Myofascial Pain/Trigger Points (TrPs)

This section was compiled by Frank M. Painter, D.C.
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Chiropractic Nimmo Receptor-Tonus Technique and McKenzie
Self-Therapy Program in the Management of
Adjacent Segment Disease: A Case Report

J Chiropractic Medicine 2020 (Dec); 19 (4): 249–259 ~ FULL TEXT

This report illuminates and informs the chiropractic management of a patient with Adjacent segment disease (ASD). After 3 weeks of therapy, VAS and ODI scores were improved. Furthermore, she discontinued her medication, pregabalin 75 mg 2 times a day, under her neurosurgeon's supervision because the outcomes were significant enough for the patient to discontinue her long-standing medical prescription.

Change in Health-Related Quality-of-Life at Group and Individual
Levels Over Time in Patients Treated for Chronic
Myofascial Neck Pain

J Evid Based Complementary Altern Med. 2017 (Jul); 22 (3): 365–368 ~ FULL TEXT

Health-related Quality of Life (HRQOL) at the group level improved in a small series of patients with myofascial neck pain who received 6 weeks of treatment with a patient-centered, scientifically informed approach to improve pain and function. Significant change at the individual level was observed in a minority of study participants.

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

J 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.

Prevalence of Myofascial Trigger Points in Spinal Disorders:
A Systematic Review and Meta-Analysis

Arch Phys Med Rehabil. 2016 (Feb); 97 (2): 316–337 ~ FULL TEXT

This systematic review shows that active and latent MTrPs can be present in different spinal disorders (eg, NP, WAD, NSLBP). However, these findings are at best underpinned by pooled estimates of point prevalence that are based on low-quality evidence, according to the Grading of Recommendations Assessment, Development and Evaluation approach. Most of the estimates for both active and latent MTrPs are based on individual studies with very small sample sizes and low methodologic quality. Future studies with large samples and high methodologic quality are needed to provide more reliable and precise estimates on the point prevalence of MTrPs in spinal disorders. Moreover, to facilitate comparison of findings and data pooling, there is an urgent need to standardize the assessment of MTrPs across clinical studies.

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

Pain Medicine 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.

Manual Treatment For Cervicogenic Headache And Active
Trigger Point In The Sternocleidomastoid Muscle:
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).

Immediate Effects of Spinal Manipulative Therapy on Regional
Antinociceptive Effects in Myofascial Tissues
in Healthy Young Adults

J Manipulative Physiol Ther. 2013 (Jul); 36 (6): 333–341 ~ FULL TEXT

This study showed that SMT evokes short-term regional increases in pressure pain thresholds (PPTs) within myofascial tissues in healthy young adults.

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.

Muscle Trigger Points, Pressure Pain Threshold, and Cervical
Range of Motion in Patients with High Level of
Disability Related to Acute Whiplash Injury

J Orthop Sports Phys Ther. 2012 (Jul); 42 (7): 634-641 ~ FULL TEXT

The current study indicates that the local and referred pain elicited from active TrPs reproduced neck and shoulder pain patterns in individu­als with a high level of disability related to acute WAD. Patients with acute WAD exhibited widespread pressure pain hypersensitivity and reduced CROM. The number of active TrPs was related to higher neck pain intensity, number of days since the accident, higher pressure pain hypersensitivity over the cervical spine, and reduced CROM. These results provide evidence to support the concept that active TrPs can be important pain generators in patients with WAD, at least in the acute stage.

Referred Pain from Myofascial Trigger Points in Head and
Neck-shoulder Muscles Reproduces Head Pain Features
in Children With Chronic Tension type Headache

J Headache Pain. 2011 (Feb); 12 (1): 35–43 ~ FULL TEXT

The current controlled and blinded study showed the existence of multiple active TrPs in head, neck and shoulder musculature in children with chronic tension type headache (CTTH). Both local and referred pain characteristics elicited by palpation of active muscle TrPs reproduced the head pain patterns in children with CTTH. Referred pain areas elicited by active TrPs were larger in children with CTTH as compared to healthy children. The size of referred pain areas of some muscles was positively related to some headache clinical parameters. Our results support a role of active TrP in children with CTTH.

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.
There are more articles on this topic at our: Rehabilitation Diplomate Information Page.

Locating and Treating Low Back Pain of Myofascial
Origin by Ischemic Compression

J Can Chiropr Assoc 2002; 46 (4): 257–264 ~ FULL TEXT

The purpose of this article is to describe a method to identify and treat trigger points of myofascial origin by ischemic compression among patients with low back pain. In addition to a review of the literature, the author draws upon his own clinical experience to accomplish this goal. In general, thumb pressure is used for the identification, localization and treatment of trigger points and tender spots within the muscles of the lumbar, pelvic, femoral and gluteal areas. The management of low back pain of myofascial origin by ischemic compression can be used in any setting, without the need of specialized equipment. In addition to clinical effectiveness within a wide range of safety, this approach is easy on the practitioner and well tolerated by the patient.

Chiropractic Management of Shoulder Pain and
Dysfunction of Myofascial Origin Using
Ischemic Compression Techniques

J Can Chiropr Assoc 2002; 46 (3): 192–200 ~ FULL TEXT
Shoulder pain and dysfunction is a chief complaint commonly presenting to a chiropractor’s office. The purpose of this article is to review the most common etiologies of shoulder pain, focusing on those conditions of a myofascial origin. In addition to a review of the literature, the author draws upon his own clinical experience to describe a method to diagnose and manage, patients with shoulder pain of myofascial origin using ischemic compression techniques. This hands-on therapeutic approach conveys several benefits including: positive therapeutic outcomes; a favorable safety profile and; it is minimally strenuous on the doctor and well tolerated by the patient.

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]

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