Myofascial pain trigger points
by John Halford
‘Myofascial’
(the term comes from ‘myo’ = muscle, and ‘fascia’ = connective tissue which
envelopes muscles, tendons and joint capsules).
The muscles are the active organs of locomotion. They are
formed of bundles of reddish fibres, consisting of fibrine, and endowed with
the property of contractility.
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The fascia (bandage) are fibro-areolar or aponeurotic
laminae, of various thickness and strength. It is the aponeurotic or deep
fascia which form sheaths for the muscles, tendons and connective tissues.
Every muscle has a potential ‘trigger
point’. When this trigger point flares up, goes into spasm
and becomes painful often that one trigger point radiates its pain to
another muscle. It triggers off pain from the
source point to the satellite point.
It is necessary to distinguish between ‘myofascial
pain’ and ‘nerve root pain’. The irritation of a nerve and
thus nerve root pain, even if in the same distribution, is not to be
confused with myofascial pain. Myofascial pain is due solely to activation
of trigger points and their associated zones of activity.
There are three kinds of trigger points which develop in the
muscles, tendons and joint capsules.
These trigger points can be:
(1) INACTIVE in which case,
although they are there, they are like a dormant volcano.
They can be
(2) LATENT like a rumbling
volcano which can erupt at any time.
They can be
(3) ACTIVE like a volcano in
action and erupting.
Each muscle has its own characteristic pattern of pain
referral. Often this can cause another trigger point to become active in
another muscle within the zone of radiation of the original trigger. These
are called ‘satellite’ trigger
points.
The moving parts of the body were created, and intended to
move through a specified range of motion freely, easily and completely. When
for any number of reasons they lose the ability to do this, there will be a
problem. The most prevalent reason for the original loss of free motion is
the residual muscle tightening which develops as a result of strain and
exertion. Other factors are age, nervous tension, mechanical or emotional
stress, infections, inflammatory conditions, exposure to draughts, the
over-development of muscle, the secondary effects of injury, maximum effort,
and/or the residual effects of previous maximum efforts.
Muscles are arranged in pairs of opposites. a muscle has two
main functions. It contracts (shortens) and by this contraction moves the
bone of its attachment in the direction of the contraction. The muscle then
must release itself completely and be stretched so that no opposition is
provided to the opposing contraction. All skeletal motion is produced in
this way.
A muscle contracts not in the manner of an elastic band, but
by a multiple folding over upon itself many, many times. It must release by
a multiple unfolding so that it may be easily stretched to full length. The
contraction process is a generated process. The release process is not. It
is in the release process rather than the contraction process that motion
problems will develop.
Every move produces its greatest stress upon a specific
point. For example: as a result of excess tension of muscle tightening, a
muscle containing a quarter of a million fibres forms a spasm of
approximately ten thousand fibres. It can be so small that you do not
realise its presence. With continued use, the spasm becomes aggravated and
begins to add more fibres to itself. As it enlarges, it causes pressure.
Pressure causes discomfort and pain.
A muscle that cannot accommodate the movement placed upon it
will pull or even tear. Thus, a movement normally within the safe context
becomes unsafe when shortening and spasm are present.
Because of the interrelationship between muscles, so you
have the development of trigger points manifesting themselves on other
muscle areas rather than the original source of pain.
These are referred by the term ‘satellite trigger points’.
Trigger points may be found in muscle which feels perfectly
normal, or they may cause two distinctive signs:-
a) Fibrositic nodules – actual
round lumps felt in the muscles on palpation. these are commonest in the
shoulder and neck areas and the lumbar area.
b) Palpable taut bands – rope
or string-like taut muscle fibres around the trigger point. They are
likeliest to occur at the edges of large muscles. They run in the direction
of the fibres of the muscle.
Trigger points must become deactivated or their effect will
linger and become chronic. Then they will extend their activity by
activating other trigger points.
Direct pressure with the finger, fingers or thumb are
all very penetrating movements. Pressure is magnified many times when
applied in this manner. The hyperaemia this produces will last for several
hours causing capillary dilation to be retained while excess blood and
oxygen softens and prepares the spasm for cross-fibre friction.
Cross-fibre friction may be applied along with any of
the direct pressure techniques by simply moving the fingers to and fro
across the muscle fibres. The hand should not slide on the surface because
the depth and effect will be lost. Hand and
tissue must move together.
This cross-fibre action forces adhesed fibres apart
freeing them up to resume their normal activity of lengthening and
shortening. the entire muscle must be relaxed. This can be done by a series
of compression applied to the length of the muscle. Compression is the
rhythmic thrusting along the muscle with the heel of the hand or the loosely
clenched fist. Remember the spasm was the
cause of the problem whilst the tightened muscle was the cause of the spasm.
The use of steroids (cortisone) can initially remove
the pain but this is more than often short lived and the pain returns
magnified. This is because although the injection of cortisone settles the
primary trigger point, it fails to take out the satellite trigger points in
the surrounding muscles. These satellite trigger points start exerting pain
in their own area of radiation and are quite likely to reactivate the
primary trigger point, the cause of the original problem.
The detection of trigger points should not be difficult
as the pressure on the point produces what has been described as the ‘jump
sign’. The patient will tell you of the pain experienced by wincing or
crying out.
Be that as it may, it is essential that no trigger
point is missed as just missing one trigger point may well reactivate the
original problem. Reassure the patient that the slight discomfort
experienced during examination is well worth while enduring to ensure the
long term relief correct treatment will provide.
The whole area of pain should be palpated for trigger
points, tight bands occurring most likely at the edges of muscle . . . and
ensure that the adjoining zone of radiation is thoroughly examined to ensure
no satellite trigger point has been missed.
Several orthodox medical textbooks and more and more
‘open minded’ doctors accept that there is a relationship between myofascial
trigger points and the acupoints of traditional Chinese medicine.
Just as this open minded approach from the medical
profession will accept that myofascial trigger
point pain and nerve root pain
are to be distinguished one from the other, so it is very
important that a practitioner of acupressure also appreciates this
difference.
Nonetheless be aware that obvious nerve root pain may
also at the same time exhibit less obvious myofascial trigger point pain and
vice versa. It is wise, even if in doubt, to treat the trigger point with
acupressure. You will do no harm if it is not myofascial trigger point pain
by treating it in this way. You may well be able to establish that it is
nerve root pain.
It can also be
demonstrated that satellite trigger points are on the same meridian as the
source myofascial trigger point. But a word of caution – in certain
instances the meridian can transfer the ‘pain flow’ over to a linking
meridian and you can find a satellite trigger point on the linked meridian
acupoint that is not obviously linked to the source trigger point. These are
‘lo points’ which connect
coupled meridians by a secondary vessel. Coupled meridians are meridians
which follow one another in the superficial circulation of energy and, at
the same time, are of opposite sign, the one being yin, the other yang. It
follows that the former lies on an embryological anterior surface, while the
latter lies on an embryological posterior surface.
From the above observations I trust it is evident that
myofascial trigger points coincide with the acupoints of traditional Chinese
medicine. Normally these trigger points are relatively simple to detect but
as I have indicated, be open minded when doing a diagnosis for the obvious
diagnosis is not always correct. However experienced the practitioner is, he
must be humble and realise that he will not always be right.
To learn more about utilizing acupressure on your own,
Self applied
acupressure
For a review of other types of massage click here
These tools may assist in the performance of self
administered acupressure.
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