Myofascial Pain Syndrome and Trigger Points: Referred Pain from Muscle Knots?

What is it?

Myofascial Pain, and Myofascial Pain Syndrome both represent the same form of Chronic Pain Syndrome, according to a number of medical practitioners within the medical community. In fact, many of the same practitioners agree that it is a disease unto itself and not a chronic pain syndrome. The prefix “Myo” means muscle, and the suffix “Fascia” means connective tissue, therefore the word “Myofascial” translates to muscle and connective tissue. The word “Syndrome” basically means a group of symptoms. In essence, Myofascial Pain Syndrome literally means muscle and connective tissue pain symptoms.

What is a Trigger Point?

Myofascial Pain Syndrome is directly related to and associated with Trigger Points. Trigger Points are extremely irritable knots in taut bands of muscle and connective tissue. Dr. Janet Travell first used the term “trigger point” in 1942 based upon the phenomena of referred pain that the knots produced. Putting finger pressure upon the knot would “trigger” referred pain, hence the term “trigger point”.

Where can Trigger Points be Found?

Trigger points have different qualities and predictable pain patterns that can overlap and require extensive treatment to eliminate them. Trigger Points can be found in many different types of soft tissue such as muscle, tendon, ligament, skin, scar tissue, and joint capsules. Trigger points can be caused by other trigger points, direct trauma to soft tissue, infection, disease, radiculopathy, smoking, or psychological distress.

Trigger Point Characteristics

  • Active Trigger Points actively refer to pain along nerve pathways locally or to adjacent locations. Latent trigger points only refer to pain when some type of pressure or force is placed upon the trigger point itself or to the soft tissue structure where the latent trigger point is located.
  • Key Trigger Points have pain referral patterns that activate or create a Latent trigger point along a nerve pathway. Key trigger points also activate “Satellite Trigger Points” in other soft tissue structures. Both must be treated in order to alleviate both sources of pain.
  • Primary trigger points may activate Secondary trigger points in other structures, and again, both must be treated in order to alleviate both sources of pain.

Properly Trained Medical Massage Therapists can treat Trigger Points Effectively

A successful, reasonably safe Trigger Point Therapy treatment plan can be administered by a highly trained medical massage therapist that has been thoroughly trained in clinical massage. This protocol begins with the applicable pain assessment for the associated locations where Myofascial pain is being experienced. Once the Trigger Points have been identified, various massage techniques are applied in a specific order. Although this is a tedious process, Trigger Point treatment in a specific order is required to ensure that all of the related soft tissue structures are thoroughly and properly treated.

You can also look into acupuncture treatments that have a similar effect in addressing pain. Click here to learn more.

What is a Proprioceptor and how does it affect treatment?

Each soft tissue structure has a sensor called a “Proprioceptor” that detects the tension, position, length, and movement of the soft tissue structure. The proprioceptors for muscle belly tissues are called “Muscle Spindle Cells” and are directly related to the reduction of muscle spasms. The “Golgi Tendon Organ” or GTO is the proprioceptor that resides in tendinous soft tissue. These proprioceptors are used to deactivate Trigger Points as well as Tender Points and are best addressed with Quasi-Static pressure to allow Central Nervous system adaptation, thorough deactivation of Trigger points that are deep in the structure, and minimization of DOMS-Delayed Onset Muscle Soreness.

What happens next?

Once that has been accomplished, Myofascial spreading or release can be used to create suppleness in normal tissue and break up any scar tissue that might be resident in the structure. Eccentric Scar Tissue Alignment can then be applied to parallelize the scar tissue with normal tissue, and range of motion, as well as pain reduction, should be checked.

What do I do at home?

The patient should be instructed on how to perform the “Vascular Flushing Technique” at home in order to increase blood flow, reduce ischemia, inflammation, and promote correct healing in the affected area. A skill set of Home Stretching Techniques should also be given to the patient to further enhance the reduction and prevention of reoccurrence.