Trigger Point Definition
A trigger point is a location on an involved skeletal muscle capable of provoking pain, usually a tensioned band (striated nodule) can be palpated at this location, which is painful when squeezed and palpated; and can cause distant involvement pain, pressure pain and sympathetic phenomena.
I. Development status
In the last 20 years, physicians in Europe and the United States have gradually classified myofascial tissue-derived pain conditions as myofascial trigger points or myofascial pain syndromes, such as: myofascial weave syndrome, myofascial pain syndrome, myofasciitis, myalgia syndrome, myofatigue syndrome, and so on. This business was first pioneered by janet Travell, an American clinical professor. Through decades of clinical experience in pain management, she found that many pain syndromes from non-organic neuromuscular fibers are due to myofascial pain trigger points. This trigger point is caused by the formation of tension bands in skeletal muscles, resulting in a long-term muscle force imbalance, which leads to a series of myofascial pain syndromes.
II. Pathophysiological mechanism
To support the study of myofascial trigger points, Professor David Simons and other clinical rehabilitation experts have conducted extensive clinical and experimental practice to confirm the existence and pathophysiological and neurophysiological basis of trigger points.
1. Microelectrode diagnostic evidence confirms that acetylcholine concentrations at the nerve endings of the abnormal muscle endplates are pathologically increased under resting conditions, resulting in sustained depolarization of the posterior junction of the muscle, resulting in persistent shortening of the muscle segments and contraction of the muscle fibers, and therefore contractile nodules at the endplates. This chronic sustained shortening of the myokinesis will greatly increase local energy expenditure and decrease local blood circulation; local ischemia and hypoxia can stimulate the release of neurovascular response substances that sensitize afferent nerves and cause trigger point pain. These substances can in turn stimulate abnormal acetylcholine release, forming a malignant stimulation loop with a positive feedback loop.
2, When the injurious receptors are sensitized, the pain signal is transmitted by the afferent nerve to the spinal cord, which generates a central pain signal that then spreads to the adjacent spinal cord segments causing referred pain.
3, Long-term central pain sensitization can increase the excitability of neurons and the expansion of neuronal receptor pools, resulting in intractable involvement pain.
4, The release of neurovascular reactive substances is the main cause of local sympathetic symptoms, which are manifested as rolling pain in the skin, hypersensitivity to touch and temperature, altered blood flow, abnormal sweating, reactive congestion, burning sensation, and skin scratching syndrome.
5.Prolonged shortening of muscle segments produces contracture of the fascia surrounding the involved skeletal muscle.
6, Trigger point-induced muscle spasm causes a disorder in the balance of normal biomechanics of the periarticular muscles, resulting in a series of pathological changes (such as degenerative spinal degeneration and unstable dysfunction) and secondary trigger points.
Third, clinical features
1, The age of onset is 20-60 years, but it can also develop in adolescents.
2. A piece of affected muscle often has several different fixed pain points, and each pain point has its own fixed area of trigger involvement pain.
3, A primary pain point can trigger another neighboring pain point, and a second pain point can trigger a more distant pain point, thus causing distant involvement pain.
4.Every muscle in normal human body can cause one or more potential trigger points due to some chronic injury, and these potential trigger points only have localized pain, and become active trigger points after being painful for some reasons and become ill.
5, potential trigger points are often in a dormant state, which can cause muscle weakness, reduced skeletal muscle tension range and joint movement restrictions.
6. Trauma, acute overstrain, overuse fatigue, exertion, cold and repeated cold can activate.
IV. Diagnostic conditions
First of all, organic and other pathologies should be excluded, such as: musculoskeletal system diseases, neurological diseases, visceral diseases, infectious diseases, neoplastic and psychogenic pain. The author had treated a typical patient with acupuncture and achieved satisfactory results at that time, but the next day it recurred, and after repeated treatments the family requested to be transferred to neurology, and the results were not obvious, and after 3 months MRI was performed and abdominal tumor was found. Therefore, the possibility of organic lesions must be considered in the treatment of this disease.
V. Diagnostic criteria of trigger point
1. Medical history: sudden onset of muscle overuse or myalgia caused by repeated and chronic overuse of the affected muscles; myalgia with no known cause.
2. The muscle tenderness point and the painful stretched band or strip-like structure around the painful point can often be palpated.
3.The painful point of each muscle (trigger point) is accompanied by characteristic distal involvement pain
4, Restricted range of motion and distraction of the affected muscle and slightly weakened muscle strength.
5, Rapid palpation and needling of painful points (trigger points) may trigger local tremors.
6.Pressure and needling of painful points (trigger points) can trigger pain and involvement pain.
7. Aggravated by lack of sleep
VI. Treatment
1.Myotherapy: pressure on the trigger point followed by muscle distraction
2.Muscle distraction and cold spray therapy
3.Acupuncture (acupuncture) and muscle distraction method.
4.Botulinum toxin injection plus muscle tension method
5, the treatment should be supplemented with various vitamins, while giving drugs to improve peripheral circulation, because most patients have vitamin deficiency in the body and normal low line performance. This medication requires a long-term course of treatment.