lundi 17 octobre 2016

Chronic Musculoskeletal pain.N°1. Myofascial pain syndrome

Chronic Musculoskeletal pain, Myofascial pain syndrome. N°1.
Dry-Wet NEEDLING and BMN. Definitions # Etiology.        

Definitions Etiology.                                                                     
The Myofascial Pain Syndrome_ MPS is one cause, in 85% of cases, of chronic musculoskeletal pain.
The MPS is the set of symptoms caused by painful functional disruption of the locomotor system involving Active (myofascial) #Trigger Points (TPs): Musculoskeletal pain, muscular weakness, mobility restriction, neurovegetative signs.
We distinguish primary and secondary form.   
• Primary MPS (in French, SDM or Syndrome Douloureux Myofascial). Consequence of muscle overuse: epicondylitis, frozen shoulder, tension. Headache…
• Secondary MPS. During various disorders: Dysfunction of the temporomandibular joint, sprain, whiplash, osteoarthritis and fibromyalgia

*The Trigger Points at the starting of myofascial pain, are the most common cause of chronic musculoskeletal pain: In 85% of cases, the cause of chronic musculoskeletal pain involves Active Trigger Points_ ATP.

Around 75% of musculoskeletal pain is caused by Trigger Points.
About 92% of TPs are Acupuncture Points _ APs: Only 20% of TPs correspond to APs listed and commonly used in acupuncture treatments but all Trigger Points correspond to ASHI points.

Trigger Points, Ashi Points
*-*Trigger Points
The terms, trigger Points, Myofascial Pain Syndrome, muscle strand, local contractile response, were defined by Dr. Janet TRAVELL (1950) and described, in the book she published, with Dr. David G. Simons ""Myofascial pain and dysfunction. The trigger point manual. Baltimore: Williams & Wilkins, 1981”,

The TPs is defined as a sensitive, painful, hyper-irritable, circumscribed nodule located in a tight, firm, palpable muscle fiber strand in contracture of a skeletal muscle: Taut Band or tight bandage. 
·         It is an irritable spot either spontaneously (active) or on digital compression (latent) able to generate either local or referred pain to other musculature, motor dysfunction, vegetative signs can accompany these two types of pain such as sweating, swelling and "goose bumps." 
The TPs are located in general, in one of the 400 skeletal muscles (for example, the TPs selected in this article are of musculoskeletal origin).
They are also located in the fascia, ligaments, tendons, joint capsules, skin and the periosteum.

These TPs may become activated by a variety of factors such as, poor posture, overuse, or muscle imbalance.
·         TPs exhibit a local twitch response (muscle fasciculation) or jump sign (flexion response) in response to digital pressure or Dry & Wet Needling.
·         Only clinical criteria currently define TPs; Two new modalities, sleep-elastography and magnetic resonance- elastography, may help to obtain objective confirmation.

*-* The ASHI points: They are not systematized APs, located in or off meridians, or APs not located d or not into meridians or meridians or   meridians. They are of random location, of varying duration, sensitive to the pressure, and depend on the causal disease.
Only clinical criteria currently define PGs;
Two new modalities, sleep-elastography and magnetic resonance elastography, may help to obtain objective confirmation.

The existence and understanding of genesis of the TPs, was the subject of many debates involving EMG, elastography, Magnetic Resonance, ultrasound etc. to both confirm their existence and obtain a more extensive knowledge of the pathophysiology of these TPs, commonly overlooked cause of chronic musculoskeletal pain and dysfunction.
The etiology and genesis of TPs have yet to be satisfactorily explained.
It is generally thought that abnormal muscle strain, in combination with emotional stress, in genetically predisposed individuals, can cause a LTP to develop in a taut muscle band and subsequent nerve sensitization.

Taut muscle bands commonly occur in pain-free individuals.
Several diverse yet complementary models have been proposed to explain the development of TPs at the cellular level, but it is still not known what the role of each is in the pathogenesis of chronic musculoskeletal pain. Nonetheless, it is clear that the pathogenesis of TPs is a complex process that involves both the central and peripheral nervous systems.

Recent basic studies have confirmed that,  at the site of an active TP, there are elevated levels of inflammatory mediators, known to be associated with persistent pain states and myofascial tenderness and that this local milieu changes with the occurrence of local twitch response.

Contributing factors
Among the various direct causes or contributing factors, generating TPs in Patients, mention may be made, with many authors of:  
·                              Occupational or athletic activities with postural deficiencies, muscle imbalances, static postures, monotonous and repetitive gestures overuse injuries, intervertebral discs diseases, trauma…
·                              Psychosocial and emotional factors, fatigue…
·                              Inflammatory diseases, fever, arthritis, viral infections…
·                              Internal disease, scar formation after surgical incision etc.

Perpetuating or aggravating factors
·                      Further aggravating factors may lead to the creation of further TPs 
·                     Chronic psychological problems. 
·                     Chronic infections. 
·                     Chronic muscle tension due to poor posture…

EXAMINATION of the Trigger Points.
• Stretch the muscle for palpation of the tight band tense meeting and TP between the relaxed muscle fibers.
• Palpation of the tight band is performed applying it against the underlying structures or by pinching it.
It often produces a localized contractile response. It may cause referred pain.

Appropriate treatment to the locally musculoskeletal pain and dysfunction could be performed by needling therapies applied into the TP, a locally painful area, to produce a “twitch” response and deactivate the TP.

Needling therapies can be divided in two groups with or without liquid drug injected:
·                    Two versions of Acupuncture: Acupuncture & Mesopuncture.
·                    Two versions of DN: Wet & Dry needling, in association with other treatments, optionally.  

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