Buckminster Fuller

Tensegrity- Tension Integrity

A model of tension and compression components

Anatomy Trains – Tom Myers

12 trains – Myofascial Meridians (70%-80% similarity to the 12 meridians of TCM)

A train is

1. A volumetric line which follows direct tension lines

2. A chain of sausages = Muscle-Connective Tissue-Muscle.. = Railway
3. Station = Bones

95% of patients having chronic pain will also have a myofascial pain component

The 6 Criteria for the clinical diagnosis of trigger points

1. Typical radiation of pain arising from the trigger point

2. Weakness and range of motion limitation in the affected muscle.
3. Ability to discriminate a taut band sensation in the muscle.
4. Hypersensitivity of the trigger point following prolonged pressure
5. Twitch response following needling of the trigger point.
6. Disappearance of pain following treatment of the trigger point
Myofascial Pain Syndrome- trigger points arise due to:

 Trauma
 Postural Asymmetry
 Anxiety and Chronic Muscular Tension
 Radiculopathy

Nociceptive pain- local pain that arises from actual or threatened tissue damage (non-neural) d/t
activation of nociceptors by noxious stimuli. Radicular Pain- pain radiating from a nerve root.
Radiculopathy- disturbed conductivity between spinal cord and periphery

*Myofascial pain- subtype of nociceptive pain

Neuropathic pain- caused by lesion or disease to neural tissue of the somatosensory NS (central or
peripheral)
Dysfunctional pain- any pain without known nociceptive or neuropathic origin

The 4 main causes of pain:

1. Trauma & Surgery

2. Cancer (& cancer related pain)
3. Spinal – mainly lower back
4. Joint – mainly osteoarthritis of the big joints

*Musculoskeletal system is a major etiology causing pain (>60% of chronic pain)

Multiple sarcomere knots form a trigger point

Knots are stuck in contraction, as a result blood flow becomes limited to the area

(within a taut band) -> oxygen starvation and accumulation of waste products irritate the trigger
point -> pain -> brain signals to stop using the muscle -> further shortens and tightens the muscle.
To treat trigger point – deep stroke massage.

Myofascial pain is characterized by- reduced ROM, weakness, tenderness/stiffness upon palpation

Muscle contraction/relaxation is the main consumer of energy

*The cause of myofascial pain according to the energy crises hypothesis

The muscle is unable to relax.

Taut bands are muscle fibers which are involuntarily contracted

In myofascial syndrome, muscle tone regulation is disturbed

*leading to shortened over-contracted muscles

Pain from myofascial trigger points may be referred in non-dermatomal patterns-

d/t convergence of afferent fibers in the dorsal horn of the spinal cord

leads to retrograde firing in non-involved nociceptive fibers.

Insertion of needle acts as an “artificial nerve”

Leading to depolarization-repolarization (twitch-reflex relaxation)

Physical Exam- Resisted Movement Interpretation

Strong and Painless = Normal

Strong and Painful = Minor Lesion in muscle, tendon or enthesos

Weak and Painless = Rupture of muscle, Nervous System malfunction

Weak and Painful = Serious Pathology to be ruled out

Pain on Repetition = Intermittent Claudication – Vascular or Neurological

All Movements Hurt = Severe Pathology of Joint/s, Neurosis

ART-N Model of Physical Exam

A = Appearance, Asymmetry

R = Range of Motion

T = Texture, Tenderness, Touch

N = Neurological Findings

Pain upon contraction – pathology in contractile structures

*Muscles, Tendons, Fascia(?)

Pain upon passive movement – pathology in inert structures

*Joint capsule, Ligaments, Fascia, Bursae, Dura matter & Sheath

Trophedema – Peau D’orange effect due to dysfunctional lymphatic drainage

The Matchstick test is used to test for segmental local trophedema

Segmental Pain Patterns are according to muscle innervation

*NOT Dermatomal

Spondylosis -> Neurogenic change -> Muscle Shortening -> Symptoms

Characteristics of Shortened Muscles

1. Thickened (Enthesopathic) Tendons

2. Palpable Tender “Taut Bands”

3. Trigger Points
Pain generating Tissue has typical signs of inflammation

*Swelling, Redness, Heat, Pain, Loss of Function

Pain generating from Nervous origin is characterized by:

1. Allodynia
2. Hyperesthesia
3. Hypoesthesia
4. Hyperalgesia

Somatic Referred pain is characterized by:

1. Taut Bands
2. Trigger Points
3. Limited ROM
4. Pain Reproduction Pattern

Allodynia - pain due to a stimulus that does not normally provoke pain *(ex. Feather)
Hyperesthesia- abnormal increase in sensitivity to stimuli of the sense. *(ex. sound that one hears,
foods that one tastes, textures that one feels)

Hypoesthesia or Numbness- a reduced sense of touch or sensation, or a partial loss of

sensitivity to sensory stimuli.

Hyperalgesia- abnormally increased sensitivity to pain

The most important part of diagnosing myofascial pain is the history taking.

The physical exam confirms the diagnosis.

Somatic vs. Radicular Pain

Location:

Radicular- mainly leg (less back)

Somatic- mainly back (less leg)

Quality:

Radicular- Stabbing, tingling, electric

Somatic- Dull, pressing, pulsing, hard to localize

Neurological Signs: are present in Radicular

Neurological Signs are NOT present in Somatic

*Somatic provocative tests are positive

SLR test- Positive in radicular

Negative in somatic

Pathophysiology of Myofascial Pain

Contraction-> Pain-> Avoidance-> Weakness-> Contraction…

Muscle strengthening reduces chance of recurring injuries (significantly) *moderately reduces pain
as well.
Metabolic Correlation exists between myofascial pain and:

1. Hypothyroidism
2. Iron deficiency
3. B12 deficiency

Is there a psychosocial factor in myofascial pain? Yes/No

Pharmacotherapy (i.e NSAIDS) is effective in Acute/Chronic myofascial pain.

*Very limited in chronic.

Acute <3 months

Chronic >3 months