Myofascial Triggerpoints in an Updated Pain Framework

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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

SCISHOW HAS PUT TOGETHER A INSIGHTFUL VIDEO ON MYOFASCIAL TRIGGER-POINTS.

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https://www.ncbi.nlm.nih.gov/pubmed/26550960

Bron, C., Dommerholt, J.D. (2012). Etiology of myofascial trigger points. Curr Pain Headache Rep.
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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. Archives of Physical Medicine and Rehabilitation.
https://www.ncbi.nlm.nih.gov/pubmed/26461163

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Fernández-de-las-Peñas, C., Dommerholt, J. (2014). Myofascial trigger points: peripheral or central phenomenon? Curr Rheumatol Rep.
https://www.ncbi.nlm.nih.gov/pubmed/24264721

Fernández-De-Las-Peñas, C., Arendt-Nielsen, L. (2017). Improving understanding of trigger points and widespread pressure pain sensitivity in tension-type headache patients: clinical implications. Expert Rev Neurother.
https://www.ncbi.nlm.nih.gov/pubmed/28745080

Fernández-de-Las-Peñas, C., Dommerholt, J. (2017). International Consensus on Diagnostic Criteria and Clinical Considerations of Myofascial Trigger Points: A Delphi Study. Pain Med.
https://www.ncbi.nlm.nih.gov/pubmed/29025044

Fuentes-Márquez, P., Valenza, M.C., ... Ocón-Hernández, O. (2017). Trigger Points, Pressure Pain Hyperalgesia, and Mechanosensitivity of Neural Tissue in Women with Chronic Pelvic Pain. Pain Med.
https://www.ncbi.nlm.nih.gov/pubmed/29025041

Gallagher, R. M. (2015). Editor's Response. Pain Medicine; 16 (4): 829.
http://painmedicine.oxfordjournals.org/content/16/4/829

Gerber, L.H., Sikdar, S., Aredo, J.V., Armstrong, K., Rosenberger, W.F., Shao, H., Shah, J.P. (2017). Beneficial Effects of Dry Needling for Treatment of Chronic Myofascial Pain Persist for 6 Weeks After Treatment Completion. PM R.
https://www.ncbi.nlm.nih.gov/pubmed/27297448

Gerwin, R.D., Dommerholt, J., Shah, J.P. (2004). An expansion of Simons' integrated hypothesis of trigger point formation. Curr Pain Headache Rep.
https://www.ncbi.nlm.nih.gov/pubmed/15509461

Gerwin, R. (2016). Myofascial Trigger Point Pain Syndromes. Seminars in Neurology.
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Gerwin, R.D. (2017). Trigger Point Diagnosis: At Last, the First Word on Consensus. Pain Medicine.

Grosman-Rimon, L., Clarke, H., Chan, A.K., Mills, P.B., Rathbone, A.T.L., Kumbhare, D. (2017). Clinicians' perspective of the current diagnostic criteria for myofascial pain syndrome. J Back Musculoskelet Rehabil. 
https://www.ncbi.nlm.nih.gov/pubmed/27858678

Landgraf, M.N., Biebl, J.T., Langhagen, T., Heinen F. (2017). Children with migraine: Provocation of headache via pressure to myofascial trigger points in the trapezius muscle? - A prospective controlled observational study. Eur J Pain.
https://www.ncbi.nlm.nih.gov/pubmed/28952174

Nascimento, J.D.S.D., Alburquerque-Sendín, F., Vigolvino, L.P., Oliveira, W.F., Sousa, C.O. (2017). Inter and intraexaminer reliability in identifying and classifying myofascial trigger points in shoulder muscles. Arch Phys Med Rehabil.
https://www.ncbi.nlm.nih.gov/pubmed/28751256

Meder, M.A., Amtage, F., Lange, R., Rijntjes, M. (2017). Reliability of the Infraspinatus Test in Carpal Tunnel Syndrome: A Clinical Study. J Clin Diagn Res.
https://www.ncbi.nlm.nih.gov/pubmed/28658894

Moraska, A.F., Schmiege, S.J., Mann, J.D., Butryn, N., Krutsch, J.P. (2017). Responsiveness of Myofascial Trigger Points to Single and Multiple Trigger Point Release Massages: A Randomized, Placebo Controlled Trial. Am J Phys Med Rehabil. 
https://www.ncbi.nlm.nih.gov/pubmed/28248690

Moraska, A.F., Hickner, R.C., Kohrt, W.M., Brewer, A. (2013). Changes in blood flow and cellular metabolism at a myofascial trigger point with trigger point release (ischemic compression): A proof-of-principle pilot study. Arch Phys Med Rehabil. (OPEN ACCESS)
https://www.ncbi.nlm.nih.gov/pubmed/22975226

Morikawa, Y., Takamoto, K., Nishimaru, H., Taguchi, T., Urakawa, S., Sakai, S., Ono, T., Nishijo, H. (2017). Compression at Myofascial Trigger Point on Chronic Neck Pain Provides Pain Relief through the Prefrontal Cortex and Autonomic Nervous System: A Pilot Study. Front Neurosci.
https://www.ncbi.nlm.nih.gov/pubmed/28442987 (OPEN ACCESS)

Palacios-Ceña, M., Wang, K., Castaldo, M., Guillem-Mesado, A., Ordás-Bandera, C., Arendt-Nielsen, L., Fernández-de-Las-Peñas, C. (2017). Trigger points are associated with widespread pressure pain sensitivity in people with tension-type headache. Cephalalgia.
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Palacios-Ceña, M., Castaldo, M., Wang, K., Catena, A., Torelli, P., Arendt-Nielsen, L.,Fernández-de-Las-Peñas, C. (2017). Relationship of active trigger points with related disability and anxiety in people with tension-type headache. Medicine (Baltimore).
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Simons, D.G. (2008). New views of myofascial trigger points: etiology and diagnosis. Arch Phys Med Rehabil. 
https://www.ncbi.nlm.nih.gov/pubmed/18164347

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https://www.ncbi.nlm.nih.gov/pubmed/25724849

Takamoto, K., Bito, I.,  Urakawa, S., Sakai, S., Kigawa, M., Ono, T., Nishijo, H. (2015). Effects of compression at myofascial trigger points in patients with acute low back pain: A randomized controlled trial. Eur J Pain.
https://www.ncbi.nlm.nih.gov/pubmed/25808188

Takamoto, K., Sakai, S., Hori, E., Urakawa, S., Umeno, K., Ono, T., Nishijo, H. (2009). Compression on trigger points in the leg muscle increases parasympathetic nervous activity based on heart rate variability. J Physiol Sci.
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Watson, D. H., & Drummond, P. D. (2012). Head Pain Referral During Examination of the Neck in Migraine and Tension-Type Headache. Headache: The Journal of Head and Face Pain.
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