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!

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

Headaches And Pain… Oh, My!

For me, the pain associated with headaches could be debilitating at times. So much so, I would sometimes just want to crawl in bed and cry like a baby until I fell asleep; however, when I first experienced PNMT, I quickly realized that there were other options out there aside from mainstream treatments. More on that later!

Before I go over the different types of headaches though, I feel it’s important that I share some RED FLAGS that I learned through becoming certified in PNMT:

  • See a physician to have other possible causes ruled out if the headaches are a new occurrence—the number of serious problems that have headaches as a side-effect is numerous.
  • See if physician immediately if you have any other global health declines.
  • See a physician if you’ve had headaches in the past but they are different in frequency, intensity, and/or location.
  • See a physician if you’ve had headaches for a long time but now they are daily; accompanied by GI symptoms, restlessness, anxiety, irritability, memory problems, difficulty in intellectual concentration, and depression. This could be considered analgesic rebound; analgesic overuse being very common.

Now, onward with different types of headaches. I will include some bullet points and reference the clinical studies, which happens to be where I got most of my information from…

TENSION HEADACHES – In the U.S., these account for 1-4% of all emergency room visits and is the 9th most common reason for doctor visits; being the most common type of chronic recurring head pain. All ages are susceptible, but most are young adults. — Michelle Blanda, MD; Tension Headache Clinical Presentation

  • These are usually associated with a stressful event, poor posture, or depression; and are not aggravated by physical activity.
  • They are of moderate intensity but can have a throbbing quality, are bilateral, and usually present in the occipitofrontal region.
  • They typically last 30-minutes up to 7-days.
  • Muscular tightness or stiffness in the neck, occipital, and frontal regions is common.
  • Cervical muscles, when palpated, may be very tender.
  • Nausea or vomiting is not present.
  • Insomnia is present.
  • Often present upon rising or shortly thereafter.

MIGRAINE HEADACHES – This disorder is one of the most common complaints in medicine. In the U.S., more than 30 million people have one or more migraines per year. — Jasvinder Chawla, MD; Migraine Headache

  • They typically throb or pulsate.
  • The pain is initially unilateral (on one side) and localized to the Temporalis and Frontalis muscles, or over the eye, but can be felt anywhere around the head or neck.
  • The pain typically builds up over a 1- to 2-hour period and then slowly diffuses towards the back of the head.
  • They typically last 4-72 hours; usually subsiding gradually within a day, and after a period of sleep.
  • Intensity is moderate to severe and intensifies with movement or physical activity.
  • Light and sound sensitivity are very common.
  • Nausea occurs in about 80% of migraines; vomiting in about 50%.
  • Other interesting symptoms include:
    – About 60% of people reported prodrome (preheadache) symptoms hours to days prior to the migraine. Postdrome symptoms may persist for 24-hours after the headache.
    – Auras—which can be visual, sensory, motor, or any combination of these—usually develop over 5-20 minutes and lasts less than 60 minutes.

CLUSTER HEADACHES – In the U.S., it is estimated that 2-9% of migraine sufferers experience these, making it relatively uncommon compared to the classic migraine. This condition is more common in males than in females. — Lori K Sargeant, MD; Headache, Cluster

  • No aura exists like they do in migraines.
  • Sudden onset peaks in 10- to 15-minutes; duration lasts 10-minutes to 3-hours per episode; frequency may occur several times a day for 1- to 4-months.
  • Typically, 1-2 cluster periods are experienced per year; each lasting 2- to 3- months.
  • The pain associated with is described as severe; as if the eye is being pushed out.
  • They are often nocturnal—active at night.
  • Triggers in some patients include stress, allergens, and seasonal changes.
  • Alcohol and smoking induce attacks during a cluster but not during remission.
  • Risk factors include: male sex; older than 30-years; small amounts of alcohol; previous head trauma or surgery (occasionally).

CERVICOGENIC HEADACHES – The presence of these headaches in the general population is estimated to be between 0.4% and 2.5%; however, the prevalence is as high as 20% in pain management clinics. This condition is four times more common in women than in men. — David Biondi, DO; Cervicogenic Headache: A Review of Diagnostic and Treatment Strategies

  • This condition is a relatively common cause of chronic headaches that is often misdiagnosed or unrecognized; clinical features may mimic those commonly associated with other headache disorders, making this headache hard to distinguish.
  • They involve head pain that is referred from bony structures or soft-tissues of the neck; TrP’s are usually found in the suboccipital, cervical, and shoulder musculature.
  • These often develop after a head or neck injury, but may also occur in the absence of trauma.
  • They are typically described as a deep—or dull—pain that radiates from the occipital to parietal, temporal, frontal, and periorbital regions.
  • Sufferers will often have restricted cervical range of motion and altered neck posture.
  • Head pain can be triggered or reproduced by active neck movement.
  • Paresthesia and numbness over the occipital scalp are usually present.
  • Many sufferers overuse or become dependent on analgesics; medication, when used alone, does not generally provide substantial pain relief.

As stated earlier in this post, I have suffered from headaches for many years, but not so much over the past five years due to the powerful effects of PNMT. In fact, many of my clients have suffered from them as well—that is until I got my hands on them. 🙂

Believe it or not, muscle involvement—which is stated in some of the above mentioned headache descriptions—can be a huge contributing factor that is definitely worth looking in to. In fact, the SCM, Longus Colli, Trapezius, and the Suboccipital muscles are just a few examples that can mimic or refer headache-related pain. Also note that muscular-skeletal alignment is a key factor as rubbing where it hurts won’t solve the problem.

If this post strikes a cord with you, consider looking for a massage therapist as an alternative option for headache related pain-relief!

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

Range Of Motion And Optimal Measurements

Range of motion (also known as ROM) refers to the distance and direction a joint can move to its full potential. If ROM is restricted, the joints ability to function normally becomes limited. Each specific joint has a normal ROM that is expressed in degrees, which can be measured using a goniometer; with the help of another person as well.


Below is a list of optimal measurements for certain areas of the body, but first, I’ve included what the mentioned movements mean in case you weren’t already aware…

Flexion – When the angle of a joint decreases, as in bending your arm at the elbow.
Extension – When the angle of a joint increases, as in straightening your arm at the elbow.
Rotation – When you turn your head, as in checking your “blind spot” while driving.
Lateral Flexion – This usually refers to the spine and would happen when you are holding your cell phone in between your ear and shoulder or bending your torso while running your arm down your leg.
Abduction – When you move a limb away from the midline of the body, as in raising your arm up perpendicular to your body.
External (Lateral) Rotation – Rotation away from the body, as in rotating your leg out so your toes point outward.
Internal (Medial) Rotation – Rotation towards the center of the body, as in rotating your leg in so your toes point inward.

According to my PNMT training manuals, the optimal measurements are as follows, but not limited to…

Cervical ROM:
Flexion – 40°
Extension – 75°
Rotation – 80°-90°
Lateral Flexion – 35°-45°

Shoulder ROM:
Flexion – 165°-170°
Extension – 50°-60°
Abduction – 165°-170°
External (Lateral) Rotation – 80°-90°
Internal (Medial) Rotation – 55°-60°

Lumbar Spine ROM:
Flexion – 60°
Extension – 35°
Rotation – 8°-10°
Lateral Flexion – 20°

Hip ROM:
Flexion – 140° (passive)
Extension – 30° (passive)
Abduction – 50° (passive)
External (Lateral) Rotation – 60° (passive)
Internal (Medial) Rotation – 40° (passive)
* Passive meaning the examiner moves the joint without assistance from the person being examined. 

As always, I hope you find this information informative! I’ll be MIA for a couple of weeks, but plan to have something good to write about for my next post.

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