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36 Cards in this Set

  • Front
  • Back
A Trigger Point is an area of hypersensitivity in a muscle from which nerve impulses travel to the central nervous system (spinal cord) giving rise to _____ pain
The area from which the pain arises is the trigger point

The area to which the pain is referred is the _____-
reference zone
A specific and reproducible reference zone has been discovered for each trigger point

The trigger points are found in the ______location in every individual
same predictable
The Patient experiences only the referred pain and may be totally unaware of the presence of the ______
trigger point.
The idea of the trigger point had its origins in ______
Germany and the Scandanavian countries.
The Germans first reported these as Muskelschmertzen (muscle pain) and _____ muscles in the mid-nineteenth century
Beginning in the 1940s, internist
______spent over 50 years researching and documenting the myofascial genesis of pain patterns and their role in diagnosis and treatment
Janet Travell, MD
Janet Travell, MD 's book
Myofascial Pain & Dysfunction: The Trigger Point Manual – 2nd Ed.
Lippincott, Williams & Wilkins 1999
Most early research was directed at doing biopsies of trigger points. Most of this showed -----
normal muscle tissue
Chronic trigger points have been shown to have muscle atrophy with ______
fatty infiltration, an increased number of nuclei per muscle fiber, fibrosis, serous exudates and abnormal mucopolysaccharide deposits.
Acute trigger points show ______
normal muscle
Types of Trigger Points
Active Trigger point

Latent Trigger point

Has pain referred to the reference zone which occurs chronically (spontaneously) or with use of the muscles containing the trigger point.
Active Trigger Point
The patient develops pain in the reference zone only after digital stimulation of the trigger point.

i.e., You poke it
Latent Trigger Point
The lowest level of identifiable tissue pain.
Located at the site of the trigger point.
Is tender to deep palpation.
Normal people do not have tenderness at these sites with deep palpation.
(remember Counterstrain?)
How Do People Get Trigger Points?
The same ways they get somatic dysfunction.
Some experts feel that trigger points are simply one special manifestation of somatic dysfunction
What Maintains Trigger Points?
I. Mechanical Stress
II. Nutritional Inadequacies
III. Metabolic & Endocrine Deficiencies
IV. Psychological Factors
V. Chronic Infection and Infestation
VI. Other Factors
Causes of Mechanical Stress
Poor Posture
Abuse of Muscles
Repetitive Movement
Constriction of Muscles
Leg Length Inequality
Small Hemipelvis
Short Upper Arms
Short First, Long Second Metatarsal
aka: Morton’s Foot
Vitamins and Minerals associated with Nutritional Inadequacies
Vitamin B-1
Vitamin B-6
Vitamin B-12
Folic Acid
Vitamin C
Diseases from Metabolic & Endocrine Deficiencies
Psychological Factors causing somatic dysfunction
Chronic Infection & Infestations causing somatic dysfunction
Viral Diseases
Bacterial Infections
Dental Infection
Urinary Tract Infection
-Diphyllobothrium latum (fish tapeworm)
-Giardia lamblia
-Entamoeba histolytica
Other Factors causing somatic dysfunction
Allergic Rhinitis
Impaired Sleep
Nerve Entrapments
How to Diagnose a Trigger Point?
1) Have the patient identify where they feel their pain
2) Using Reference Zone Charts establish which muscles could contain trigger points producing that pain
3) Search each muscle for trigger points
headache on top of the head is due to what?
sphenoid sinusitis
Have the patient identify where they feel their pain
Do little kids ket frontal sinusitis?
How Do You Treat A Trigger Point?
1: Do something to the trigger point.

2: Stretch the muscle containing the trigger point.

3: Recheck the trigger point.
How many things can you do to a trigger point?
There are literally about fifty different things you can do to a trigger point.
Stuff That Has Been Shown to Work in Relieving Trigger Points

Osteopathic Manipulative Treatment:
Correct Segmental Dysfunction associated with innervation of the muscle containing the trigger point. (Somato-somatic Reflex)
Muscle Energy
Direct Soft Tissue / Myofascial Release
Deep Inhibitory Pressure
Percussion Vibrator
Stuff That Has Been Shown to Work in Relieving Trigger Points

Physical Modalities:
Application of Cold, followed by stretch
Ice Massage
Topical Skin Refrigerant
(Spray & Stretch)
Electrical Muscle Stimulation
Magnetic Therapies
Energy Techniques
Stuff That Has Been Shown to Work in Relieving Trigger Points

Local Anesthetics
Diazepam (Valium)
Ketorolac Tromethamine (Toradol)
5% Phenol
Botulinum Toxin Type A
Sterile Saline
Sarapin (Pitcher plant derivative)
Bee Venom
Dry Needling
Comment on step 2 of treating a trigger point.
It is critical that the muscle fibers containing the trigger point be stretched.
Simply injecting or treating the trigger point alone won’t relieve it.
Travell herself said that the cold application was distraction for the patient, the real treatment is the stretching.
Which of the following histological findings is compatible with a chronic trigger point?
A) Kupfer Cells
B) Multinucleated Muscle Fibers
C) Multilobed Nuclei in Leukocytes
D) Presence of Loose Areolar Tissue
E) Reduplication of Nucleoli
b increase number of nuclei in muscle fibers
Which of the following conditions has been demonstrated to contribute to persistence of trigger points?
A) Hyperuricemia
B) Hyperglycemia
C) Hypertension
D) Hypertrichosis
E) Hyperthyroidism
A patient presents to your office reporting suboccipital headaches ever since a minor automobile accident. During your physical examination you discover a Trapezius trigger point which reproduces this pain. You opt to inject this trigger point with 1% Lidocaine. You then apply warm compresses to the area for 15 minutes. The patient returns to the office one week later reporting no benefit from this treatment. Why did your trigger point treatment fail?
A) The use of heat following trigger injection negates the effect of the injection
B) You did not address potential nutritional deficiencies contributing to this patient’s pain.
C) You did not address the psychological factors contributing to this patient’s pain.
D) You did not stretch the muscle containing the trigger point.
E) You should have used 2% Lidocaine in the injection