What exactly is a Trigger Point?

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THEY ARE THE MOST COMMON CAUSE OF MUSCULAR PAIN AND DYSFUNCTION.

Myofascial Trigger points (TrPs) are discrete, focal, hyperirritable spots located in a taut band of skeletal muscle. They produce pain locally and in a referred pattern, and almost always accompany musculoskeletal disorders. Palpation of a hypersensitive bundle or nodule of muscle fiber of harder than normal consistency is the physical finding typically associated with a trigger point. They can develop in any area of a muscle as well as connective tissue. Referred pain patterns are their identifying signature.

TrPs are one of the most overlooked and ignored causes of musculoskeletal disorders (MSDs). Evidence suggests they are a common primary dysfunction (not secondary to other diagnoses), but we also know they co-occur with a variety of musculoskeletal conditions such as Osteoarthritis, Myofascial Pain Syndrome, Fibromyalgia, Multiple Sclerosis and with many visceral conditions. Trigger points may also manifest as tension headache, tinnitus, temporomandibular joint pain, as well as decreased range of motion in the legs, and low back pain.  They provoke motor dysfunction, muscle weakness, altered motor recruitment, muscle inhibition, muscle cramps and muscle knots. The muscle affected has higher stiffness, reduced vibration amplitude, higher peak systolic velocities and negative diastolic velocities compared to normal muscle.

TrPs form due to a variety of factors including repetitive muscle overuse, acute muscle overload, muscle trauma, microtrauma (as with invasive surgical procedures), sustained low-level muscle contractions, psychological stress and visceral disorders.

TrPs act as ongoing nociceptive stimuli contributing to pain propagation and widespread pain. The referred pain is a central nervous system phenomenon initiated and activated by peripheral sensitization, whereby the peripheral nociceptive input from the muscle can sensitize dorsal horn neurons that were previously silent. This input is the stimulus by which we perceive damage or potential damage caused to our body by excessive heat—excessive cold -– or physical injury.

ACTIVE TRIGGER POINTS (TrPs) CAUSE YOUR PAIN; LATENT TrPs ARE THE REASON IT PERSISTS.

After more than 40 years of clinical research and studies, Drs. Janet Travell and David Simons wrote what is considered the Medical Bible on TrPs. They found TrP manual therapy and TrP injection therapy were especially effective to inactivate trigger points. Many therapists also incorporate ultrasonography and laser therapy as treatment modalities, although there is no clinical evidence either are indicated for effective treatment.

A few interesting and not so well-known facts about TrPs:

• They can form anywhere in a muscle and connective tissue (ligaments and tendons)—although Travell and Simons developed what is known as the trigger point charts, they were intended to provide a starting examination point for locating TrPs related to specific disorders. Many believe the charts provide definite TrP locations —which is incorrect. 
• Referred pain patterns of TrPs located in specific regions are consistent and predictable which helps the therapist in locating related TrPs. However, self-applied therapy reveals these patterns clearly to the patient with absolute accuracy. Deactivating ALL related TrPs is essential to the therapy process.
  
• Where TrPs are present, the muscle cannot be effectively stretched or strengthened without first eliminating/deactivating them.

 Our device affects neurotransmission which activates biochemical changes at the sarcomere level to deactivate TrPs. This reconnection is critical in recovering normal muscle function.  One serendipitous discovery we made--actually concluded as a result of 100% of subjects in one study; the neurotransmission/reconnection was more readily achieved through self-applied therapy as opposed to a PT applying it. 

TREATMENT INDICATIONS

 The most effective therapeutic techniques for treating musculoskeletal disorders require forms of manual therapy (including compression) to relieve knots, relax spasm and deactivate TrPs. Compressive TrP therapy techniques are applied to the active TrPs with our device. The referred pain pattern is then followed to locate and deactivate the relating latent/satellite/secondary TrPs. Ice and stretching, including the spray and stretch method, are applied before any exercises to reestablish range of motion are performed. In some chronic cases, dry needling or TrP injections may also be indicated and usually administered by the Physician. Other therapeutic treatment modalities such as electronic muscle stim, ultra-sound, traction and even chiropractic can be helpful with specific issues. The purpose of therapeutic intervention should ultimately be to avoid more drastic surgical intervention. The results of surgery are never guaranteed and often lead to other issues for the patient down the road. Prescription medications are usually prescribed for pain, however, once resolved, Doctors usually recommend over-the-counter pain medications to avoid the risk of addiction. Prescription medications, unfortunately, can produce side-effects that can often be more damaging than the original injury. Even over-the-counter medications can have adverse effects on the kidneys and liver. Since these injuries don’t necessarily produce active symptoms; the patient doesn’t know the extent of damage until it has reached a level requiring more drastic medical intervention. 

Injury

In treatment of injury, the TrPro-Relief device is indicated as a part of the overall therapeutic process. To prevent further weakening or strains while a patient is in rehabilitation mode, muscle knots and TrPs must be eliminated before stretching, range of motion or strengthening exercises can be effective. Functional compensation leading to new injuries is a common pitfall for the injury patient that can dramatically hinder outcomes and pre-dispose them to further complications. A patient will subconsciously favor an injury due to pain, weakness, lack of mobility or altered motor recruitment; this favoring (functional compensation) most often results in new injuries to an opposite or supportive muscle group. TrPs form in the compensating musculature causing the entire injury process to begin in a new region.

Pain

Treating pain symptoms can get complicated by the prevalent use of medications: both prescription and over-the-counter. A person in pain suffers at rest and while moving. Mobility and range of motion are usually compromised and an overall state of helplessness can be common. Medications temporarily eliminate pain and can be mood altering which can help a patient deal with quality of life restrictions caused by their disability. The TrPro-Relief device, again, can play a supporting role or be the focal point of treatment. It can help alleviate pain, increase mobility and support other therapy. 

Preventative

Preventative Medicine is a wide scope in the medical community. Relative to the TrPro-Relief device, it means preventing future disability resulting from functional compensation and identifying/eliminating injury potential at onset or the very earliest stages. Treating TrPs and muscle knots before they become debilitating is best practice medicine. Whether treating a surgical rehab patient or a patient limited by injury and musculoskeletal dysfunction, our device is instrumental as it reinforces the importance of treating latent and secondary/satellite TrPs that ordinarily would not be identified or addressed in typical musculoskeletal therapy practices.

Rehabilitation from surgical intervention

Invasive procedures such as joint surgery almost always form TrPs. With TrPs present, the rehabilitation steps pertaining to strengthening or increasing range of motion are unproductive. The TrPs must be addressed first for other modalities to be effective. It is also imperative with surgery rehabilitation to be aware of the potential for compensation injuries. The TrPro-relief device is an ideal management tool for this issue. Configuration of our device with the mobility attachments is particularly beneficial.