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Where can TrP Therapy be used?
Therapeutic settings, as a therapy by itself, or integrated into a session with complementary techniques
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Active TrPs exacerbate several syndromes as well as joint, muscle and visceral pain. What are some examples
- Fibromyalgia Syndrome (Chronic Myofascial Pain Syndrome)
- Fibrositis (Muscular Rheumatism)
- Carpal Tunnel Syndrome
- Piriformis Syndrome
- Headahces
- Sciatica
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Objectives of Trigger Point
- Identify problem muscles
- Work related muscles and structures
- Eliminate pain
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Very active trigger points vs. inactive trigger points
- Very active: agonizing and incapacitating pain
- Inactive: painless restriction of movement and distortion of posture
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Assessing Dysfunction
- Posture
- Joint ROM
- Pain Referral
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3 Types of ROM
- Passive: therapist moves client
- Active: client moves
- Resisted: resist against active
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Continuous muscle tightness of a muscle or muscle group / contracted or locked short
hypertonicity
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Continuous muscle weakness or a muscle or muscle group / taut or locked long or overstretched
Sustained inhibition
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What is the #1 reason for musculoskeletal dysfunction
Trigger points
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What is musculoskeletal dysfunction
- Constant tensional force in a muscle pulls on bones and structures.
- Body segments get pulled out of correct alignment.
- Poor posture and constant tension cause muscles to become 'loaded'. This means that they being playing the structural role of bones, providing structure and support for the area and the rest of the body.
- Eventually these muscles become fatigued from overuse and other muscles become weak from disuse.
- The nervous system functions in overdrive and a cycle of pain occurs
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Prolonged positioning in a certain posture causing muscles to become hypertonic or weak.
Static Stress
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Any injury that changes the normal function of a muscle, including atrophy, hypertoncity as a result of guarding, or compensation for injured muscles by other muscle groups
Muscle injury
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ROM for a joint comprised as a result of injury, misalignment of structures compromising joint
Joint dysfunction
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Creates muscle tension, which leads to dysfunction (reduced circulation to tissue, trigger points, short tissue etc.)
Emotional/psychological stress
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Repetitive motions of certain muscle groups
Chronic overuse
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Sustained inhibition, injury, casts, etc.
Disuse (atrophy)
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Dysfunctions of organs that lead to dysfunction to muscles (stomach cramps causing dysfunctions to surrounding muscles)
Vicerosomatic relfexes
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Agonist stronger than antagonist or vice versa as a result of injury, structural imbalance etc.
Muscle imbalance
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Different phases of a condition (chronic, subacute, acute)
- Chronic: starts on day 14
- Subacute: starts on 7-14 (10 days-5 weeks) *strokes need to be slower and lighter
- Acute: starts 1-3 days
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What is a Myofacial TrP?
a FIRM, PALPABLE, HIGHLY IRRITABLE spot in a TAUT band of muscle fibers or fasica characterized by EXQUISITE TENDERNESS, REFERRED PAIN and LOSS of ROM
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The specific region of the body at a distance, often entirely remote from its source, the trigger point, where phenomena (sensory, motor, and/or autonomic) caused by the trigger point are observed
Pain Referral Zone (PRZ)
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What is this:
1. Insult to muscle (stress or trauma)
2. Stimulus sent / received to CNS
3. Spasm-continual contraction
4. Formation of Trigger Point
Neurological Theory Summary
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What is this:
1. Insult to muscle (stress or trauma)
2. Mediators of inflammation - edema
3. Build up of metabolic waste - spasm
4. Reactive ischemia - lack of blood flow
5. Formation of Trigger Point
Chemical Theory Summary
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6 Classifications of Trigger Points
- 1. Active - Awake: TrP that causes px at the site of pathology and usually in that muscle's px referral zone
- 2. Latent - Asleep: TrP that is not causing symptoms at the site of pathology (unless palpation activates it) but may have symptomatology in the pain referral zone. Tend to show up more in muscles that were used consistently for a long period of time (yrs) and them become sedate.
- 3. Key or Primary Myofascial TrPs: activated directly by the original stress or trauma whether there be acute or chronic overload. Key TrPs are not the result of TrP activity in another muscle
- 4. Satellite Myofascial Trigger Points: induced by the activity of a Key TrP
- 5. Central Myofascial TrP: located near the center of muscle fibers
- 6. Attachment TrP: located at the musculotendinous junction and/or osseous attachment of the muscle.
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What are the two common symptoms of Latent TrPs?
- Loss of ROM or stiffness w/out px in a muscle
- Chronic aching and weakness within the px referral zone
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A Satellite TrP may develop because: (4)
- The referral zone of a Key TrP
- In an overloaded synergist that is substituting for the muscle containing the Key TrP (primary muscle)
- In an atagonist countering the increased tension of the key muscle
- In a muscle apparently only linked neurogenically to the key TrP
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You will know when you are palpating a true trigger point when one of the following four things occur
- Jump sign
- Intensified px in PRZ
- Px is blocked in the PRZ
- Local Twitch Response
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Eradicating TrPs and improving the quality of one's life is a two step process:
- Step 1: a thorough interview identifying exactly what TrPs are responsible for the px or dysfunction and to identify the activities in one's life that are causing the TrPs to activate. / Treatment portion of the session
- Step 2: To educate and teach the client about his or body and how to incorporate stretching and alternative activities such as self massage and re-patterning into his or her life that will continue to support the healing process and the work you do as a professional therapist
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The process of lengthening CT and muscle fibers by taking attachment points of a muscle away from each other
Stretching
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These methods all employ some degree of voluntary (active) contraction followed by relaxation / client does action, we do a stroke
Voluntary Contraction and Release Methods
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Digital (or other) pressure is applied to the TrP location. Pressure is applied gently and gradually increasing until therapist encounters a definite increase in tissue resistance. Pressure maintained until there is a sense of relief in tension.
TrP Pressure Release
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Digital pressure is used starting before the TrP moving along the length of the taut band to elongate the shortened muscle releasing tension.
Deep stroking (stripping) massage
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Uses body positioning for releasing tender points, which have little relation to fibromyalgia tender points, but may fit the concept of myofasical attachment TrPs
Indirect Techniques
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A system of therapy that continues principles and practice from soft tissue technique, muscle energy technique, and inherent force craniosacral technique.
Myofascial release
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A needle is inserted to the site of TrP. Typically an injection of a local anesthetic is done, but in some cases 'Dry' needling can be effective. Dr.'s ONLY
Trigger Point Injection
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A number of techniques can assist and supplement the specific TrP therapies.
- Accessory Techniques:
- Controlled Respiration
- Directed Eye Movement
- Skin Rolling
- Heat and Cold
- Therapeutic Ultrasound
- Transcutaneous Electrical Nerve Stimulation (TENS)
- Drug Therapy
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What occurs in specific locations that are symmetrically located
Tender Points
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Fibromyalgia Tender Point Locations
- Occiput
- Low Cervical
- Trapezius
- Supraspinatus
- Second Rib
- Gluetal
- Greater Trochanter
- Knee
- Lateral Epicondyle
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