10/05/2024

Myofascial Trigger
Points
Muhammad Osama
DPT (Gold Medalist), MS-OMPT (Ortho), PhD* (Rehab Sci), CHPE, ACMEd, PGC (Neurology), PGC (Med
Ethics NIH, USA), MPPTA, HCPC (UK).
Assistant Professor - Foundation University Islamabad
Editorial Board Member - Journal of Back and Musculoskeletal Rehabilitation, IOS Press (Netherlands) Post
Graduate Mobility Researcher – University of Hasselt (Belgium)
Consultant Physical Therapist - Bahria Town Stroke & Rehabilitation Centre Associate
Editor - Foundation University Journal of Rehabilitation Sciences (FUJRS)

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Trigger point
• “A trigger point is a site of increased irritability in a
tissue that demonstrates a hypersensitive reaction to
mechanical stimulus (pressure or traction) and
causes (triggers) an additional (pathological)
physiological reaction”.
• Symptoms can be local or regional
• Additional symptoms far removed from site are
reported

Trigger point terminology

Type of Trigger Affected Characteristics Example
Point Structure
Cutaneous Cutaneous nerve Electrifying, Primary
ending hyperaesthetic hyperaesthesia
Connective Connective tissue Swelling of Panniculus
Tissue, connective tissue
Subcutaneous
Involving Ligaments, Frequently Epicondylopathy
ligaments & tendons inflammatory
tendons components
Myofascial Muscles Dull, pressing Myofascial pain
syndrome
Periosteal, bony Bone & Deep pain Periostitis
periosteum
Visceral Visceral organs Dull, diffuse McBurney’s point

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Myofascial trigger point (mTrP)

• “Compared to the surrounding are, the mTrP is a

particularly sensitive, over excitable, tender area
within a cord like a shortened skeletal muscle fibre
bundle (taut band), which is frequently palpable as
thickened section
• A mTrP can have various levels of sensitivity

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Active mTrp
• Already symptomatic at rest and/or during
physiological strain, and feels tender as well as
having sensory, motor and autonomic phenomena
in its related transfer zones

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Latent mTrp
• Not symptomatic at rest and/or during physiological
strain, but still demonstrates localized tenderness as
well as causing regional sensory, motor and
autonomic phenomena in its related transfer zones
• A latent mTrP can turn into an active mTrP

Primary (initial) trigger

point
• A primary (initial) trigger point is an mTrP
activated by acute or chronic strain, traumatic
overextension, or direct trauma to the affected
muscle.

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Related trigger point

• A relater trigger point is a small mTrP in the
immediate neighborhood of the primary mTrP,
which is located in the same muscle.

Associated trigger point

• Occur as a result of trigger point activity in
another muscle
• Fall in two categories
– Secondary, &
– Satellite

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Secondary trigger point

• An mTrp that is developed secondarily in a
muscle affected by the primary mTrP.
• A secondary mTrP arises from strain because the
muscle must either excessively support the muscle
affected by the primary mTrP as a synergist or
counteract its increased tension as an antagonist

Satellite trigger point

• An mTrp that has formed in the reffered pain
zone of a primary mTrP.
• Can be caused by mTrP activity in another
muscle

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FINDING ACTIVE LATENT TENDER POINT

mTrP mTrP (FIBROMYALGIA
)
Palpable Common Possible Rare
thickening
Taut band Yes Yes No
Spontaneous pain Yes No Possible
Tenderness Yes Yes Yes
Restricted Common Possible Possible
movement
Reffered pain Common Possible No
Clinically known Yes No Possible
symptoms can be
reproduced

Local Twitch Response

• The local muscle twitch response is a micro
contraction within a taut band of muscle and is
caused by mechanical stimulation of an mTrP
within the taut band.

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Referred Pain
• Radiation of pain from a pathologically changed
structure into the surrounding area or even into
other regions of the body
• The pattern of spread can not be explained by a
radicular segmental innervation pattern or
peripheral nerves

MFS & MPS

• Myofascial syndrome (MFS)
– Refers to all of the symptoms caused by mTrPs
– Occurs regionally and can be distinguished from
generalized diorders
• Myofascial pain syndrome (MPS)
– Refers to a MFS where the same symptom is pain and
can represent a complex psychological and
physiological event in the sense of a chronic pain
syndrome
– Primary and Secondary MPS

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Course of myofascial pain

Change in
Muscle
Tension

Taut Band

Latent mTrP Active mTrp

Continues to
Spontaneous exist without Recuritment
Healing progression of other mTrp

Chronicity

MFS

MPS

Causative Factors of Acute

Myofascial pain
• Blunt Muscle Trauma
• Pulled Muscle (eccentric muscle strain)
• Torn muscles (complete or incomplete, usually caused by
eccentric muscle strain)
• Sprain or dislocation of joints
• Increased isometric contractions
• Shortening of the muscles
• Increase in muscle tension caused by climate
• Change in muscle tension of psychogenic cause
• Slight muscular strain due to prior causes (diabetes, hypothyroidism,
myositis, neuromuscular diseases, vascular diseases, vitamin c,b deficiency)

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Causative Factors of delayed

Myofascial pain
Chronic strain
• Continues use of muscles on one side
• Too many demands placed on the muscle
• Being forced into awkward position
• Advanced functional disorders
• Lack of coordination
• Poor exercise technique
• Poor posture
• Deformity of vertebral column or joints
• Peripheral nerve root irritation or entrapment
Psychogenic factors

Suitable Treatments
(Manual Techniques)
• Acupressure/Ischemic Pressure
• Traditional Acupuncture
• Dry Needling
• Dejung Manual Trigger Therapy
• Lewit treatment techniques
• Neuromuscular techniques
– PNF & MET
• Relaxation Techniques
• Spray and Stretch
• Fascia Techniques
• Stretching and detensioning

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Acupressure

Dry Needling

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Spray & Stretch

Suitable Treatments
(Physical Procedures)
• Heat Therapy
• Cold Therapy
• Electrotherapy
– Low frequency electrical stimulation (Bernard diadynamic
electricity)
– Middle frequency therapy
– Transcutaneous electrical nerve stimulation (TENS)
– Interferential therapy
• Cupping (Baguanfa)
– Dry cupping
– Cupping with blood letting
• Laser therapy
• Shockwave therapy

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Questions and Queries?

References
• Myofascial Trigger Points:
Comprehensive diagnosis and
treatment By Dominik Irnich

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