Trigger Points

The myofascial trigger point therapy was created about six decades ago by the American doctors and scientists David G. Simons and Janet Travell.

But already back in 1900 some people described changes in the musculature:

• Cornelius (around 1900) the “Cornelius’ nerve-points”
• Schade (1919) the “Myogelosis”
• Lange (1931) the term “Gelosis”

With this they described pressure-sensitive changes in the muscles and increase in viscosity in the soft tissue.

David G. Simons and Janet Travell discovered that because of stress certain transitional points between nerves and muscles could sicken, which causes certain strains in the muscles to clench and shorten. These strands squeeze off the blood and oxygen supply, which causes, like it would with a heart attack, strong local pain. These sensitive areas within a clenched muscle are called trigger points. In case of a severe disturbance the trigger points cause chronic pain. In case of a small disturbance only the movement and the stretching of the muscle is painful.

Within the spinal marrow, due to the constant bombardment with stimuli within the pain directing nerve system, certain pain-transferring liquids can overflow and can activate other pain-tracks. Through this great or chronic pain can be felt in body parts, which have nothing to do with the original injury.

The described muscle pain occurs within the whole body. A significant amount of back pain has a muscular origin. Only a fraction is caused by arthritis, slipped discs or degenerative changes.

The place at which the pain results and the place, where the pain is eventually felt, are often far apart from one another. This is one of the reasons why the muscular causes of pain are often overlooked. For example in cases of shoulder pain the pain often only partly originates within the joint itself, most of the time it’s only the surrounding muscles that have fallen ill. The reason for a so called tennis elbow is most of the time within the thenar muscles and headaches are frequently caused by tense neck musculature. Muscle diseases caused by overuse are often found in the knees and Achilles tendon of runners, but often originate within the muscles of the calf.

In principle a trigger point is the more stubborn the longer it exists. Like how motion sequences for example shifting gears while driving, become routine and the responsible nerve connections are hardened, trigger points can create long-lasting nerve connections.

Clinically speaking a myofascial trigger point is a localized, microscopically small zone within the skeletal muscles, which lies on a myogelosis thread. It responds strongly to stimuli like pressure and tension.

The reaction to mechanical stimuli can be referred pain or it can be a sensory disruption, as well as a vegetative reaction (vertigo, tinnitus, sweating, lacrimation, etc.).

Mtrp’s are created through a vicious circle. First a deficit of ATP occurs (ATP: adenosine triphosphate / the universal and instantly available energy carrier within cells and an important regulator of energy supplying processes), this causes a hypoxia (undersupply of oxygen to the tissue) and also failure of the ion pump –

It is called a local energy crisis, during which the muscle can no longer expand. Subsequently the contracted part of the muscle remains in a stable “rigor complex” (a stable connection also called “the actomyosin cross bridge cycle

This state is also part of the rigor mortis, since the dead body is lacking the mechanisms to resolve the tension. A rigor complex can only be resolved by an ATP-addition. The dead body is unable to produce anymore ATP.)

A complete shortening eventually shows upon palpitation as nodule, ergo a myofascial trigger point.

• Contractions of muscle fiber within the myogelosis upon mechanical stimulation of the trigger point
• local twitch response: transferred pain into a remote area upon activating the trigger point
• referred pain: reproduction of the ailments of the patient upon activation of the trigger point
• reduced extensibility
• reduced strength development

• Radiating pain, mostly numb, very intense and unbearable or uncomfortable
• The more hypersensitive the pain, the more intense and constant the radiating pain
• Mostly one sided pain regarding the body
• No pain radiation along the dermatome
• Autonomic phenomena in the field of radiation such as: sweating, vasoconstriction, lacrimation
• Proprioceptive disruption such as: vertigo, difficulties walking, tinnitus

Active myofascial trigger point

• Is a spot that causes the patient pain.
• It always reacts painfully to pressure; the muscle is generally shortened
• Under direct compression of the point it often triggers the referred pain.
• Senso-motoric or vegetative symptoms aren’t rare.

Latent myofascial trigger point

• It can show all the clinical characteristics of an active trigger point.
• It is always accompanied by a tenseness of a fiber bundle. It does not create clinical disorders.
• Through exact pressure symptoms similar to the active trigger point can occur.

Primary myofascial trigger point

• It is a central trigger point, which develops due to acute or chronic overstressing or due to injury.
• It is not created through activation of a different trigger point.

Secondary myofascial trigger point

• Previously this term was used to describe trigger points within synergists, neighboring muscles and antagonists.
• Today everything falls under the term satellite trigger point.

Satellite trigger point

• It is a trigger point that developed within the area of transferable pain of a primary trigger point.

Through the direct treatment of a myofascial trigger point the blood flow into the affected tissue or organ increases, this is also called hyperemia.

A, through pressure and stimulation of a vessel’s segment, created collection of blood.

Nozigenic substances like serotonin, prostaglandin and bradykinin are squeezed out.

Due the intensive pressure cells tear and myoglobin can leak out.

The functional unit as neuromuscular connection is destroyed and the energy crisis ends. The shortened muscle returned to its functional length through techniques of the conjunctive tissue, as well as the elasticity of the surrounding conjunctive tissue and the fascia.

The intramuscular spaces are extended – the mobility and neuro-mobility is improved.