Summary Notes: Myofascial pain and self Myofascial release Adam Floyd B.Sc (Physio) B.PE (Hons) Physiotherapist and Exercise Physiologist www.adamfloyd.com.au What is Myofascial Pain? Much of the early work in this area can be attributed to Dr Janet Travell as far back as 1942 and later with her colleague David Simmons. She introduced the Myofascial pain concept and described it as a focal hyperirritability in muscle that can strongly modulate central nervous system functions. Studies estimate that in 75 95 percent of cases, Myofascial pain is a primary cause of regional pain. Myofascial pain is associated with muscle tenderness that arises from trigger points, focal points of tenderness, a few millimetres in diameter, found at multiple sites in a muscle and the fascia of muscle tissue. The term "trigger point" was coined in 1942 by Dr Travell to describe a clinical finding with the following characteristics: Pain related to a discrete, irritable point in skeletal muscle or fascia not caused by acute local trauma, inflammation, infection or other pathological causes.. The painful point can be felt as a nodule or band in the muscle, and a twitch response can be elicited on stimulation of the trigger point. Pressure over the trigger point reproduces the patient's complaint of pain, and the pain radiates in a distribution typical of the specific muscle harbouring the trigger point. Biopsy tests found that trigger points were hyperirritable and electrically active muscle spindles in general muscle tissue (Jantos, 2007) An active trigger point is one that actively refers pain either locally or to another location (most trigger points refer pain elsewhere in the body along nerve pathways). A latent trigger point is one that exists, but does not yet refer pain actively, but may do so when pressure or strain is applied to the myoskeletal structure containing the trigger point. Latent trigger points can influence muscle activation patterns, which potentially can result in poorer muscle coordination and balance. When trigger points are present in muscles there is often pain and weakness in the associated structures. These pain patterns in muscles follow specific nerve pathways and have been readily mapped to allow for identification of the causative pain factor. Trigger points are diagnosed by examining signs, symptoms, pain patterns and manual palpation. A 2009 review of nine studies examining the reliability of trigger point diagnosis found that physical examination could not be recommended as reliable for the diagnosis of trigger points (Lucas et al, 2009). Diagnosis should of course be made by an appropriate health professional such as a physiotherapist. There is a strong correlation between trigger points and both traditional acupuncture points and ah shi points in traditional Chinese medicine (Dorsher 2006).
Treatment There are a number of treatments used to release trigger points and Myofascial pain. These include massage techniques such as Myofascial release and trigger point release/acupressure (similar to Japanese shiatsu massage). Some doctors will use injections of procaine (a local anaesthetic) or other substances such as saline. There is much discussion over whether the benefit it from the substance or just the needle itself and many practitioners use dry needling (acupuncture needles) to successfully treat Myofascial pain. Physiotherapists often use high dose ultrasound. Travel and Simmons also advocated the use of spray and stretch techniques using a cooling spray. Once the point is released it is essential to work on posture and muscle balance to prevent recurrence. When should you not attempt SMFR Acute injury the spasm is there for a reason. Severe or significant pain that presents as non- muscular, such as neuropathic (nerve) pain Are you insured for it? Discussing with the client Why you are doing it and that it is not treatment What should you feel afterwards What to do if the pain increases Fix the problem Improve clients awareness of how to hold themselves against gravity Reduce static load for long periods Recovery between bouts of exercise Stretch stiff areas fascial lines Massage as a prevention? Strengthen the synergist or agonist References Dorsher PT (May 2006). "Trigger points and acupuncture points: anatomic and clinical correlations". Medical Acupuncture 17 (3 Jantos M (June 2007). "Understanding chronic pelvic pain". Pelviperineology 26 (2). ISSN 1973 4913. Lucas N, Macaskill P, Irwig L, Moran R, Bogduk N (2009 Jan). "Reliability of physical examination for diagnosis of myofascial trigger points: a systematic review of the literature". Clin J Pain 25 (1): 80 9. Travell, Janet, Simons David and Simons Lois (1999). Myofascial Pain and Dysfunction: The Trigger Point Manual (2 vol. set, 2nd Ed.). USA: Lippincott Williams & Williams.
Upper Trapezius Sub occipitals Rhomboids Infraspinatus/Posterior Cuff
Pec Major and minor Latissimus Dorsi Erector spinae ITB/TFL
Other Piriformis Medial Gatrochnemius/Soleus Plantar fascia