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January - February, 1999
TRIGGER POINT
AND MYOFASCIAL THERAPY.
AN ANSWER TO PAIN.
One of the most fascinating things in physical Therapy, and other health professions, especially when dealing with pain, is to replace the agonizing, frustrating feeling of pain from the patient's faces with a feeling of comfort, relaxation, and hope. Pain is the fear of all living creatures who are equipped with pain receptors. Pain is counter-survival.
Pain is the number one reason that brings a patient to see the doctor. Pain has the power to
affect all four major domains in people's lives: physical, emotional, mental, social.
The common denominator for all living organisms is 'survival", and because pain is counter survival, people try to invent different mechanisms and strategies to avoid or get rid of pain. Others feeling hopeless and tired of fighting, learn to live with it.
Several health care professionals deal with the diagnosis and treatment of pain. To effectively treat a condition, accuracy in diagnosis is very essential. A major cause of somatic, somatovisceral and somatoemotional pain can be MyoFascial Dysfunction. Although skeletal muscle is the largest organ of the human body, it is the least studied in the different medical schools. This accounts for the large amount of misdiagnoses related to MyoFascial pain. Physical Therapists study the musculoskeletal system in great detail, however MyoFascial Dysfunction is hardly ever mentioned in the most Physical Therapy curricula.
How Things Started
The term "Myofascial" did not appear in the medical literature until late 1940. In 1952, Janet
6. Travell, M.D. adopted the term 'myofascial" after observing the reffered pain pattern of a muscle.
MyoFascial Trigger Points
A trigger point is a hypersensitive point in a muscle that when compressed, is locally tender and gives rise to referred pain to other regions of the body, away from the area of the Trigger Point.
How Trigger Points Are Formed
When a muscle becomes overstretched or overshortened or even due to direct trauma some of the muscle fibers may be destroyed.
This will cause a sequence of physiological phenomena that will lead to formation of Trigger Points. Trigger Points will refer pain to various areas of the body and therefore muscle flexibility will be further impeded.
Classification of Trigger Points
Active Trigger Point: An active Trigger Point causes the patient pain or referred pain, either with pressure or without.
Latent Trigger Point: A latent Trigger Point is usually silent without causing any pain, but it may cause restriction in the range of Motion as well as muscle weakness. Latent Trigger Points may exist in the muscle for years following recovery from an injury.
The Therapy
Dimitrios Kostopoulos, MA, PT, FAAPM and Konstantine Rizopoulos, PT, FABS, have been involved in the study, research and clinical application of several MyoFascial Techniques and they have created their own comprehensive therapeutic model.
This model incorporates in various forms:
* John Barnes' Superficial Myofascial Release (Superficial Layer)
* Dr. Travell's Trigger Point intervention (Deep Layer) and
* Dr. Janda's Proprioceptive Therapy (Post-Myofascial Treatment)
Myofascial Therapy is a comprehensive therapy approach that promotes pain relief, restoration of function, relaxation, and helps in obtaining optimum health. MyoFascial Therapy approaches the person under treatment in it's total. It reaches all layers of the body.
Their treatment approach utilizes several techniques including:
1. Trigger Point Therapy
2. Dry Needling Technique
3. Superficial MyoFascial Stretch
4. Deep MyoFascial Stretch
5. Self Release Techniques
6. Muscle Strengthening Programs
7. Proprioceptive Training
8. Neuromobilization and Cranial Manipulation Techniques
Their treatment approach utilizes and always considers the emotional field of the patient, and the effects of treatment to the emotional and psychosocial domains of the individual.
In Trigger Point Treatment, one may use the thumbs or the fingers, the knuckles, the elbows, or a combination of the above to apply pressure. When using the thumbs or four fingers of one or both hands, apply steady pressure moving inward toward the center, then slowly release. Pressure application varies in quantity and may start from a few pounds, up to 10 Ibs., and should last from 30 to 45 seconds. Travell calls this technique "ischemic compression" because on release, the skin is at first blanched and then shows reactive hyperemia. The patient should breathe deeply and slowly while you progressively increase the pressure. Deep relaxation is very important for the effectiveness of the technique. There are different trigger point self help devices which allow an individual to apply the trigger point techniques on oneself (Thera-cane, Thumbsaver, etc.).
Health professionals may also use low volt electrical stimulation, ultrasound, hot packs, or laser for the treatment of trigger points.
The second, but very important part of the MyoFascial Therapy is the application of MyoFascial Stretching Exercises.
A muscle to efficiently deliver power to a movement is placed on a gentle stretch before performing a shortening contraction. So before an activity is performed, a muscle must be able to properly stretch and lengthen without causing injury to other structures in the musculoskeletal system. An injured muscle loses this property. Therefore, after we help the muscle relax releasing the trigger point, ischemic compression, we have to stretch the muscle to maintain the degree of relaxation and to bring the muscle at an ergonomically rich state.
For the proper MyoFascial stretching, we need deep relaxation with proper concentration and breathing. The muscle must be allowed to "relax out" rather than "pushing through." This is a subtle difference that requires concentration on what is occurring in the patient's body.
Myofascial stretch is divided in Superficial (SMFS) and Deep (DMFS) depending on the muscle and the technique used for the release.
Home Exercise Program: Patients must be instructed in self stretching exercises to be performed between treatments.
The above treatments are part of the protocols followed at Hands-On Physical
Therapy and all clinicians are trained extensively to apply these techniques.
For additional information, please call our offices.
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