Trigger point therapy

definition

goal of Trigger point therapy is the elimination of Muscle trigger points. A muscle trigger point is a noticeably hardened point in a tense one muscle, its fascia (muscle skin) or Tendon, in which upon a pressure pain is triggered. In addition, a Transmission pain arise, a trigger point leads to pain in completely different body regions. Various factors such as overloading, incorrect loading, too little movement or pain-related relieving posture lead to a Reduced blood flow in the area of ​​the trigger point. This is therefore not sufficiently supplied with energy and contracts permanently. If this hardening occurs permanently, there is again the risk of a pain-related relieving posture, which favors the development of further trigger points.

The most common causes of trigger point formation are Sedentary lifestyle and Improper loading. Incorrect stress is stress that the body was not naturally made for. This includes, for example, sitting for hours at work, but also relieving postures, which are often assumed unconsciously after injuries. Congenital misalignments can also lead to unnatural strain on the body. Other factors that play a role in the development of trigger points are Arthrose and psychological influences such as stress. The creation of trigger points is often based not only on one influencing factor, but on the interaction of several of them.

These factors ultimately lead to reduced blood flow and thus to an undersupply of oxygen and energy to the muscle. Local changes in the interaction of muscle fibers, Muscle fascia and Tendons cause irritation of nerve endings, causing pain. Eventually the muscle contracts and progressively loses the ability to relax. In the long run this ends up in a shortening of these muscle fibers, what is called myofascial syndrome referred to as. The danger is that a Vicious circle, since the pain caused by a trigger point may cause the patient to adopt a relieving posture. However, this gentle posture is a risk factor for the development of further trigger points.

Diagnosis

Trigger points cannot be recognized in the imaging process. For this reason, the Medical history and the physical examination of the patient in the foreground. The patient is asked to describe his pain as precisely as possible. The place should be shown and the so-called Pain quality, the nature of the pain. For example, pain can be classified as stabbing, boring, dull or burning be characterized. Also the Pain intensity is an important factor, this is usually queried on a scale from 0-10. With 0 there is freedom from pain, pain level 10 stands for the strongest imaginable pain. It is also relevant whether the pain is always present or recurs regularly and whether and by which factors the pain can be intensified or alleviated.

The physical exam consists of Tensile tests, Strength tests and Tactile findings. It is examined whether movement restrictions in the joint exist. These can result from the permanent shortening of the muscle that is associated with the trigger point. Attention is paid to palpable knots, which, depending on size, are described as stone, pea or grain of sand palpable findings as well as a hard tension cord, which is called Guitar string tactile findings referred to as. A trigger point is characterized in that the exertion of pressure on the trigger point creates a reproducible pain pattern and that this pressure leads to a reflex twitching of the local muscle fibers. After finding a trigger point, the examiner checks whether another pressure creates the same pain pattern. In addition, you will be asked about accompanying symptoms, for example, whether the irritation of the trigger point is increasing nausea or increased sweating leads. If there are multiple trigger points, this is called myofascial pain syndrome designated.

Frequency distribution

Only a few studies are currently available on the frequency distribution of trigger points, which differ significantly in their results. One study found that about 30% of patients who went to a pain clinic saw trigger points as the cause of their pain. Another study described that in a highly specialized pain clinic, about 85% of patients experienced pain due to trigger points.

Symptoms

The complaints caused by trigger points are numerous and varied. Typically, irritation of the trigger point leads to referred pain, which can last from a few seconds to days. The pain is classically described as itself Burning deep pain, spreading upwards or downwards. However, the trigger point can also manifest itself as superficial pain or through numerous other complaints. Chronic pain should be mentioned primarily. They can often be found, for example, in the head and face area, they are often expressed by problems with the Temporomandibular joint, unusual Toothache or one-sided Facial pain.

Problems with swallowing and speaking can also occur. Also common are neck, Spine and Shoulder joint affected. The lower extremity is also a typical location for pain caused by trigger points, here are classic hip, knee and foot affected. In addition to pain, the presence of trigger points can also manifest itself through restricted movement. Often there are complaints in the area of Spine and Intervertebral disc as well as in the area of Sacroiliac joint. Trigger points can cause postural disorders and irritation in the tendons and areas bone lead and also in the emergence of arthritis and arthrosis be involved.

Also sleep disorders can be justified by the presence of trigger points. The trigger points are also said to play a role in the development of circulatory disorders. This would cause serious problems such as insufficient blood flow in the Heart muscles and Cardiac arrhythmias involved. Also through Tinnitus, migraine and dizziness, cramps and temporary Visual disturbances the trigger points can possibly express themselves. In addition, they should also be able to lead to vegetative disorders such as cold hands and feet as well as profuse sweating. The entrapment of nerves and vessels can also cause discomfort in areas supplied by these structures, such as pain in the arms and legs.

therapy

First the trigger point has to be found. Since each trigger point is a typical pain pattern causes the patient to recognize the pain when the therapist applies pressure to the trigger point. The goal of therapy is this To resolve trigger point. This is supposed to be done by the Metabolic processes activated in the affected region. About the Nervous system the induration associated with the trigger point then relaxes as a reflex. After all, shortened connective tissue structures should be expanded again. There are various methods for performing trigger point therapy, some of which are done with the hands and some with the aid of devices.

A common method is the so-called ischemic compression. The therapist presses with his finger or one Trigger rod directly on the trigger point. In this way he creates a sustained pressure which is tolerably painful for the patient. After about 10 to 15 seconds the pain subsides, this is due to the fact that the tension in the muscle is reduced. The therapist then increases the pressure, which again leads to tolerable pain. In turn, the body reacts by reducing muscle tension and thus relieving pain. After three to four rounds in 60 to 90 seconds per trigger point, the reduction in tension is exhausted; a further increase in pressure cannot reduce muscle tension any further. In addition to ischemic compression, for example Shock waves, laser or Needles (Dry needling) can be used to dissolve the hardening. The so-called black roll can also be used to treat trigger points.

It is important, however, that trigger point therapy often eliminates the pain, but the cause persists. Therefore, the cause of the trigger point development should be clarified and treated.

prophylaxis

In order to prevent the development of trigger points, it is important to reduce the corresponding risk factors as far as possible. Probably the most common causes of trigger point development are Sedentary lifestyle and Improper loading, for example through long, non-ergonomic sitting. Also psychological factors like stress should not be underestimated and reduced as far as possible.

forecast

The prognosis of trigger point therapy depends on the complexity of the symptoms. If there are only individual trigger points, the majority of patients are symptom-free after just a few sessions. If the symptoms are more complicated, affect several muscles or keep recurring, longer treatment is necessary. In general, it should always be noted that although trigger point therapy often eliminates pain, it does is unable to eliminate the causal factors. Finding out and eliminating these factors is therefore essential to prevent painful trigger points from recurring after trigger point therapy.