Trigger points
CONSULT TREATMENT PROTOCOL

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Myofascial trigger points (MFTPs) are a common cause of chronic neck and back pain. They are localized segments of muscle that are thought to be subjected to trauma by acute injury or microtrauma from repetitive stress. MFTPs can occur in any skeletal muscle.

Diagnosis is clinical and includes the identification of small knots (2-5 mm in diameter) and tight bands within affected muscles that are painful when palpated. Diagnostic imaging is not helpful and should only be considered to rule out other causes of muscle pain.

It is still unclear whether or not MFTPs are true pathologic entities. It has been hypothesized that muscle injury or stress disrupts the sarcoplasmic reticulum within muscle fibers, releasing free calcium ions. These free calcium ions causes the actin and myosin of the muscle fibers to lock into place as long as adenosine triphosphate is available. The resulting contraction of small parts of the muscle leads to diminished blood flow with subsequent ischemia and release of painful substances such as serotonin, histamine and prostaglandins in the affected area.

MFTPS are a very common condition, especially in the cervical musculature. Up to 85% of back pain and approximately 55% of neck pain and headaches are caused by myofascial pain.

The predominant age is 30 to 50 years. Women are more affected than men. Very often MFTPs are associated with poor posture. Notably MFTPs frequently produce neurological complaints including headache, dizziness, sensory symptoms, as well as gastrointestinal problems.

The treatment of MFTPs should start with a manual technique that involves applying pressure to a trigger point to release the pathologic contraction of the muscle segment and to stretch the segment to restore normal muscle fiber length. This can be accompanied by acupuncture, stress management and relaxation techniques. Pharmacologic treatment is unspecific and may comprise muscle relaxants, nonsteroidal anti-inflammatory drugs (NSAIDs), anticonvulsants, or topical application of local anesthetics or botulinum toxin.

Radial shock wave therapy (RSWT) is very effective for MFTPs and may mimic manual therapy in applying pressure to a trigger point to release the pathologic contraction of the muscle segment. Prevention of recurrence should focus on appropriate ergonomic changes in patients’ day-to-day activities to avoid repetitive stress to the injured muscles.