Research suggests that myofascial trigger points (MTP) are prevalent in all patient populations, and are not exclusive to people with chronic disorders of the musculoskeletal system (1).
The skeletal muscle is the largest single organ of the human body, which provides ample potential sites for the development of myofascial trigger points (1).
MTPs have the capability to cause motor dysfunction through stiffness and restricted range of motion and to create pain. These impairments can greatly restrict activities of daily living.
What is a Myofascial Trigger Point?
A myofascial trigger point is a hyperirritable area in skeletal muscle, or in muscle fascia, that is associated with a palpable nodule (2). Trigger points are commonly located by palpation.
Criteria to help the practitioner to identify MTPs include: a tender spot on a taut muscle band, local twitch response elicited by palpation, referred pain or altered sensation, and restricted range of motion in the joint the muscle crosses (3).
What Types of Myofascial Trigger Points Are There?
Trigger points can be categorized as either active or latent. Active MTPs cause pain with active muscle contraction or at rest.
Latent MTPs do not create pain but limit range of motion and produce weakness of the muscle (3). It is thought that trigger points may develop from trauma, repetitive microtrauma to muscles (overload), neuropathy of the nerve serving the affected muscle, postural faults or psychological stress (1,2).
Subjectively, patients with MTPs will report poorly localized, regional, aching pain in tissues, stiffness, restricted motion and sleep disturbance. Upon objective examination, the clinician will observe disturbances of motor function caused by MTPs including weakness of involved muscle, loss of coordination, and decreased work tolerance of the involved muscle. MTPs can commonly be located inpostural muscles of the neck, shoulder, pelvic girdle and the muscles of mastication (1). If the MTP is not addressed then the patient will compensate with alternate muscles and activation sequencing to perform the activity. This substitution can further establish weakening and deconditioning of the involved muscle.
Myofascial Treatment Options
Invasive treatment strategies such as Intramuscular Stimulation (IMS) and noninvasive techniques such as ischemic pressure, have been recognized for MTPs.
The goal of treatment is to decrease trigger point sensitivity and restore range of motion and impaired movement patterns. A recent systematic review of the literature investigating myofascial trigger points and management conclude that manual therapies are useful in short term relief of trigger point pain (4).
Specifically, it supports the use of ischemic pressure.
Ischemic pressure is a technique, which involves application of gentle persistent digital pressure producing elimination of the trigger point. Pressure is applied and maintained until the clinician feels reduction in tension (5). Further, a study conducted by Hanten et al. found a home program of ischemic pressure and sustained stretching was effective in reducing MTP sensitivity and pain intensity (6).
After locating and treating a trigger point, a therapist will provide explanation of predisposing activities including postural faults and biomechanical errors to prevent further perpetuation of MTPs. Follow up visits consist of correction of these elements by manual therapy and instruction in a variety of home-based exercises to correct compensatory patterns and deconditioning.
To Roll or Not to Roll…
Myofascial release is commonly used in clinical practice as a successful massage technique in treating individuals with soft tissue adhesions, reducing muscular pain, and promoting tissue healing.
Similar to myofascial release techniques, foam rolling has become increasing popular and effective self treatment strategy. As people are acknowledging the benefits of preventive medicine, they are looking for any opportunities to facilitate recovery, enhance performance and minimize the effects of post exercise soreness.
Schroeder et al (2015) recently published a literature review evaluating the effects of self myofascial release techniques (ie. foam rolling) on range of motion (ROM), delayed onset muscle soreness (DOMS) and vertical jump performance. Although there is some conflicting research, the conclusion of the study suggests that foam rolling is a valuable treatment option and are various different theories in which account for these benefits.
Increasing ROM
Foam rolling decreases adhesions between layers of tissue therefore altering the thixotropic properties of the muscles. It is also suggested that the foam rolling increases the temperature within the tissue thereby making it more extensible.
Reducing DOMS
Foam rolling may alter the parasympathetic activity decreasing the release of cortisol and therefore decreases the post exercises soreness. Foam rolling may also activate the unmyelinated mechanoreceptors and thus reduces muscle soreness post activity.
Increasing Vertical Jump
Foam rolling is suggested to reduce the neural inhibition and increase the afferent receptor and contractive tissue communication, resulting in stronger power production of the working muscle.
Although the exact dosage and timing of foam rolling is still debatable among researchers, Schroeder et al (2015) conclude that foam rolling is a helpful self treatment strategy in the management of tissue recovery and performance.
If you’re struggling with trigger point pain and live in Victoria or Langford, visit us at Parkway Physiotherapy & Performance Centre.
References:
- Simons DG, Travell JG & Simons LS. Myofascial pain and dysfunction: The trigger point manual 2nd ed. Philadelphia: Lippincott Williams & Wilkins; 1999.
- Lavelle DL, Lavelle W & Smith HS. (2007) Myofascial trigger points. The medical clinics of north America. 91: 229-239.
- Hou CR, Tsai LC, Cheng KF, Chung KC and Hong CZ. (2002) Immediate effects of various physical therapeutic modalities on cervical myofascial pain and trigger-point sensitivity. Arch Phys Med Rehabil. 83:1406-1414.
- Veron H and Scheinder M. (2009) Chiropractic management of myofascial trigger points and myofascial pain syndrome: A systematic review of the literature. Journal of manipulative and physiological therapeutics. 32:1. 14-24.
- Simons DG. (2002) Understanding effective treatments of myofascial trigger points. Journal of bodywork and movement therapies. 6:2. 81-88.
- Hanten WP, Olson SL, Butts NL and Nowicki AL. (2000) Effectiveness of a home program of ischemic pressure followed by sustained stretch for treatment of myofascial triggers points. Physical Therapy. 80:10. 997-1003.
- Schroeder A, Best, T. Is Self Myofascial Release an Effective Preexercise and Recovery Strategy? A Literature Review. American College of Sports Medicine. (2015) 14;3, 200-208
