The myofascial pain syndrome (MPS)
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The myofascial pain syndrome (MPS)
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Features of MTrPs Motor:
disturbed motor function
muscle weakness as a result of motorinhibition
muscle stiffness
restricted range of motion
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Autonomic:
vasoconstriction
vasodilatation
Features of MTrPs
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Features of MTrPs Sensory:
local tenderness referral of pain to a distant site
peripheral sensitization
central sensitization
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Definition and type of Terms
Check handout please
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Examples of the two directions in
which trigger point may referred
A .)Peripheral projection of pain from suboccipital and
infraspinatus trigger points( . B .)Mostly central projection of pain from biceps brachii
trigger points with some pain in the region of thedistal tendinous attachment of the muscle .
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Other Muscle Pain
Terminology Fibrositis (Gowers,
1904)
Fibromyositis
(Telling, 1911) Myofasciitis (Albee,
1927)
Myofibrositis(Murray, 1929)
Perineuritis (Clayton& Livingstone, 1930)
Idiopathic myalgia (Gutstein-
Good, 1940)
Rheumatic myalgia (Good,
1941)
Myofascial Pain Syndrome
(Travell, 1948)
Myodysneuria (Gutstein,
1955)
Fibromyalgia (Yunus, 1977)
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Prevalence
Research has shown that MTrPs are commonly associated with facet
joint dysfunctions, disc herniation, osteoarthritis, migraine, tensiontype headache, (Fybromyalgia), visceral disorders etc.Dommerholt, J. and T. Issa, Differential diagnosis: myofascial pain, in Fibromyalgia syndrome; a practitioner's guide to
treatment, L. Chaitow, Editor. 2003, Churchill Livingstone: Edinburgh. p. 149-177.
A survey of APS (American Pain Society)-members shows that88.5% consider MPS as a legitimate diagnosisHarden, R.N., et al., Signs and symptoms of the myofascial pain syndrome: a national survey of pain management providers. Clin J Pain, 2000. 16(1): p. 64-72.
80% of 1096 subjects involved in low-velocity activity developedactive trigger points (MTrP)Schuller, E., W. Eisenmenger, and G. Beier, Whiplash injury in low speed car accidents. J Musculoskeletal Pain, 2000.8(1/2): p. 55-67.
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MTrPs have been identified with:
Radiculopathies joint dysfunction disk pathology tendonitis
Craniomandibular dysfunction migraines tension-type headaches carpal tunnel syndrome computer-related disorders whiplash associated disorders spinal dysfunction
pelvic pain and other urologicsyndromes
most pain syndromes
nocturnal cramps
phantom pain etc.
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Etiology of MTrPs
Acute Overuse
Direct Trauma
Persistent Muscular Contraction(emotional or physical cause), i.e,:poor posture, repetitive motions, stress
response
Prolonged Immobility
Systemic Biochemical Imbalance
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Diagnostic Criteria
taut band: the group of tense muscle fibersextending from a trigger
point to the muscleattachments, the tensionbeing caused bycontraction knots that are
located in the trigger pointregion
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Diagnostic Criteria
spot tenderness within the taut band (nociceptiveinput into the dorsal horn contributing to wind-up
and central sensitization)
local twitch response.
referred pain.
Jump sign.
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Identification
Myofascial Trigger Points
are identified by
physical examination,
specifically by palpation
There are two palpation
techniques:
Flat palpation
Pincer palpation
dependent upon the muscle
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Manual Trigger Point Therapy
Trigger Point Techniques
Trigger Point Compression (Technique I)
Manual stretching of the taut band in muscle fibre direction (Technique II)
Release Techniques:
Myofascial Release (Technique III)
Intermuscular mobilisation (Technique IV)
Stretching Techniques:
Therapeutic stretching (Technique V)
Self stretching (Technique VI)
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Manual Trigger Point Therapy
Trigger Point Compression (Technique I)
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Manual Trigger Point Therapy
Manual stretching of the taut band
in muscle fiber direction
(Technique II)
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Manual Trigger Point Therapy
Myofascial Release
(Technique III)
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Manual Trigger Point Therapy
Intermuscular mobilisation
(Technique IV)