The RMT Education Project attempts to simplify the complex and inspire a shared vision where massage therapists are headed as a profession. If you are looking for a place to start, check out our 'Research Reviews'.
Can You Feel That Knot?
Can you feel that knot? We have heard many of our patients say this during a massage. Some call them 'knots', others call them 'myofascial trigger-points'. One of the things that is confusing about those sore spots is the plurality of definitions. Knots are often used as a layman's term to describe myofascial trigger-points, but depending on who you are talking to knots and myofascial trigger-points may not be synonymous.
For The Critical Thinkers: What Does The Research Say?
Whatever you call these sore spots, you are likely to be familiar with the pain attributed 'myofascial trigger-points'. What is surprising is that 24 years after the publication of The Trigger Point Manual by David Simons and Janet Travell, there is still no consensus on the etiology of these sore spots, hypothesis include: neurogenic inflammation, central sensitization, end-plate noise and fascial densification.
To further complicate the situation, the main trigger-point hypotheses from Travell and Simmons may even be flat out wrong. This was the crux of a recent critical evaluation of the trigger point phenomenon. This critical review shines some much need light on dogmatic views of pain, stating that past trigger-point theories have been "flawed both in reasoning and in science".
So, it appears that there is a need to update our explanations as to what these sore spots are. In 2015 the journal PM&R published Myofascial Trigger Points Then and Now: A Historical and Scientific Perspective by Jay Shah, this paper serves to forward our understanding on the subject of 'myofascial trigger-points'.
This narrative review acknowledges that the etiology of these sore spots is still not well understood, but that does not deny the existence of the clinical phenomenon. A contemporary view of 'myofascial trigger-points' is presented by Shah, this categorizes 'myofascial trigger-points' by the a number of measurable characteristics: local and remote inflammation, local acidic milieu, local sensitization, local regions of hypoxia, local muscle stiffness.
Stepping Back: What is the Big Picture?
The issue that most critics have with myofascial trigger-points or other tissue-driven pain problem is that it is an oversimplification of a very complex process. It is still not know if our manual treatments are ‘correcting a local pathology' or if it just sensory input leading to a cascade response through the nervous system resulting in the 'descending modulation' of the pain experience.
Even though the etiology of these enigmatic sore spots is still not completely understood, people seem to benefit from treatments aimed at localized sore spots. Often what therapists are assessing and treating is described as a local induration of soft tissue with a replicable pain pattern which may or may not be associated with a local twitch response. The explanations used in the past of this observable phenomenon seem to be flawed in reasoning, but I do not think there is a need to abandon treatment approaches that provide patients with pain relief. What is needed is an updated model of what causes these sore spots to develop and what is the most effective way of delivering a treatment that will help people in pain.
The explanations used in the past of this observable phenomenon seem to be flawed in reasoning, but I do not think there is a need to abandon treatment approaches that provide patients with pain relief.
Links for The Curious
Bron, C., & Dommerholt, J. D. (2012). Etiology of Myofascial Trigger Points. Curr Pain Headache Rep Current Pain and Headache Reports, 16(5), 439-444.
Chen, Q., Bensamoun, S., Basford, J. R., Thompson, J. M., & An, K. (2007). Identification and Quantification of Myofascial Taut Bands With Magnetic Resonance Elastography. Archives of Physical Medicine and Rehabilitation,88(12), 1658-1661.
Chen, Q., Wang, H., Gay, R. E., Thompson, J. M., Manduca, A., An, K., . . . Basford, J. R. (2016). Quantification of Myofascial Taut Bands. Archives of Physical Medicine and Rehabilitation, 97(1), 67-73.
Meakins, A. (2015). Soft tissue sore spots of an unknown origin. British Journal of Sports Medicine, 49(6), 348-348.
Quintner, J., Bove, G., & Cohen, M. (2015). A critical evaluation of the trigger point phenomenon. Rheumatology, 392-399.
Shah, J., Thaker, N., Heimur, J., Aredo, J., Sikdar, S., & Gerber, L. (2015). Myofascial Trigger Points Then and Now: A Historical and Scientific Perspective. Pm&r, 746-761.