This heralds the sensitized state, one of the features of a chronic pain disorder, in which the pain itself is the pathology and requires medical intervention for its resolution. In some cases, however, muscle pain persists long after resolution of the injury it may even refer to other parts of the body, usually contiguous or adjacent rather than remote. This type of pain frequently resolves in a few weeks with or without medical treatment. Few people live without ever having experienced muscle pain as a result of trauma, injury, overuse, or strain. Myofascial pain is prevalent and a frequent cause of visits to primary care physicians and pain clinics 1, 2.
The criteria for diagnosis and their relative importance have evolved over time. Myofascial pain is a clinical problem that has generated interest and confusion for decades. The authors will chronicle the advances that have led to the current understanding of MTrP pathophysiology and its relationship to MPS, and review the contributions of clinicians and researchers who have influenced and expanded our contemporary level of clinical knowledge and practice. Data suggest that the soft tissue milieu around the MTrP, neurogenic inflammation, sensitization, and limbic system dysfunction may all play a role in the initiation, amplification, and perpetuation of MPS. In order to address these deficiencies, investigators have recently applied clinical, imaging (of skeletal muscle and brain), and biochemical analyses to systematically and objectively study the MTrP and its role in MPS. Unfortunately, much of the terminology, theories, concepts, and diagnostic criteria are inconsistent, incomplete, or controversial. According to Travell and Simons, MTrPs are central to the syndrome-but are they necessary? Although the clinical study of muscle pain and MTrPs has proliferated over the past two centuries, the scientific literature often seems disjointed and confusing.
MPS is a term used to describe a pain condition which can be acute or, more commonly, chronic and involves the muscle and its surrounding connective tissue (e.g. active), or painful only on compression (i.e. MTrPs are hard, discrete, palpable nodules in a taut band of skeletal muscle that may be spontaneously painful (i.e. DDN proved to be significantly easier than MPal in evoking an LTR.ĭry needling referred pain shoulder pain trigger points visual analogue scale.The intent of this paper is to discuss the evolving role of the myofascial trigger point (MTrP) in myofascial pain syndrome (MPS) from both a historical and scientific perspective. The study found no significant differences in the ReP pattern by sex and when comparing MPal with DDN of MTrP of the infraspinatus muscle. The ReP pattern of the infraspinatus muscle coincides with the original pattern described by Travell and Simons, although the neck area should be questioned. There were significant differences between sexes in zone 2 (p = 0.041) and no statistically significant differences were found by technique.
DDN proved to be significantly easier than MPal in evoking an LTR (p ≤ 0.001). The areas with the highest percentage of ReP were the front (area 3 27.1%) and back (area 11 21.1%) of the arm, anterior (area 4 36.1%) and posterior (area 12 42.1%) shoulder, and infraspinatus muscle area. Local twitch response (LTR) and ReP assessed through a visual analogue scale and features of ReP of the infraspinatus muscle. The physiotherapist did not ask participants about their pain features or other relevant issues. The same physiotherapist carried out the techniques on all participants, and the same protocol was followed for both the DDN and MPal groups. One hundred thirty-three participants (70.7% women) with shoulder complaints were randomly assigned to either an MPal (n = 67) or DDN group (n = 66). Students and staff recruited from Miguel Hernandez University (Southeast Spain).
#Travell and simons trigger pain point patterns manual
To identify the most common referred pain (ReP) pattern of the infraspinatus myofascial trigger point (MTrP) and compare its coincidence with the original ReP pattern, to verify whether there are any significant differences by sex and types of technique and to determine the observed signs and symptoms evoked by deep dry needling (DDN) and manual palpation (MPal).Ī cohort study of patients randomized to two different examination methods (July and August 2016).
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