More On Myofascial Trigger Points (TrP’s)

Back in May of this year, I posted an article titled Trigger Points (TrP’s) In Detail and thought I would take it a step further by describing additional TrP’s that I learned about via the Precision Neural Mobilization seminar I attended. Before I list them however, please allow me to give you some other details.

1) TrP’s may be caused by several factors, including acute or chronic muscle overload, activation by other TrP’s, disease, psychological distress, homeostatic imbalances, direct trauma to the region, accident trauma, radiculopathy, and infections/health issues.

2) TrP’s form only in muscles—as a local contraction in a small number of muscle fibers located within in a larger muscle or muscle bundle. They can pull on tendons and ligaments associated with the muscle, which in turn, can cause pain deep within a joint where there are no muscles. They can also cause muscle weakness.

3) TrP referral patterns follow specific nerve pathways and have been readily mapped—thanks to Travell & Simons—to aid in the identification of pain. Many TrP’s have pain patterns that overlap, and some create reciprocal cyclic relationships.

4) A taut band in muscles containing TrP’s can feel like hard nodules. Upon palpation, a twitch response can often be felt; activateing the “all or nothing” response in a muscle that causes it to contract. Pressing on an affected muscle can often refer pain, and clusters of TrP’s are not uncommon in some in larger muscles (i.e. the gluteus group).

As promised, here is a list of TrP’s above and beyond what I gave you the last time; the first three being what was listed in my previous post…

  • Active – A TrP that causes a clinical pain complaint. It is always tender; prevents full lengthening of a muscle; weakens a muscle; activates a local twitch response when stimulated; direct compression refers patient-recognized pain that is generally in it’s pain reference zone. (Click here for a website that lists reference zones and pain referral patterns.)
  • Latent – A TrP that is clinically inactive with respect to spontaneous pain; painful only when palpated. It may have all other characteristics of an active TrP and always has a taut band that increases muscle tension and restricts range of motion (ROM).
  • Satellite – A TrP that is influenced neurogenically or mechanically by the activity of a key TrP.
  • Associated – A TrP in one muscle that develops in response to compensatory overload, a shortened position, or referred phenomena cause by TrP activity in another muscle. Satellite and secondary TrP’s are types of associated TrP’s.
  • Attachement – A TrP at the musculotendinous junction and/or at the osseous attachment of a muscle that identifies the enthesopathy caused by unrelieved tension, characteristic of the taut band that is produced by a central TrP.
  • Central – A TrP that is closely associated with dysfunctional end-plates and is located near the center of muscle fibers.
  • Key – A TrP responsible for activating one or more TrP’s.
  • Primary – A central TrP that is activated by acute or chronic overload, or repetitive overuse of a muscle in which it occurs, and was not activated as a result of TrP activity in another muscle.

The misdiagnosis of pain is the most important issue taken up by Travell and Simons. Referred pain from trigger points mimics the symptoms of a very long list of common maladies, but physicians, in weighing all the possible causes for a given condition, rarely consider a myofascial source. The study of trigger points has not historically been part of medical education. Travell and Simons hold that most of the common everyday pain is caused by myofascial trigger points and that ignorance of that basic concept could inevitably lead to false diagnoses and the ultimate failure to deal effectively with pain.

The above quote comes from a workbook titled The Trigger Point Therapy Workbook. With this book, you will learn about TrP’s and how to treat them; however, it is important for you to keep in mind that if your muscular-skeletal system is misaligned, other muscles are affected, which in my opinion, makes it hard to self-treat in a way that is more than just temporary. Every little bit helps though!

As always, I hope you find this information informative!

* * * * *

“Neutral balance alignment is key to becoming pain free!”™ ~ Me

Some Info On Whiplash From Automobile Accidents

According to an estimate of the National Safety Council, there were 11,900,000 motor vehicle accidents in the United States in 1993. Of these, 2,750,000 were rear-end collisions. Although the precise number of whiplash injuries per year cannot be determined, a rather rough estimate is more than one million. Nearly one-third of all motor vehicle accidents are rear-end collisions, and it is this type of accident that is responsible for most whiplash injuries. — RW Evans

A couple of years ago, I completed a Distance Education course from “The Complete Guide to Whiplash” written by Michael R. Melton, owner of BodyMind Publications and founder of ChiroHosting, and learned what factors and variables—among many other things—are used when determining the difference between an accident with no injury and an accident with serious injury. They include…

  • The angle of the collision
  • The speed and size of the rear car
  • The speed and size of the front car
  • Road conditions
  • Occupant head position
  • Gender
  • Occupant awareness
  • Head restraints
  • Safety belts
  • Secondary collisions
  • Direct body impact
  • Loss of consciousness
  • Medical history
  • Pain onset

As you can see there are many variables involved, and believe it or not, each crash possesses its own characteristics.

According to an equation related to the physics of acceleration, the less a car is damaged or crushed in a collision, the higher the acceleration of the struck vehicle and the greater the risk of injury. — MC Robbins

That being said, it is crucial that a complete history be examined in order to help a whiplash patient recover quickly and easily. Following are some physical and psychological symptoms also found in The Complete Guide to Whiplash…

PHYSICAL

PSYCHOLOGICAL

  • Anxiety
  • Depression
  • Anger
  • Substance abuse

Per Michael’s book, one of the most common claims made by insurance companies is that whiplash injuries heal within six weeks and that care after that time is unnecessary. While many patients do recover within this six-week period, many studies show that between 20-30% have symptoms that last one year or more. In addition, studies also show that some symptoms may even take days or weeks to develop after an accident; however, insurance companies will often attempt to discredit a patient’s symptoms if they aren’t reported at the time of the accident; as if malingering.

It is very difficult for an ingenuine individual to fake a profile typical of a whiplash patient. — BJ Wallis

I wanted to write this post because I have had several clients over the years, whom suffered from whiplash as a result of an automobile accident, and eventually became pain-free using Precision Neuromuscular Therapy (PNMT) techniques. Although PNMT won’t necessarily treat every single symptom that was mentioned above, it can help with muscular-skeletal imbalances, which can cause many that were mentioned.

Here are some other great resources related to whiplash from automobile accidents:
The Neck Disability Index (NDI) Study
T
he NDI Questionnaire
The Crash Pulse in Rear-End Car Accidents
The National Crash Analysis Center
Motor Vehicle Accident Reconstruction and Biomechanical Physics

As always, I hope you found this information to be informative!

* * * * *

“Neutral balance alignment is key to becoming pain free!”™ ~ Me