Omm 9-20-07 Trigger Points

Front 1

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

Back 1

referred

Front 2

The area from which the pain arises is the trigger point

The area to which the pain is referred is the _____-

Back 2

reference zone

Front 3

A specific and reproducible reference zone has been discovered for each trigger point

The trigger points are found in the ______location in every individual

Back 3

same predictable

Front 4

The Patient experiences only the referred pain and may be totally unaware of the presence of the ______

Back 4

trigger point.

Front 5

The idea of the trigger point had its origins in ______
(where)

Back 5

Germany and the Scandanavian countries.

Front 6

The Germans first reported these as Muskelschmertzen (muscle pain) and _____ muscles in the mid-nineteenth century

Back 6

“hard”

Front 7

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

Back 7

Janet Travell, MD

Front 8

Janet Travell, MD 's book

Back 8

Myofascial Pain & Dysfunction: The Trigger Point Manual – 2nd Ed.
Lippincott, Williams & Wilkins 1999

Front 9

Most early research was directed at doing biopsies of trigger points. Most of this showed -----

Back 9

normal muscle tissue

Front 10

Chronic trigger points have been shown to have muscle atrophy with ______

Back 10

fatty infiltration, an increased number of nuclei per muscle fiber, fibrosis, serous exudates and abnormal mucopolysaccharide deposits.

Front 11

Acute trigger points show ______

Back 11

normal muscle

Front 12

Types of Trigger Points

Back 12

Active Trigger point

Latent Trigger point

Tenderpoint

Front 13

Has pain referred to the reference zone which occurs chronically (spontaneously) or with use of the muscles containing the trigger point.

Back 13

Active Trigger Point

Front 14

The patient develops pain in the reference zone only after digital stimulation of the trigger point.

i.e., You poke it

Back 14

Latent Trigger Point

Front 15

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?)

Back 15

Tenderpoint

Front 16

How Do People Get Trigger Points?

Back 16

The same ways they get somatic dysfunction.
Some experts feel that trigger points are simply one special manifestation of somatic dysfunction

Front 17

What Maintains Trigger Points?

Back 17

I. Mechanical Stress
II. Nutritional Inadequacies
III. Metabolic & Endocrine Deficiencies
IV. Psychological Factors
V. Chronic Infection and Infestation
VI. Other Factors

Front 18

Causes of Mechanical Stress

Back 18

Poor Posture
Abuse of Muscles
Immobility
Repetitive Movement
Constriction of Muscles
Leg Length Inequality
Small Hemipelvis
Short Upper Arms
Short First, Long Second Metatarsal
aka: Morton’s Foot

Front 19

Vitamins and Minerals associated with Nutritional Inadequacies

Back 19

Vitamin B-1
Vitamin B-6
Vitamin B-12
Calcium
Iron
Potassium
Folic Acid
Magnesium
Vitamin C

Front 20

Diseases from Metabolic & Endocrine Deficiencies

Back 20

Hypothyroidism
Hypoglycemia
Gout

Front 21

Psychological Factors causing somatic dysfunction

Back 21

Hopelessness
Depression
Stoic

Front 22

Chronic Infection & Infestations causing somatic dysfunction

Back 22

Viral Diseases
Bacterial Infections
Dental Infection
Sinusitis
Urinary Tract Infection
Infestations
-Diphyllobothrium latum (fish tapeworm)
-Giardia lamblia
-Entamoeba histolytica

Front 23

Other Factors causing somatic dysfunction

Back 23

Allergic Rhinitis
Impaired Sleep
Nerve Entrapments

Front 24

How to Diagnose a Trigger Point?

Back 24

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

Front 25

headache on top of the head is due to what?

Back 25

sphenoid sinusitis

Front 26

.

Back 26

Have the patient identify where they feel their pain

Front 27

Do little kids ket frontal sinusitis?

Back 27

no

Front 28

How Do You Treat A Trigger Point?

Back 28

1: Do something to the trigger point.

2: Stretch the muscle containing the trigger point.

3: Recheck the trigger point.

Front 29

How many things can you do to a trigger point?

Back 29

There are literally about fifty different things you can do to a trigger point.

Front 30

Stuff That Has Been Shown to Work in Relieving Trigger Points

Osteopathic Manipulative Treatment:

Back 30

Correct Segmental Dysfunction associated with innervation of the muscle containing the trigger point. (Somato-somatic Reflex)
Counterstrain
Muscle Energy
Direct Soft Tissue / Myofascial Release
Deep Inhibitory Pressure
Percussion Vibrator

Front 31

Stuff That Has Been Shown to Work in Relieving Trigger Points

Physical Modalities:

Back 31

Application of Cold, followed by stretch
Ice Massage
Topical Skin Refrigerant
(Spray & Stretch)
Ultrasound
Electrical Muscle Stimulation
Magnetic Therapies
Energy Techniques

Front 32

Stuff That Has Been Shown to Work in Relieving Trigger Points

Injections:

Back 32

Local Anesthetics
Corticosteroids
Diazepam (Valium)
Ketorolac Tromethamine (Toradol)
Opiates
5% Phenol
Botulinum Toxin Type A
Sterile Saline
Sarapin (Pitcher plant derivative)
Bee Venom
Dry Needling

Front 33

Comment on step 2 of treating a trigger point.

Back 33

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.

Front 34

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

Back 34

b increase number of nuclei in muscle fibers

Front 35

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

Back 35

a

Front 36

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

Back 36

d