The Physiology of a Trigger Point overstimulated sarcomeres become unable to release their contraction muscle fiber to become shorter

er and wider(the nodule/knot) segment of the muscle fiber distant from the contraction to be over stretched and tightened(the taut band) When sarcomeres hold their contraction, blood flow stops in the area, resulting in oxygen starvation and accumulation of waste products irritating the TrP and sending out pain signals. Trigger Point Symptoms Distinctively painful (on compression) Give rise to jump sign local, or in referral zone; stretching is painful; contraction is painful Local Twitch Response A transient contraction of a group of tense muscle fibres (taut band) Motor dysfunction TrPs keep muscles short and tense, therefore reducing ROM TrPs prevent MM from relaxing, causing tire quickly, recover slowly, contract excessively Stretching and contracting irritates TrPs and increase pain, making one less likely to move `splinting` or `guarding` Specific Health History Questions 2. Previous acute or overuse injury to the affected muscle? 5. Does the pain refer anywhere else? 7. Are there any autonomic symptoms present? 8. What aggravates/alleviates the pain? 9. Was the involved muscle placed in a shortened position for a long period of time? 10. Is there muscle stiffness, limitation of movement or weakness? Testing AF ROM -Reduced pain and spasm end feel PR ROM -Reduced pain and spasm end feel AR testing -Weakness maximum contraction in shortened position = painful Muscle length tests Decreased length TreatinqTrigger Points D.breath, Warm up the area muscle in a pain free comfortably lengthened position Palpate across fibres for the taut band skin rolling, flat palpation, or pincer grasp palpation Palpate with fibres of taut band to locate TrP Techniques 1. Slow skin rolling Reduces panniculosis, Increases local circulation 2. Slow repetitive muscle stripping light- gradually increases, Causes temporary local ischemia, reactive hyperemia Flushes out metabolites Px Indicates when local and referred pain decreases , Palpable nodule disappears 3. Alternating ischemic compressions Pressure within the Px pain tolerance is applied for 7-10 seconds at a time and released Causes temporary local ischemia, reactive hyperemia Pressure re-applied 7-10 seconds and released Pain should decrease with each application Used for hyperirritable TrPs

4. Prolonged ischemic compressions Takes between 20 seconds and 60 seconds TrP feels as though it is softening/melting Px feels pain diminish , Repetitive petrissage is used to flush Followed by heat and slow stretch If pain does not completely diminish, reapply pressure until pain tolerance is reached If TrP is not eradicated after a minute of IC, apply repetitive petrissage, use a slow stretch and heat However you choose to treat TrPs, you MUST follow with: Restoring ROM passive stretch, PIR, AF ROM Applying appropriate hydrotherapy local deep moist heat to increase circulation KickBack Pain - a recurrence of Px symptoms hours or days after Tx. If ischemic compressions are applied too quickly and deeply, released too quickly, and not followed by either a passive stretch and heat or slow full AF ROM and heat. If headache results, cool hydrotherapy may help Assess synergists and antagonists for satellite TrPs Self care Self massage muscle stripping and alternating IC and stretch Repeat slow, full, pain-free stretches frequently Stretch before and after activity Perpetuating factors reduced/eliminated Postural imbalances should be corrected Treatment frequency and Expected Outcome 12 TrPs may be treated during a relaxation massage Many TrPs should be treated in 30 minute sessions 2-3 times per week Contraindications In Tx TrPs that are proximal to an area of acute inflammation, the usual use of heat as postTx hydrotherapy is CI In this situation, repetitive proximal effleurage to increase drainage is indicated following Tx of the TrP In the case of acute or early subacute overstretch injuries, such as strains or sprains, Tx of TrPs local to the injury is CI Trauma and the inflammatory process preclude the use of local muscle stripping and IC, as well as postTx stretching and heat Percussion and stretch are CI on the anterior or posterior leg compartments. A possible compartment syndrome could result if a hematoma were created by an overly vigorous application of the technique Avoid combining prolonged IC, and frictions to the same muscle at the same appointment, since this can over treat the tissue. Use muscle stripping for the TrPs Although a full stretch usually follows the Tx of a TrP, it is CI to fully stretch muscles that cross a hypermobile joint. Instead, IC is followed with repetitive muscle stripping and heat