulting in a shortage of glucose and oxygen for metabolism and subsequent sarcomere contracture (Gerwin et al 2004).
  • Neurogenic Inflammation - the release of inflammatory substances from the nerve axon, result in a lower the threshold for depolarization (Quintner et al. 2015).
  • Central Sensitization - several studies support the hypothesis that persistent nociceptive input from MTrP 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 MTrP activity (Fernández-de-las-Peñas et al. 2014).

More to Explore


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