# What Are Myofascial Triggerpoints?

A Massage Therapy Treatment

## From a Clinical Perspective, Myofascial Trigger Points Describe a Phenomenon

An international panel of 60 clinicians and researchers was recently consulted to establish a consensus for identification of a myofascial trigger point. The panel agreed on two palpatory and one symptom criteria: a taut band, a hypersensitive spot, and referred pain.

These clinical findings may be help clinicians investigate common pain patterns, such as:
• Neck Pain[1]
• Carpal Tunnel Syndrome[4]
• Low Back Pain[5]
• Chronic Pelvic Pain [6]

## Sore Spots Exist, but Their Etiology is Still Not Well Understood.

It has been demonstrated that patients benefit from hands on work aimed at MTrPs, but this may not always be due to reasons we once were taught. One issue is that ascribing patient’s pain solely to MTrPs or other tissue-driven pain problem is often an oversimplification of a complex process. When it comes to MTrPs there are a number of competing hypothesis, including, but not limited to:

• Cinderella Hypothesis - low-level, continuous muscle contractions overload tissues and makes “Cinderella” fibers susceptible to calcium dysregulation and subsequently sarcomere contracture[7]
• Expanded Integrated Hypothesis - the zone around a MTrP seems to be in an ischemic state resulting in a shortage of glucose and oxygen for metabolism and subsequent sarcomere contracture[8].
• Neurogenic Inflammation - the release of inflammatory substances from the nerve axon, result in a lower the threshold for depolarization[9].
• Central Sensitization - several studies support the hypothesis that persistent nociceptive input from MTrP contributes to the development of central sensitization and/or changes in the dorsal horn. In contrast, preliminary evidence suggests that central sensitization can also promote MTrP activity[10].

## Stepping Back: What is the Big Picture?

The explanations used in the past of this observable phenomenon seem to be flawed in reasoning, but I do not think there is a need to abandon treatment approaches that provide patients with pain relief. What is needed is an updated model of musculoskeletal pain and what is the most effective way of delivering a treatment that will help people in pain.

## More to Explore

Chen, Q., Wang, H., Gay, R. E., Thompson, J. M., Manduca, A., An, K., . . . Basford, J. R. (2016). Quantification of Myofascial Taut Bands. Archives of Physical Medicine and Rehabilitation. Archives of Physical Medicine and Rehabilitation.
https://www.ncbi.nlm.nih.gov/pubmed/26461163

Courtney, C.A., Fernández-de-Las-Peñas, C., Bond, S. (2017). Mechanisms of chronic pain - key considerations for appropriate physical therapy management. J Man Manip Ther.
https://www.ncbi.nlm.nih.gov/pubmed/28694674

Quintner, J., Bove, G., & Cohen, M. (2015). A critical evaluation of the trigger point phenomenon. Rheumatology.
https://www.ncbi.nlm.nih.gov/pubmed/25477053

Rathbone, A.T., Grosman-Rimon, L., Kumbhare, D.A. (2017).  Interrater Agreement of Manual Palpation for Identification of Myofascial Trigger Points: A Systematic Review and Meta-Analysis. Clin J Pain.
https://www.ncbi.nlm.nih.gov/pubmed/28098584

Shah, J., Thaker, N., Heimur, J., Aredo, J., Sikdar, S., & Gerber, L. (2015). Myofascial Trigger Points Then and Now: A Historical and Scientific Perspective. Pm&r. (OPEN ACCESS)
https://www.ncbi.nlm.nih.gov/pubmed/25724849
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