MYOFASCIAL TRIGGER POINTS
 
   

Myofascial Trigger Points (TrPs)

This section was compiled by Frank M. Painter, D.C.
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  Frankp@chiro.org



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Chiropractic Perspectives On Myofascial Therapy
Chapter 15 from:   “Applied Physiotherapy in Chiropractic”

By Richard C. Schafer, D.C., FICC and the ACAPress
The purpose of this chapter is to improve the doctor of chiropractic’s understanding of the significance of myofascial pain and dysfunction, and to improve the chiropractor’s level of competence in diagnosing the myofascial component of the subluxation complex. The myofascial orientation in the chiropractic setting directs the doctor to look first for a myofascial source of the patient’s pain, and when found, to use numerous techniques and procedures to offer rapid relief. Lowe recommends broad spectrum therapeutics to be employed after the performance of myofascial therapy to assure maximum flexibility. [1]

Comparison Between the Effects of Passive and Active Soft Tissue
Therapies on Latent Trigger Points of Upper Trapezius Muscle in Women:
Single-Blind, Randomized Clinical Trial

Journal of Chiropractic Medicine 2016 (Dec);   15 (4):   235–242 ~ FULL TEXT

Both passive and active soft tissue therapies were determined to reduce pain intensity and increase active cervical contralateral flexion (ACLF) range of motion, although passive therapy was more effective in increasing PPT in these patients compared with the control group.

Effect of Two Consecutive Spinal Manipulations in a Single Session
on Myofascial Pain Pressure Sensitivity: A Randomized Controlled Trial

J Can Chiropr Assoc. 2016 (Jun);   60 (2):   137–145 ~ FULL TEXT

Two consecutive SMT interventions evoke significant decreases in mechanical pressure sensitivity (increased PPT) within neurosegmentally linked myofascial tissues. The antinociceptive effects of SMT may be summative and governed by a dose-response relationship in myofascial tissues.

Myofascial Trigger Points in Patients with Whiplash-Associated Disorders
and Mechanical Neck Pain

Pain Med. 2014 (May);   15 (5):   842–849 ~ FULL TEXT

Active MTPs are more prominent in WAD than MNP and related to current pain intensity and size of the spontaneous pain distribution in whiplash patients. This may underlie a lower degree of sensitization in MNP than in WAD.

Myofascial Trigger Points, Pain, Disability, and Sleep Quality
in Individuals With Mechanical Neck Pain

J Manipulative Physiol Ther. 2012 (Oct);   35 (8):   608–613 ~ FULL TEXT

Patients exhibited a greater disability and worse sleep quality than controls (P < .001). The Pittsburgh Sleep Quality Index score was associated with the worst intensity of pain (r = 0.589; P = .021) and disability (r = 0.552; P = .033). Patients showed a greater (P = .002) number of active MTrPs (mean, 2 ± 2) and similar number (P = .505) of latent MTrPs (1.6 ± 1.4) than controls (latent MTrPs, 1.3 ± 1.4). No significant association between the number of latent or active MTrPs and pain, disability, or sleep quality was found.

Manual Treatment For Cervicogenic Headache And Active Trigger Point In The
Sternocleidomastoid Muscle: A Pilot Randomized Clinical Trial

J Manipulative Physiol Ther. 2013 (Sep);   36 (7):   403–411 ~ FULL TEXT

The purpose of this preliminary study was to determine feasibility of a clinical trial to measure the effects of manual therapy on sternocleidomastoid active trigger points (TrPs) in patients with cervicogenic headache (CeH).

Chiropractic Management of Myofascial Trigger Points and
Myofascial Pain Syndrome: A Systematic Review of the Literature

J Manipulative Physiol Ther. 2009 (Jan);   32 (1):   14–24 ~ FULL TEXT

Myofascial pain syndrome (MPS) and myofascial trigger points (MTrPs) are important aspects of musculoskeletal medicine, including chiropractic. The purpose of this study was to review the most commonly used treatment procedures in chiropractic for MPS and MTrPs.

A Distinct Pattern of Myofascial Findings in Patients After Whiplash Injury
Archives of Physical Medicine and Rehabilitation 2008 (Jul);   89 (7):   1290–1293

Forty (85.1%) of the patients with whiplash had positive trigger points in the semispinalis capitis muscle. The patients with whiplash had a significantly higher prevalence of positive trigger points in the semispinalis capitis muscle than any of the control groups (P<.05). For the other examined muscles, the prevalence of trigger points in the patients with whiplash did not differ significantly from the patients with fibromyalgia or nontraumatic chronic cervical syndrome. It did differ from the patients with endogenous depression and the healthy controls.

Changes in Pressure Pain Thresholds Over C5–C6 Zygapophyseal Joint After a
Cervicothoracic Junction Manipulation in Healthy Subjects

J Manipulative Physiol Ther. 2008 (Jun);   31 (5):   332–337 ~ FULL TEXT

The application of a cervicothoracic junction manipulation induced changes in PPT in both right and left C5–C6 zygapophyseal joints in healthy subjects. In addition, the effect size for the groups that received C7–T1 manipulation was large, suggesting a clinically important increase in PPT after intervention. Different therapeutic mechanisms, either biomechanical or neurophysiologic, can be involved at the same time.

Chiropractic Management of Myofascial Trigger Points and
Myofascial Pain Syndrome: Summary of Clinical Practice

Recommendations from the Commission of the Council on Chiropractic Guidelines
and Practice Parameters 2008

Review of these articles resulted in the following clinical recommendations regarding treatment: Moderately strong evidence supports manipulation and ischemic pressure for immediate pain relief at MTrPs, but only limited evidence exists for long-term pain relief at MTrPs. Evidence supports laser therapy (strong), transcutaneous electrical nerve stimulation, acupuncture, and magnet therapy (all moderate) for MTrPs and MPS, although the duration of relief varies among therapies. Limited evidence supports electrical muscle stimulation, highvoltage galvanic stimulation, interferential current, and frequency modulated neural stimulation in the treatment of MTrPs and MPS. Evidence is weak for ultrasound therapy.

Changes in Pressure Pain Sensitivity in Latent Myofascial Trigger Points
in the Upper Trapezius Muscle After a Cervical Spine Manipulation
in Pain-Free Subjects

J Manipulative Physiol Ther. 2007 (Oct);   30 (8):   578–583 ~ FULL TEXT

Our results suggest that a cervical spine manipulation directed at the C3 through C4 segment induced changes in pressure pain sensitivity in latent MTrPs in the upper trapezius muscle. Different therapeutic mechanisms, either segmental or central, may be involved at the same time.

Myofascial Trigger Points, Neck Mobility, and Forward Head
Posture in Episodic Tension-Type Headache

Headache 2007 (May);   47 (5):   662–672

Active TrPs in the upper trapezius, sternocleidomastoid, and temporalis muscles were more common in ETTH (Episodic Tension-Type Headache) subjects than in healthy controls, although TrP activity was not related to any clinical variable concerning the intensity and the temporal profile of headache.   ETTH patients showed greater FHP and lesser neck mobility than healthy controls, although both disorders were not correlated with headache parameters.

Trigger Points in the Suboccipital Muscles and Forward Head Posture
in Tension-Type Headache

Headache: The Journal of Head and Face Pain 2006 (Mar);   46 (3):   454–460

Twenty chronic tension-type headache (CTTH) subjects and 20 matched controls without headache participated. Trigger points (TrPs) were identified by eliciting referred pain with palpation, and increased referred pain with muscle contraction. Side-view pictures of each subject were taken in sitting and standing positions, in order to assess forward head posture (FHP) by measuring the craniovertebral angle. Suboccipital active TrPs and FHP were associated with CTTH. CCTH subjects with active TrPs reported a greater headache intensity and frequency than those with latent TrPs.   The degree of FHP correlated positively with headache duration, headache frequency, and the presence of suboccipital active TrPs.

Upper Crossed Syndrome and Its Relationship to Cervicogenic Headache
J Manipulative Physiol Ther 2004 (Jul);   27 (6):   414–420 ~ FULL TEXT

The principles of upper crossed syndrome and the use of exercise, chiropractic care, and myofascial release in the treatment of cervicogenic headache are discussed. A review of the literature indicates that analyzing muscle imbalance as well as vertebral subluxation may increase the effectiveness of chiropractic treatment for cervicogenic headache.
NOTE: There are more articles on this topic in the Rehabilitation Diplomate Information Page.



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