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One of the most cost-effective methods of treating active TrPs is by using an inexpensive cryocompression tool (such as CryoProbe) that can be applied firmly over the suspected TrP. Physical therapists use dry needling to stimulate intramuscular knots or TrPs with the goal of providing pain relief.įigure D. The use of PA in evaluating the presence/absence and resolution of TrPs in myofascial dysfunction is a crucial outcome measure from a clinical perspective.ĭry needling involves inserting needles into a known TrP, which is active (symptomatic) and lies in the causal pathway of a patient’s pain response. The use of PA as an outcome measure is indicative of injury or pathology status (as injuries or pathologies heal, they become less tender). Tenderness may be the best surrogate measure for pain through the quantification of the pain threshold, which can be measured using pressure algometry (PA). Temperature variations can often alert the practitioner of underlying metabolic dysfunction in tissue as observed in musculoskeletal injury and subsequent inflammation. The author has used infrared thermography to provide temperature readings over dysfunctional tissue, including active trigger points. Interventions and Instrumentation Used in the Treatment of Trigger Points (TrPs) It is difficult to determine, therefore, whether the presence of trigger points is the primary cause of TTH, or whether chronic tension in the suboccipital and paraspinal muscles may be causing the problem. In the author’s clinical experience, TrP assessment in patients does not always meet all the aforementioned criteria. refers pain on deep palpationdisplays a “twitch” response under the palpating fingers.is located in a firm or taut band of muscle.
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4Īccording to classic TrP doctrine described by Simons and Travell, 5 an active TrP has the following characteristics: Sensitization of nociceptive pain pathways secondary to persistent nociceptive activity from active TrPs may then contribute to the progression from acute to more chronic tension headache attacks. 3 There is evidence to suggest that TrPs may initiate a peripheral nociceptive mechanism which contributes to changes in the central nervous system (CNS). That the presence of TrPs is associated with TTH has already been established whether they cause, or are a manifestation of, the headache, however, is not clear, since not every patient with TTH has active TrPs. (Source: 123RF) Current Theories On the Mechanism of Trigger Points The author provides scientific evidence to the presence of trigger points in tension headaches. This report focuses on the role of TrPs in TTH as they are understood today, how they are implicated, and their various treatment strategies (see "Interventions and Instrumentation Used in the Treatment of Trigger Points"). Research over the past several years, however, has added substantial scientific evidence in the form of histochemistry, imaging, electro-diagnostic, and echo-diagnostic methods. 1,2įor many years, the diagnostic process for differentially diagnosing TrPs has relied upon careful clinical examination, which has caused many to doubt their existence. These TrPs, also called contraction knots, have been characterized as discrete, hard, irritable nodules found in taut bands of muscle and associated with pain, tenderness, and subsequent restrictions in muscle strength and joint mobility. Headache and trigger points, it seems, are interconnected, especially when treating tension-type headaches (TTH). In musculoskeletal medicine, the putative role of trigger points (TrPs) in myofascial pain spurs much divisiveness. A tendency to want to diagnose or identify the causative agent has led to much speculation. The mysteries of muscle pain or myalgia, including headache pain, continue to perplex clinicians.