Myofascial trigger points (MTrPs), also known as trigger points, are described as hyperirritable spots in the skeletal muscle. They are associated with palpable nodules in taut bands of muscle fibers. They are a topic of ongoing controversy, as there are limited data to inform a scientific understanding of the phenomenon. Accordingly, a formal acceptance of myofascial "knots" as an identifiable source of pain is more common among bodyworkers, physical therapists, chiropractors, osteopaths, and osteopathic doctors. Nonetheless, the concept of trigger points provides a framework that may be used to help address certain musculoskeletal pain. The trigger point model states that unexplained pain frequently radiates from these points of local tenderness to broader areas, sometimes distant from the trigger point itself. Practitioners claim to have identified reliable referred pain patterns that associate pain in one location with trigger points elsewhere. There is variation in the methodology for diagnosis of trigger points and a dearth of theory to explain how they arise and why they produce specific patterns of referred pain. Compression of a trigger point may elicit local tenderness, referred pain, or local twitch response. The local twitch response is not the same as a muscle spasm. This is because a muscle spasm refers to the entire muscle contracting, whereas the local twitch response also involves the entire muscle but only causes a small twitch, without any contraction. Among medical doctors, various specialists might use trigger point therapy. These include physiatrists (medical doctors specializing in physical medicine and rehabilitation), family medicine, and orthopedics. Osteopathic (as well as chiropractic) schools also include trigger points in their training. Other health professionals, such as athletic trainers, occupational therapists, physiotherapists, acupuncturists, massage therapists and structural integrators are also aware of these ideas and many of them make use of trigger points in their clinical work as well.
Diagnosis A 2009 review of nine studies examining the reliability of trigger point diagnosis found that physical examination could not be recommended as reliable for the diagnosis of trigger points.
Imaging Since the early 2000s several research studies have been conducted to determine if there was a way to visualize myofascial trigger points using tools such as ultrasound imaging and magnetic resonance elastography. Several of these studies have been dismissed under meta-analysis. Another synthetic literature review expressed more optimism about the validity of imaging for myofascial trigger points, but admitted small sample sizes of the reviewed studies.
Myofascial pain syndrome Myofascial pain syndrome is a focal hyperirritability in muscle that can strongly modulate central nervous system functions. Scholars distinguish this from fibromyalgia, which is characterized by widespread pain and tenderness and is described as a central augmentation of nociception giving rise to deep tissue tenderness that includes muscles. Myofascial pain is associated with muscle tenderness that arises from trigger points, focal points of tenderness, a few millimeters in diameter, found at multiple sites in a muscle and the fascia of muscle tissue. Biopsy tests found that trigger points were hyperirritable and electrically active muscle spindles in general muscle tissue.
Misdiagnosis of pain The misdiagnosis of pain is the most important issue taken up by Travell and Simons. Referred pain from trigger points mimics the symptoms of a very long list of common maladies. Medical doctors, in weighing all the possible causes for a given condition, rarely consider a myofascial source. The study of trigger points has not historically been part of medical education. Travell and Simons hold that most of the common everyday pain is caused by myofascial trigger points and that ignorance of that basic concept could inevitably lead to false diagnoses and the ultimate failure to deal effectively with pain.
Treatment
Physical muscle treatment Physical exercise aimed at controlling posture, stretching, and proprioception has all been studied with no conclusive results. However, exercise proved beneficial to help reduce pain and the severity of symptoms that one felt. Muscular contractions that occur during exercise favor blood flow to areas that may be experiencing less than normal flow. This also causes a localized stretching effect on the fascia and may help relieve the abnormally tight fascia. Evidence that supports these exercises for treatment is scarce, but physical exercise can be beneficial in reducing the intensity of pain. Researchers of evidence-based medicine concluded as of 2001 that evidence for the usefulness of trigger points in the diagnosis of fibromyalgia is thin. More recently, an association has been made between fibromyalgia tender points and active trigger points.
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