Active Myofascial Trigger Point Therapy

Hi, I am a 3rd year physiotherapy student and just about to start my dissertation, for which i have chosen to research the 'effectiveness of ischaemic compression therapy for active trigger points'. I believe that it is important to retain manual skills in light of recent 'medicalised' approaches to many conditions (i.e. injections). But of course I need to be able to provide evidence on their effectiveness. Although there is information out there for this well used technique, there is little research either clinical or evidentially based from which i can justify this method of treatment. Just hoping that someone out there could help - with views, research or clinical details.
Thank you in anticipation.

[Physiobase]

Try to ask fellow physios in this instance for single case design data, i.e. one patient who benefited from this technique when applied in a way to justify that it was the treatment causing the change. Or if no one can supply data but uses the technique - perhaps be even more radical by outlining a single case design and ask those using the technique to follow your single case guideline and report back to you!

Numerous single case techniques are perhaps more powerful than any RCT

Hi Jilly,
I trained in the u.s. in neuromuscular therapy - a well defined method for treating trigger points that utilises ischaemic compression as one of the soft-tissue techniques. It works very well, but like much of physio, is poorly researched.
You may want to use 'neuromuscular therapy' or 'nmt' as search terms on google.
Authors on the subject include the classic works by Travell & Simons, and newer texts by Leon Chaitow & Judith Walker DeLany.
Look for papers by David Simons, e.g. in the J. of Bodywork & Movement Therapies.
Finally, take a look at the papers by Chan Gunn on trigger points and myofascial pain. I now use his techniwue of dry-needling (Intramuscular Stimulation) to treat TP's.
Hope this helps.
Cris[/i]

Thanks Chris

Hello Jillybutt,

For the treatment of the "so called" trigger points, in my experience the problem is not in the muscle per se , but is being caused by another problem ie- neural , postural , or joint. Your job is to find out what the source of the problem is and that will resolve it the most effectively. Have long ago stopped trying to "massage out" or use ischemic pressure as these in my experience usually provide only transiet relief of the so called "trigger point". Muscle biopsies have not shown any abnormality in the muscle itself, so just treating the muscle is unlikely to help in the long term.

Good luck on your new career......Thomas

hi jilly nice idea, but have you done your search adequately, cos there are few articles that might be quite interesting to you, one is hong CZ et al published in arch phy ned rehab, and other in the journal physical therapy, both the studies have dealt with ischemic compression to a major extent,amd i have done quite a bit of study on this myself, you can contact ,me on my mail id, mageshanand@gmail.com if you want any further suggestions, as it may not be much importance to the readers, in this forum.

[fisiosimo]

Hello. I've searched for fluorimethane (or alternative vapocoolants) on the internet, without success. Can you help me ?

[Baby_Physio_Kieran]

I have to agree with Bravocosta. In my (admittedly limited) experience I've found that most "trigger points" and "knotted muscles" seem to be caused by a more proximal problems. And (I'm sorry to generalize as this is generally considered the cardinal sin) tend to respond well to mobs of the appropriate spinal level. I have experienced many patients claiming that certain mobs at the corresponding spinal level causes the pain to "switch on and off". Gentle rhythmic mobs relieved the more distal muscular pain/knot/trigger point and combined with regular stretches to firmly break the pain-spasm cycle. I would appreciate opinions on the possible mechanism of this re. ?merely pain-gate at nerve root or ?"freeing up" nerve root.

[physiobob]

Originally Posted by fisiosimo

Hello. I've searched for fluorimethane (or alternative vapocoolants) on the internet, without success. Can you help me ?

I think you mean Fluorimethane.

I found this info on the site: http://www.bayareapainmedical.com/wtrgrpnts.html

MYOFASCIAL TRIGGER POINTS

Myofascial trigger points are small areas of muscle spasm in larger muscles. These small areas can be exquisitely painful. There is often an area of inflammation in the surrounding fascia. Trigger points can be palpated using the finger tips and this type of palpation not only induces pain, but also reveals the actual area of spasm of the muscle being evaluated. The fascia around the trigger point is pulled taught and can lead to inflammation of that area. The pain caused by chronic trigger points can be severe, breaking through high doses of opioid medications and combinations of medications. Pain can be referred and may imitate neuropathic pain. It can be aching, stinging, burning or throbbing in nature. Referred patterns of headache are quite common from the shoulder and intrascapular areas of the trapezius muscle.

Several approaches to treating these pinpoint areas of muscle spasm have been tried. Message therapy can be helpful, but should probably be combined with the use of Fluorimethane and trigger point injections. Using cold in the form of Fluorimethane spray and stretching after this treatment can be quite effective. Injecting the trigger points with a small gauge needle and local anesthetic can also be helpful. The injections should be aimed at multiple puncture of the part of the muscle in spasm, using 1 to 2% Lidocaine for local anesthesia and some local anti-inflammatory effects. The key here is not the pain relief from the infiltration with the Lidocaine, but is more for the needle penetration, breaking up the muscle spasm. Some people inject steroids with the anesthetic, but the IM nature of the steroid injections can lead to cumulative steroid toxicity, if the injections need repeating every three to four weeks.

In instances of chronic trigger point recurrence the use of botulinum toxin can give longer term relief. This treatment is somewhat controversial, but patient's can gain excellent long term results, when other methods have failed.

A less invasive approach can be to put a Lidoderm® patch over the area of trigger points or to use transdermal Ketamine in PLO. Muscle relaxers, such as cyclobenzaprine may also be helpful. Again this treatment tends to stretch the length of time between trigger point injections and can be very helpful with referred pain.

[ginger]

Agree with Bravacosta and Kieren, dealing with "trigger points " will provide only short term relief from altered patterns of recruitment of muscle , and elements of referred pain associated with hypertonicity. Long term solutions will be provided by appropriate mobilisation to the relevant spinal facet joints. By freeing these joints from protective responses leading to inflammatory events of joint and nerve . There are lots of compelling ways to waste time, trigger point therapies are just another. I'd put it right up there with cupping.

[martinbs@mail.bg]

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[Dhul-Qarnayn]

Originally Posted by ginger

There are lots of compelling ways to waste time, trigger point therapies are just another. I'd put it right up there with cupping.

Wow, just wow. You are binning the works of some of the top therapists on the planet with that comment. Around 600 of my clients say quite the opposite. I have completely mended people with Myofascial techniques alone, and they have gone onto to enjoy a life free of pain (long term)

[Lorcan]

Hi Jill! Just wondering did you manage to get your dissertation finished on the "trigger points" as would be extremely interested in getting a copy of it?

[hariharan]

dear physio, its the best technique i have practised in tr. points. you try TRAVELL and SIMONS book. if you have doubts contact me at hariortho@aol.in.
did the best , do the best

[rosinbag]

do whichever myofascial/trigger point treatment works and then look for the imbalance or other structural issue might be causing the pain.