Trigger Based On Janet Travell Md -myofascial Pain – Flashcards

-Create discomfort and/or pain. -Can affect any soft tissue structure of the body. -Are caused by some type of injury to the muscle or soft tissue structure. -Are treatable with specific massage techniques.

A hyperirritable spot in skeletal muscle that is associated with a hypersensitive palpable nodule in a taut band. The spot is painful upon compression and can give rise to characteristic referred pain, referred tenderness, motor dysfunction, and autonomic phenomena. (sometimes an itchy sensation cold/hot ringing in the ears etc...)

Muscles Tendons Ligaments Fascia Periosteum Scars Joint Capsules Dermal layer (skin)

Trauma - insult or injury Overuse or overload (muscle size or strength is irrelevant) Posture, Prolonged mobility or immobility, Poor body mechanics, Occupation Compensation Age - The likelihood of trigger point formation increases with age.

Described as any type of a sensation that the client feels somewhere in the body. The Referral Pattern is often familiar to the client and becomes what they present to you. It is their complaint or symptomology.

The trigger point is rarely located where the person feels the sensation, it is "referred" away from, or felt a distance spot in the body. Fascia plays a key role in why this is so. For example... When a sensation travels away from the trigger point, it is said to go distal (except head and neck) Referral can also spread out from the trigger point location

Most muscles have predictable patterns of referral/sensation. Trigger point referral patterns are distinctive to themselves. They do not follow nerve pathways, meridians, or dermatomes, etc. There are some patterns that are similar to these examples...this is coincidental.

ACTIVE: The trigger point fires on it's own. Therefore, it is a familiar or recognizable pattern of sensation. The sensation becomes the client's symptoms: Headaches, Aching in elbow, Throbbing in back, etc.

LATENT: Do not fire on their own, they need to be compressed. This pattern of referred sensation is often unfamiliar to the client - because it is not referring all the time. Can become active trigger point through overload, sustained contraction, and/or trauma of the soft tissue structure. Even something as simple as sleeping or sitting "wrong".

Central Located in the center of the muscle fibers, the muscle belly

Attachment Located at the attachment of the muscle to the tendon or the attachment of the tendon to the bone

Key: Responsible for the formation of other trigger points.

Satellite: trigger points that form in response to key trigger points. Usually located in the referral zone of the key trigger point.

The taut fibers (bands) Keep a constant pulling or tension on the muscle's attachments, which can also affect the joints. Decreases tissue range of motion (ROM) Keeps muscle in a tight and weakened condition, which affects strength and endurance Metabolic process of the tissue is compromised; circulation, waste disposal, decreased oxygen, and nutrients, etc. Characteristic Referral Pattern Non-uniform tissue consistency. Local twitch response. Can create a pattern of compensation. There is a direct relationship between the level of tenderness of the trigger point and the severity of the client's symptoms. More hyper-irritable the trigger point is= greater intensity of symptoms.

1. The referral pattern is familiar to the client and matches the description of the client's symptoms. 2. When we press the trigger point, we duplicate the client's symptoms. 3. As the trigger point melts away the client's symptoms diminish. There is a direct relationship between the level of tenderness of the trigger point and the severity of the client's symptoms. The more hyperirritable the trigger point is, the greater the client's symptoms.

Use of the muscle or soft tissue structure. Stretching - especially active. Direct pressure to the trigger point. Weather changes. Shortening of the muscle for extended periods of time (posture or position). Sustained repetitive contraction of the muscle. Stress

1. Nutritional Inadequacies: B vitamins, Magnesium (muscle relaxer), Potassium (nutrients in and out), Calcium, hydration. 2. Metabolic/Endocrine Inadequacies: Impaired metabolism, Thyroid, Anemia 3. Psychological Factors: Depression, Tension, Anxiety, Stress, Trauma 4. Illness: Viral infections, disease, etc.

Therapeutic Massage (yay us!) Short periods of activity followed by rest. Slow, steady, passive stretching of the muscle. Ice Heat

Trigger Point Pressure Release - that's us! Spray and Stretch - Vapocoolant sprayed unilaterally while passively stretching the area Injection - Local anesthetic, procaine, saline, lidocaine, etc.

Trigger Point vs Tender Point Trigger Point has a referral pattern, which is usually in a distal direction. Tender Point does not have a referral pattern, but is tender for the client when pressed. They may not be able to describe the tenderness because there is not a related sensation. Treatment is the same process as for a trigger point: The Pressure Release Method