“The Pain from Someplace Else”
Myofascial Pain and Trigger Point
Therapy
3 Hours Continuing Education
Carolyn McMakin, M.A.,D.C.
Private Practice
Portland, Oregon
Physical examination:
The examination for trigger points should be performed in conjunction with
a general medical and neuromusculoskeltal examination.
Patient
Mobility and Posture:
Watch the patient's spontaneous posture and movements. People with active
trigger points move carefully to avoid stretching the affected muscles.
Does the patient use their arms and hands bilaterally? Do they turn the
whole body instead of their head? Do they perform spontaneous stretching
movements? Is their posture unbalanced and asymmetrical?
Neuromuscular
Functions:
- Any movement, especially a quick maneuver, causing contraction or stretch
in the muscle causes pain.
- Muscle strength testing reveals weakness usually caused by cessation of
effort due to pain either in the muscle containing the trigger point or
in a distant stabilizing muscle.
- The stretch range of the muscle is reduced - range of motion may be normal
or decreased.
- Passive or active stretching increases pain.
- Resisted contraction causes pain.
- The maximum contractile force of the muscle is weakened but there is no
atrophy.
Cutaneous Signs:
- Dermographia is most often associated
with active myofascial trigger points located over the back of the torso
and less frequently with muscles in the limbs.
- Panniculosis is a broad flat thickening
of the subcutaneous tissue with an increased consistency that feels coarsely
granular. It is identified by hypersensitivity and resistance to
"skin rolling". The skin has a characteristic mottled or dimpled "orange
peel" effect.
Trigger Point
examination and palpation:
- The trigger point is found in a palpable tight band as a sharply circumscribed
spot of exquisite tenderness using flat or pincer palpation. Muscles in
the vicinity of the trigger point feel tense to palpation.
- “Jump sign”, “Helicopter sign” - Digital pressure on an active TP usually
elicits some immediate, reflexive, avoidance behavior.
-
Moderate sustained pressure on a sufficiently irritable trigger point causes
or intensifies the pain, or other symptoms, in the referral zone of that
TP. When a TP is so active that it is already causing maximal referred
pain, pressure on the TP cannot induce additional referred pain only local
pain.
-
Active trigger points commonly refer deep tenderness and paresthesias to
the referred pain zone. The patient says it feels "numb" but sensation
is normal. The referral area can be quite hypersensitive and painful
to palpation. It is easy to be diverted from the actual problem area
by this phenomenon.
-
Disturbances of autonomic function are sometimes induced in the referral
zone, including dizziness, increased or decreased vasomotor activity, lacrimation,
coryza, and pilomotor activity.
© copyright
1997