Chronic Musculoskeletal pain, N°3, Myofascial pain syndrome.

Chronic Musculoskeletal pain, N°3, Myofascial pain syndrome.

Dry-Wet NEEDLING and BMN

CLASSIFICATION OF TRIGGER POINTS_TPs  

TPs can be Active or Latent, depending on their varied clinical characteristics (Han and Harrison, 1997; Travell and Simons, 1999); however, either of these may cause musculoskeletal pain (Travell and Simons, 1999; Wilks, 2002; Hou, 2002): Active and Latent TPs can cause significant motor dysfunction but more commonly occurring with Latent TPs than Active TPs (Travell and Simons, 1999).

Active Trigger Point ATP

It is a hypersensitive point; it may display continuous pain in the zone of reference with or without palpation.
Palpation of the muscle injured, reveals a

·                    Muscular stiffness and weakness: Muscle is with increased muscular tension, reduced muscular stretch, restricted range of motion.

·                    Taut band and local twitch response located in the muscle.

·                    Spontaneous pain referral.  Localized and referred pain appeared on manual compression simulating by all aspects the current pain. [Travell and Simons (1999); Chaitow and DeLany (2002) Wilks (2002)].

Latent Trigger Point_ LTP

Is a TP more commonly occurring, hypersensitive with active nociceptors but not enough to generate spontaneous pain and it is not associated with spontaneous pain referral (Travell and Simons, 1999; Alvarez & Rockwell, 2002). We find also a taut band.
However, it exhibits all the muscular characteristics of an ATP: Stiffness and restricted range of motion due to increased muscle tension and shortening, muscular weakness.  
Manual compression causes localized pain, local twitch response with a ‘jump sign’ (muscular flexion}.

ATP and LTP can be subdivided into Primary TP and Satellite TP.

·                    Primary TP
A Primary TP is defined as a TP that has been activated directly by acute or chronic overload or repetitive overuse of the muscle in which it occurs and was not activated as a result of TP activity in another muscle (Travell and Simons, 1999)

A Primary TP contains nociceptors activity and is mainly responsible for the development of the Myofascial pain.
 Further aggravating factors can lead to the creation of an active trigger point, which may recover spontaneously or persist without further development.

·                    Satellite TP
A Satellite TP is induced mechanically by an Active Primary TP (Travell and Simons, 1999). A Satellite TP forms within the pain referral zone of another muscle containing a Primary TP. Satellite TP result from the stress and muscle spasm caused by neighboring TPs. As such an Active TP in one muscle can induce an Active Satellite TP in another muscle and vice versa, inactivation of the key TP will therefore lead to inactivation of its Satellite TP without actually treating the Satellite TP (Travell and Simons, 1999).

According to Davies and Davies ‘long term chronic pain is often a compound effect from a chain of Satellite TPs, cascading from muscle to muscle.

·                    Secondary TP
A Secondary TP develops in synergistic muscles of the affected muscle. An imbalance of tension in the primary muscle, due to shortening muscle fibers and, compensatory overload of the synergistic muscles, causes Secondary TPs to develop.

·                    Of the trigger points actually found within the zone of pain, most of those are not very common trigger points, or they formed because they were satellite trigger points formed due to primary trigger points elsewhere.