MYOFASCIAL PAIN SYNDROME

THE TRIGGER POINT MANUAL

HISTORICAL NOTE ON MPS:-

MPS

Fibroscitis[Sir.William Goyers]

Myofascitis[Albee]

Nonarticular rhuematism

Tension myalgia MPS are among the most commonly overlooked causes of chronic pain and disability in medicine (Simons 1988).

Travell described the term “Trigger point’ and adopted the expression Myofascial pain syndrome.

“fibrositis”myofascial pain syndrome+fibromyalgia.

MYOFASCIAL PAIN SYNDROME-Myofascial pain syndrome (MPS), also known as chronic myofascial pain (CMP), is a syndrome characterized by chronic pain caused by multiple trigger points and fascial constrictions.

Characteristic features of a myofascial trigger point include: focal point tenderness, reproduction of pain upon trigger point palpation, hardening of the muscle upon trigger point palpation, pseudo-weakness of the involved muscle, referred pain, and limited range of motion following approximately 5 seconds of sustained trigger point pressure.

INTRODUCTION:-

CHECK THIS OUT…

PHYSIOLOGY OF TRIGGER POINTS…

CHARACTERISTICS OF TRIGGER POINTS:- 1.Focal point of tenderness to palpation of the involved muscle

2. Reproduction of pain complaint by trigger point palpation (about 3 kg pressure)

3. Palpation reveals an induration of the adjacent muscle (the “taught band”)

4. Restricted range of movement in the involved muscle

5. Often pseudo-weakness of the involved muscle (no atrophy)

6. Often referred pain on continued (~5 secs) pressure over trigger point.

TRIGGER POINTS OF HUMAN MUSCLES:-

Muscles of scapular region:-

Muscles in pectoral Muscles of Ant compt of leg region

Muscles of gluteal and post compt of leg-

85% cases of 283 admissions in a comprehensive pain clinic---Skootsky et al,1989

55.4% among 296 sufferers of chronic head and neck pain --Fricton et al,1985

Female predominance varying between 1.5:1-3:1 and major cause of disability after trauma---Evans ,1992

52 women out of 116 subjects developed MPS after breast cancer surgery (CI: 35.6 to 54.3) ---Torres Lacomba et al,2010

Myofascial trigger points are primarily responsible for pain

among 10% of 61 patients—simons 1991

A GLANCE AT INCIDENCE OF SYNDROME:-

Activating mechanisms- Muscle overuse or underuse Faulty positioning malalignment of forces underlying joint dysfunction. Exceeded critical loadmuscle dysfunctionpremature

muscle fatigue

Myofascial trigger point--point where the muscle was no longer capable of handling the load, perhaps as a result of local injury or disruption of the myofibrillar structure.

ETIOLOGY OF MPS:-

Perpetuating mechanismsMECHANICAL SYSTEMIC

Postural stresses • Poor posture, sustained contraction,

repetitive motion, immobility, bruxism, dental malocclusion, nonergonomic furniture

 Structural stresses • Leg length inequity, small hemipelvis,

scoliosis, spinal spondylosis or spondylolisthesis

 Deconditioning  Articular dysfunction • Inflammatory, degenerative  Periarticular dysfunction • Bursitis, tendonitis  Neurogenic • Radiculopathy, spasticity, RSD

neuropathic and nociceptive pain  External compression

Sleep disturbances • Insomnia, restless legs, nocturnal

myoclonus  Nutritional deficiencies • B complex vitamins  Metabolic dysfunction • Uremic or hepatic disease Fatigue  Endocrinopathies • Thyroid, diabetes Temperature  Other concurrent disease • Primary fibromyalgia, anemia,

chronic fatigue syndrome, infections  Medication dependencies  Immune-mediated disease • Connective tissue, vasculitis  Electrolyte disturbance

MTrP HYPOTHESIS:-

Medications.  Noninvasive techniques Counterpoint stimulation Spray (freeze) and stretch. Physical therapy. Acupuncture. Transcutaneous electrical stimulation (TENS). Ultrasound Massage.  Ischemic compression therapy. Topical medications. Medications for injection---local anasthetics,dry

needling,miniscalpel needle release

MANAGEMENT-APPROACH TO PERPETUATING FACTORS:-

Myofascial release ( MFR) is a soft tissue therapy for the treatment of skeletal muscle immobility and pain.Principle of MFR is gentle application of sustained pressure into fascial restrictions.A low load applied slowly allows a viscoelastic medium to elongate.  

Self-myofascial release (or SMFR) This alternative medicine therapy aims to relax contracted muscles, improve blood and lymphatic circulation, and stimulate the stretch reflex in muscles.

"myofascial release" was coined in the 1960s by Robert Ward Ward, along with physical therapist John Barnes, are considered the

two primary founders of MFR

Direct release Indirect release Tissue is loaded with constant fascia unwind itself with least forces until ‘release’ occurs resistance until free movement is achieved

YOU KNOW WHAT IS MFR…

DIRECT THERAPY Land on the surface of the body

with the appropriate 'tool' (knuckles, or forearm etc.).

Sink into the soft tissue. Contact the first

barrier/restricted layer. Put in a 'line of tension'. Engage the fascia by taking up

the slack in the tissue. Finally, move or drag the fascia

across the surface while staying in touch with the underlying layers.

Exit gracefully. --Micheal stanborough

INDIRECT THERAPY Lightly contact the fascia with

relaxed hands. Slowly stretch the fascia until

reaching a barrier/restriction. Maintain a light pressure to

stretch the barrier for approximately 3–5 minutes.

Prior to release, the therapist will feel a therapeutic pulse (e.g., heat).

As the barrier releases, the hand will feel the motion and softening of the tissue.

The key is sustained pressure over time.

---Barnes

Principles of MFR:-

Back Pain Bladder Problems (Urgency, Frequency, Incontinence, Overactive

Bladder, Leakage) Birth Injuries Bulging Disc Bursitis Carpal Tunnel Syndrome Cerebral Palsy Cervical and Lumbar Injuries Chronic Fatigue Syndrome Chronic Pain Degenerative Disc Disease Endometriosis Emotional Trauma Fibromyalgia Frozen Shoulder (Adhesive Capsulitis) ….contd

Conditions that can be managed by MFR:-

Herniated Disc Headaches or Migraines Infertility Interstitial Cystitis Menstrual Problems Myofascial Pain Syndrome Neck Pain Osteoarthritis Pelvic Pain Plantar Fascitis Pudendal Nerve Entrapment Scars (hypertrophic, hypersensitive, painful, burn scars,

mastectomy scars) Sciatica Scoliosis Shin Splints Tennis Elbow Tinnitus (Ringing of the ears) TMJ Syndrome Trigeminal Neuralgia Vulvodynia Whiplash

The importance of sustaining pressure at the restricted barrier to create“phase transition” is paramount for lasting results and stimulates the production of Interleukin 8 which is our body’s natural anti-inflammatory.

Resonance is essential for the reduction of pain, increase in range of motion, and for authentic healing to occur which cant be produced by other types of therapies.

Piezoelectricity[pressure electricity]:- Our cells are crystalline in nature. When you place pressure into a crystal it creates an electrical flow. The sustained pressure coupled with the essential time element creates a bioelectrical flow (the motion of our mind which leads into mechanotransduction)

Mechanotransduction:-sustained mechanical pressure can also create biochemical changes within our bodies.Importantly, MFR produces IL 8.Inflammation is a important part of the healing process.when inflammation has been thwarted it tends to solidify the ground substance of the fascial system which should be fluid. This blocks healing and over time tends to continue to solidify into crushing restrictions that produce the symptoms .

Phase Transition:-These two occurrences dove tail together and then Phase Transition takes place. This is the phenomena of ice transforming into water. In our bodies a similar occurrence happens. The solidification of the groundsubstance becomes more fluid allowing the tissue to rehydrate and to glide taking crushing pressure (appro.2,000 pounds per square inch) off of pain sensitive structures

IMPORTANCE OF MFR:-

Chaos Theory:-true growth and healing cannot occur in a controlled,orderly way.“Systems Theory” states that nature goes through continuous of order, chaos, order,chaos, etc. It is in the “ChaoticPhase” that reorganization occurs.For Phrase Transition to occur, there is a period of Chaos for the solidified ground substance of the fascial system to transform into a more viscous/fluid state.Resonance:-When one person touches another person their vibratory rates are quite different on the molecular level, however with sustained pressure at the fascial restriction, the vibratory rates will become identical creating resonance[Release]. Resonance unfortunately does not occur in other forms of therapy as other forms of therapy are too quick,hence providing only temporary results. Myofascial Release coupled with other formsof techniques will enhance effectiveness.“art” of locating the fascial Restrictions..

“My son fractured his clavicle during a karate class. I took him to the emergency room where he received an x-ray, was given a sling,medication, and was told he will heal in a couple of weeks, but his clavicle will stay deformed.So, after we went home, I performed MFR for his neck, shoulder, and chest wit very gentle touch. He felt much better. His pain went significantly down, he slept well, and the next day we decided to see an orthopedist and re-x-ray his shoulder. According to the orthopedist, he couldn’t explain why his bone was reset in as little as 16 hours. My son is doing just fine; he has no pain, and played basketball today!

BEFORE AFTER MFR,1 DAY LATER

Case study-1:-

My wife told me thatshe has a cyst on her right ovary and “ it does not look good”.During her routine ultrasound it was discovered that she had a dermoid cyst.The doctor suggested surgery to remove the whole right ovary. He warned us that solid cysts do not go away and that my wife would need surgery.My wife saw an advanced John F.Barnes’ Myofascial Release therapist the following day and subsequently completed 10 Myofascial Release sessions. When my wife had her second ultrasound performed, the cyst was completely gone! “No surgery” the doctor said. What a relief!

CASE STUDY 2:-

“Therapists and patients who have experienced the profound reduction of pain and the restoration of mobility using Myofascial Release are the trailblazers and innovators of healthcare.”--Barnes

CONCLUSION:-