Myofascial Trigger Points

A myofascial trigger point is an area of tenderness in a muscle or its fascia that can cause referred pain and is palpated as a taut band with a nodule.  This malfunction can be contributed to both soft tissue and neurological dysfunction aggravated by repetitive stress.

It is believed that afferent (sensory) stimulus to the spinal cord produces a ten-fold efferent (motor) discharge which results in an increased stream of efferent pulses to the muscle which causes a state of abnormal contraction.  This sends additional afferent impulses which produce even more efferent impulses back to the muscles resulting in a vicious cycle of myospasms.

Definition of trigger point:

• Can be located in myofascial, cutaneous, fascial, ligamentous, and periosteal tissue
• Taut band of muscle tissue
• A central focal point of tenderness and thickness lies within the taut band
• The focal point appears as a nodule
• Pressure on the nodule can cause referred pain or an autonomic response
• Active trigger points
• Latent trigger points

Trigger point characteristics:

• Tenderness is usually a dull ache but can be sharp or stabbing
• Pressure on the trigger point can cause referred pain
• The more irritable the trigger point, the more severe and extensive is the referred pain
• Each muscle has characteristic referred-pain patterns
• Pain is aggravated by muscle activity, passive stretch, movement after prolonged positioning, cold exposure, direct pressure
• Eased by short rest periods, heat with slow and sustained stretches, short-term low-level activity, and specific trigger point release techniques

Causes of trigger points:

• Injury
• Overload
• Fatigue

Trigger point examination:

• Causes of pain must be assessed to rule out trigger points as a possible factor
• Trigger point pain-referral chart
• Compression test to detect taut bands, nodules, and local and referred pain
• A local twitch confirms the presence of a trigger point

Trigger point treatment:

• Ice-stretch (ice stroking along muscle)
• Ischemic compression of the trigger point
• Stripping of the taut band
• PNF, hot packs, ultrasound, electrical stimulation