Involved Muscle. A muscle that has developed one or more active or latent trigger points.

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1 TRIGGER POINT THERAPY - GLOSSARY OF TERMS Active Myofascial Trigger Point. A focus of hyper-irritability in a muscle or its fascia that is symptomatic with respect to pain; it refers to a pattern of pain at rest and/or motion that is specific for the muscle. An active trigger point is always tender, prevents full lengthening of the muscle, weakens the muscle, usually refers pain on direct compression, mediates a local twitch response of muscle fibres when adequately stimulated, and often produces specific referred autonomic phenomena, generally in its pain reference zone. To be distinguished/torn a latent myofascial trigger point. Associated Myofascial Trigger Point. A focus of hyper-irritability in a muscle or its fascia that develops in response to compensatory overload, shortened range, or referred phenomena caused by trigger point activity in another muscle. Satellite and secondary trigger points are types of associated trigger points. Composite Pain Pattern. Total referred pain pattern of two or more closely adjacent muscles. No distinction is made among the pain patterns of the individual muscles. Essential Pain Zone (Area). The region of referred pain (indicated by solid red areas in pain pattern figures) that is constantly present in nearly every patient when the trigger point is active. To be distinguished from a spill over referred pain zone. Involved Muscle. A muscle that has developed one or more active or latent trigger points. Latent Myofascial Trigger Point. A focus of hyperirritability in muscle or its fascia that is clinically quiescent with respect to spontaneous pain; it is painful only when palpated. A latent trigger point may have all the other clinical characteristics of an active trigger point, from -which it is to be distinguished. Myofascial Syndrome. Pain and/or autonomic phenomena referred from active myofascial trigger points with associated dysfunction. The specific muscle or muscle group that cause the symptoms should be identified. Myofascial Trigger Point. A hyperirritable spot, usually within a taut band of skeletal muscle or in the muscle's fascia, that is painful on compression, and that can give rise to characteristic referred pain, tenderness and autonomic phenomena. A myofascial trigger point is to be distinguished from cutaneous, ligamentous, periosteal and non-muscular fascial trigger points. Types include active, latent, primary, associated, satellite and secondary. Myofascitis. Pain. Tenderness, other referred phenomena, and the dysfunction attributed to myofascial trigger points. Primary Myofascial Trigger Point. A hyperirritable spot within a taut skeletal muscle band that was activated by acute or chronic overload (mechanical strain) of the muscle in which it occurs, and was not activated as a result of trigger point activity in another muscle of the body. To be distinguished from secondary and satellite trigger points MCPT Trigger Point 2 (Lower Extremities) - Diploma (HLT50307) Version 2 July

2 Referred Autonomic Phenomena. Vasoconstriction (blanching), coldness, sweating, pilomotor response, ptosis, and/or hypersecretion that are caused by activity of a trigger point in a region separate from the trigger point. The phenomena usually appear in the same area to which that trigger point refers pain. Referred Trigger Point Pain. Pain that arises in a trigger point, but is felt at a distance, often entirely remote from its source. The pattern of referred pain is reproducibly related to its site of origin. The distribution of referred trigger point pain rarely coincides with the entire distribution of a peripheral nerve or dermatomal segment. Referred (Trigger Point) Phenomena. Sensory and motor phenomena, such as pain, tenderness, increased motor unit activity (spasm), vasoconstriction, vasodilation, and hypersecretion caused by a trigger point, which usually occur at a distance from the trigger point. Satellite Myofascial Trigger Point. A focus of hyperirritability in a muscle or its fascia that became active because the muscle was located in the zone of reference of another trigger point. To be distinguished from a secondary trigger point. Secondary Myofascial Trigger Point. A hyperirritable spot in a muscle or its fascia that became active because its muscle was overloaded as a synergist substituting for, or as an antagonist countering the tautness of, the muscle that contained the primary trigger point. To be distinguished from a satellite trigger point. Spillover Pain Zone (Area). The region where some, but not all, patients experience referred pain beyond the essential pain area, due to greater hyperirritability of a trigger point. The spillover zone is indicated by red stippling in the pain-pattern figures. To be distinguished from an essential referred pain zone. Trigger Point. A focus of hyperirritability in a tissue that, when compressed, is locally tender, and if sufficiently hypersensitive, gives rise to referred pain and tenderness, and sometimes to referred autonomic phenomena and distortion of proprioception. Types include myofascial, cutaneous, fascial, ligamentous and periosteal trigger points. Zone of Reference. The specific region of the body at a distance from a trigger point where the phenomena (sensory, motor, autonomic) that it causes are observed MCPT Trigger Point 2 (Lower Extremities) - Diploma (HLT50307) Version 2 July

3 TYPES OF MYOFASCIAL TRIGGER POINTS * ACTIVE Painful Prevents fall lengthening of muscle Weakens the muscle Usually refers pain on compression Referred autonomic phenomena Disturbed sleep Depression * LATENT Same as an active trigger point except that it is only painful when palpated * SATELLITE Occurs in Zone of Reference of another trigger point * ASSOCIATED Develop in response to compensatory overload, shortened range or referred phenomena caused by a trigger point in another muscle. Types include: Satellite & Secondary Trigger Points * PRIMARY Activated by acute or chronic overload of the muscle in which it occurs, (not referred) * SECONDARY Occur in overloading synergist (substituting for) or antagonist (countering tautness in muscle containing primary trigger point) 2010 MCPT Trigger Point 2 (Lower Extremities) - Diploma (HLT50307) Version 2 July

4 PRESUPPOSITIONS Normal Muscles do not contain T.Pts An Active T.Pt. is capable of generating spontaneous pain and other referred symptoms as well as causing weakness and tightness. A Latent T.Pt. by definition is involved by causing weakness and tightness only. Pain generated by a T.Pt. is seemingly unrelated to the size or importance of the muscle in which it is located. Pain tends to be referred distally in the limbs and to joints involved with the muscle. T.Pts. cause pain but something has to cause the T.Pt. Locations described in texts represent the most common sites only and are by no means exhaustive. An area described as a T.Pt. may in fact consist of multiple discrete points. Pain in the upper body can result from a primary T.Pt. anywhere in the upper body. Pain in the lower body can result from a primary T. Pt. anywhere in the lower body. Both the upper and lower body can be affected by problems and changes in the other area MCPT Trigger Point 2 (Lower Extremities) - Diploma (HLT50307) Version 2 July

5 TRIGGER POINTS BASICALLY ACT LIKE A MUSCLE FUSE THAT "BLOWS IN RESPONSE TO SOME FORM OF OVERLOAD. Within muscle tissue they will feel like an elastic band with a knot tied in it (with due consideration for the thickness & type of overlying tissue) Effective treatment comes with consideration for the CAUSE & LOCATION of Primary Tr. Pts MCPT Trigger Point 2 (Lower Extremities) - Diploma (HLT50307) Version 2 July

6 TRIGGER POINTS ARE THE PHYSICAL MANIFESTATIONS OF OTHER PROBLEMS CAUSE Consideration of the cause will result in eradication of the point. TRIGGER POINT SYMPTOMS Treating the trigger point will usually relieve the symptoms. Treating the symptoms can have anything from a minimally positive to an extremely negative effect MCPT Trigger Point 2 (Lower Extremities) - Diploma (HLT50307) Version 2 July

7 PERPETUATING FACTORS Mechanical Structural Small hemipelvis, short leg, large 2nd metatarsal Postural Poor ergonomics, poor posture, muscle abuse, prolonged immobility, constricting pressure Nutritional Deficiencies Vit. Bl, B6, folic acid, minerals & trace elements Metabolic & Endocrine Disorders Altered thyroid function, hypoglycemia, disorders affecting muscle function such as anaemia & hypoxia. Psychological Factors Depression, anxiety, tension, ignoring pain, secondary gain (sickles etc) Chronic Infection Allergic rhinitis Impaired Sleep Nerve Impingement 2010 MCPT Trigger Point 2 (Lower Extremities) - Diploma (HLT50307) Version 2 July

8 AGGRAVATING FACTORS Strenuous use of the involved muscle. Stretching of the involved muscle. Pressure or constriction on the Tr.Pt. Prolonged shortening. Sustained or repeated use of involved muscle. Cold & damp. Viral illness. Nerve tension Chilling of fatigued muscle Cold applied to the Tr.Pt MCPT Trigger Point 2 (Lower Extremities) - Diploma (HLT50307) Version 2 July

9 EASING FACTORS Short periods of rest Slow, careful stretching, preferably with heat. Heat over Tr.Pt. (less so if over referral zone). Short periods of light activity. Cold applied to reference zone. Specific treatment strategies MCPT Trigger Point 2 (Lower Extremities) - Diploma (HLT50307) Version 2 July

10 Treatment of Trigger Points Have you considered the cause of the point you wish to treat? Graded massage and/or moist heat can be used to reduce irritability, decrease symptoms & relax surrounding tissue. The points can be treated using Digital Ischaemic Pressure (DIP) or Stripping Techniques. Moist heat can be used post treatment to multiply its effects or as a self-help maintenance strategy. Stretching the affected muscle/s after treatment (without causing pain) can multiply the effect of general treatment. NB: Each individual strategy is effective. Combinations can be more so MCPT Trigger Point 2 (Lower Extremities) - Diploma (HLT50307) Version 2 July

11 ILIOPSOAS (p 89ff) Causes Corrections Sudden overload such as a fall Prolonged sitting (in car, desk) Excessive sit-ups Pregnancy Sleeping too long in foetal position Tight Rec Fem Leg length differences/small hemi pelvis Deactivate associated Tr Pts Correct leg length differences Stretch 2010 MCPT Trigger Point 2 (Lower Extremities) - Diploma (HLT50307) Version 2 July

12 QUADRATUS LUMBORUM (p 28ff) Causes Corrections Sudden accidental trauma (car accident) Lifting heavy or awkward objects (TV, lawnmower, children) Putting clothes on and stumbling, losing balance Leg length difference Repetitive strain (from gardening, scrubbing the floor etc) Weak abs Walking/jogging on uneven surfaces Small hemi pelvis Soft mattress Firm mattress Correct lifting technique Stretches Deactivate associated Tr pts Strengthen abs Address any leg length discrepancies Superficial Deep Superficial Deep MCPT Trigger Point 2 (Lower Extremities) - Diploma (HLT50307) Version 2 July

13 GLUTEUS MAXIMUS (p 132ff) Causes Corrections Overload stress from a fall or near fall Prolonged uphill walking Incorrect sleeping posture Prolonged sitting Sitting on a wallet Stretching Deactivate associated Tr Pts 2010 MCPT Trigger Point 2 (Lower Extremities) - Diploma (HLT50307) Version 2 July

14 GLUTEUS MEDIUS (p 150ff) Causes Corrections Sudden falls Weight bearing on one hip for prolonged periods Sleeping in foetal position for long periods Sitting on a wallet Stretching Placing a pillow between legs when sleeping on side Deactivate Tr Pts 2010 MCPT Trigger Point 2 (Lower Extremities) - Diploma (HLT50307) Version 2 July

15 GLUTEUS MINIMUS (p 168ff) Causes Corrections A fall Walking too far/too fast on rough ground Distortion of normal gait Prolonged immobility (foot on accelerator for long periods) Pillow between legs whilst sleeping Regularly change foot/leg position 2010 MCPT Trigger Point 2 (Lower Extremities) - Diploma (HLT50307) Version 2 July

16 PIRIFORMIS (p 186ff) Causes Corrections Catching yourself from falling Incorrect lifting technique Running Prolonged immobilisation Breaking up prolonged activities Change positions Stretch Pay attention to correct lifting techniques 2010 MCPT Trigger Point 2 (Lower Extremities) - Diploma (HLT50307) Version 2 July

17 TENSOR FASCIA LATAE (p 218ff) Causes Corrections Chronic overload (jogging up/down hill with poor support) Prolonged sitting Abnormal bulk in quadriceps muscles (cyclists, bodybuilders) Incorrect sleeping position Change of position Stretching Ensure sleeping position is adequate (hip flexion as close as possible 2010 MCPT Trigger Point 2 (Lower Extremities) - Diploma (HLT50307) Version 2 July

18 SARTORIUS (p 226ff) Causes Correction Not usually a single muscle syndrome, other muscles are involved Acute overload strain in a twisting fall Relieving associated Tr Pts Stretch Upper trigger point Middle trigger Point Lower trigger point 2010 MCPT Trigger Point 2 (Lower Extremities) - Diploma (HLT50307) Version 2 July

19 PECTINEUS (p 236ff) Causes Corrections Tripping or falling Horseback riding Prolonged sitting in a cross legged position Avoid sitting in cross legged position Stretch 2010 MCPT Trigger Point 2 (Lower Extremities) - Diploma (HLT50307) Version 2 July

20 RECTUS FEMORIS (p 248ff) Causes Corrections Fall or accident Sitting with a heavy weight in lap Mis-step Overload compensating for other muscular Tr Pts (egg soleus and hamstrings) Immobilisation Avoid overload Avoid immobilisation Stretch 2010 MCPT Trigger Point 2 (Lower Extremities) - Diploma (HLT50307) Version 2 July

21 VASTUS MEDIALIS (p 248ff) Causes Corrections Prolonged kneeling on hard surfaces Strenuous athletic activity Overload compensating for other muscular Tr Pts (egg soleus and hamstrings) Immobilisation Avoid overload Avoid immobilisation Stretch Trp MCPT Trigger Point 2 (Lower Extremities) - Diploma (HLT50307) Version 2 July

22 VASTUS INTERMEDIUS (p 248ff) 2010 MCPT Trigger Point 2 (Lower Extremities) - Diploma (HLT50307) Version 2 July

23 VASTUS LATERALIS (p 248ff) 2010 MCPT Trigger Point 2 (Lower Extremities) - Diploma (HLT50307) Version 2 July

24 ADDUCTOR LONGUS AND ADDUCTOR BREVIS (p 289ff) Causes Corrections Sudden overload Strenuous horseback and bicycle riding Running up and down hill Stretch Avoid/minimise activities that will affect adductors 2010 MCPT Trigger Point 2 (Lower Extremities) - Diploma (HLT50307) Version 2 July

25 ADDUCTOR MAGNUS (p 289ff) TrP MCPT Trigger Point 2 (Lower Extremities) - Diploma (HLT50307) Version 2 July

26 GRACILIS (p289ff) 2010 MCPT Trigger Point 2 (Lower Extremities) - Diploma (HLT50307) Version 2 July

27 POPLITEUS (p339ff) 2010 MCPT Trigger Point 2 (Lower Extremities) - Diploma (HLT50307) Version 2 July

28 HAMSTRINGS (p 315ff) Causes Corrections Under thigh compression from ill-fitting chairs Overuse from the crawl swimming stroke Bicycle seat too low Immobilisation Reaction to explosive quadriceps contraction Avoid/minimise under thigh compression Stretch Biceps femoris (Both heads) 2010 MCPT Trigger Point 2 (Lower Extremities) - Diploma (HLT50307) Version 2 July

29 TIBIALIS ANTERIOR (p 355ff) 2010 MCPT Trigger Point 2 (Lower Extremities) - Diploma (HLT50307) Version 2 July

30 PERONEALS (p 370ff) 2010 MCPT Trigger Point 2 (Lower Extremities) - Diploma (HLT50307) Version 2 July

31 GASTROCNEMIUS (p 397ff) Causes Corrections Climbing steep slopes, jogging uphill High heels Prolonged standing Long socks with tight elastic band at the top or garters Check posture Change shoes Stretch TrP1 TrP3 TrP1 TrP MCPT Trigger Point 2 (Lower Extremities) - Diploma (HLT50307) Version 2 July

32 SOLEUS (p 427ff) Causes Correction Slipping or losing balance Excessive jogging Stretch 2010 MCPT Trigger Point 2 (Lower Extremities) - Diploma (HLT50307) Version 2 July

33 PLANTARIS (p 427ff) 2010 MCPT Trigger Point 2 (Lower Extremities) - Diploma (HLT50307) Version 2 July

34 TIBIALIS POSTERIOR (p 460ff) 2010 MCPT Trigger Point 2 (Lower Extremities) - Diploma (HLT50307) Version 2 July

35 LONG EXTENSORS OF TOES (p 472ff) Extensor digitorum longus trigger point Extensor Hallucis Longus Trigger Point 2010 MCPT Trigger Point 2 (Lower Extremities) - Diploma (HLT50307) Version 2 July

36 LONG FLEXORS OF TOES Flexor Digitorum Longus trigger point Flexor Hallucis Longus trigger point 2010 MCPT Trigger Point 2 (Lower Extremities) - Diploma (HLT50307) Version 2 July

37 SUPERFICIAL INTRINSIC FOOT MUSCLES (p 501ff) Extensor hallucis brevis Extensor digitorum brevis Abductor hallucis 2010 MCPT Trigger Point 2 (Lower Extremities) - Diploma (HLT50307) Version 2 July

38 Abductor digit minimi Flexor digitorum brevis 2010 MCPT Trigger Point 2 (Lower Extremities) - Diploma (HLT50307) Version 2 July

39 DEEP INTRINSIC FOOT MUSCLES (p 501ff) Quadratus Plantae Dorsal interosseous Plantar interosseous Plantar view 2010 MCPT Trigger Point 2 (Lower Extremities) - Diploma (HLT50307) Version 2 July