1Trigger Point Therapy Basics
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Transcript of 1Trigger Point Therapy Basics
8/3/2019 1Trigger Point Therapy Basics
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Trigger Point Therapy Basics
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Myofascial Pain and Dysfunction:
The Trigger Point Manual (1999)
Au. Janet Travell, M.D. and David Simons,M.D.
The quintessential text on Trigger PointTherapy. It is a medical textbook. Large
amounts of information in the followingpresentation were developed utilizinginformation from this volume.
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The Trigger Point Therapy Workbook:Your Self-treatment Guide for Pain Relief,2nd Edition, 2004
Au: Claire Davies
A Massage Therapist’s Guide to
Understanding, Locating and Treating
Myofascial Trigger Points, 2006
Au: Leon Chaitow
Sandy Fritz
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Trigger Point Therapy
A Trigger Point is an area of local nerve
facilitation and chemical imbalance of a musclethat is aggravated by stress.
The stressor maybe of many sorts and can affectan individual psychologically or physically.
Trigger Points are small areas of hyperirritability
within a muscle, fascia or tendon.
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Trigger Point Therapy
If the area is located near a motor nerve end
point, the individual may experience referredpain caused by stimulation of the nerve due to
the muscular facilitation.
Trigger Points are often located at these
positions.
Trigger Points consist of a small band of taut
fibers and may be palpated.
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Trigger Point Therapy
Palpation of a Trigger Point may elicit a twitch
response, a slight jump of in the muscle fibers.
Any of the more than 400 muscles within the
body can develop Trigger Points. They are oftendifficult to detect in the deeper layers of muscle.
Trigger Points are generally accompanied by
characteristic referred pain patterns.
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Trigger Point Therapy
In addition, Trigger Points often will restrict
range of motion and induce muscular andmyofascial pain.
With classic Trigger Points the referred painpatterns will direct back to the site of origin, i.e.
headache back to the trapezius.
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Trigger Point Sensitization
Process that encourages the stimulationof local nerve structures that leads toincreased sensitivity and pain.
Involvement includes the release ofchemical mediators as found in the
process of inflammation.
This may result in the swelling of thesurrounding tissues.
Trigger Point Therapy
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Trigger Point Sensitization
The sequence is believed to happen inthe following manner: (Mense and Simons 2001)
‘Something happens’ to the muscletissues. This could be sudden strain, blunttrauma, cold, or rapid stretch.
This ‘something happening’ causes the
release of irritating chemicals includingbradykinins and prostaglandins.
Trigger Point Therapy
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Trigger Point Sensitization
The chemical release increases thesensitivity of local nerve cells that reportpain to the CNS.
The chemical mediators create localizededema.
Swollen tissue decreases blood flowresulting in ischemia and reduced oxygenlevels in the blood.
Trigger Point Therapy
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Trigger Point Sensitization
Once stimulated to an increasedsensitivity, local nerve cells have areduced tolerance resulting in greater
sensitivity to stimulation.
Stimulated nerve cells then amplify the
messages being received andoccasionally sending misinterpreted non-pain signals as pain.
Trigger Point Therapy
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Trigger Point Therapy
Trigger Points are usually located through the
use of palpation.
The following responses may be noticed with
palpation:
-Skin changes: tense and resistive togliding strokes, damp due to perspiration
from sympathetic stimulation.
-Temperature changes: increased in acutephases but decreased in chronic phases
due to restricted circulation because of
fibrotic tissues.
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Trigger Point Therapy
-Noticeable changes in tissue density due to
the contracted fibers of the Trigger Point.
These contracted fibers are often felt as a
small nodule or linear fibers in contraction
such as a ‘spaghetti noodle’.
Credit: Travell & Simons
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Credit: Davies
T i P i Th
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Trigger Point Therapy
Treatment:
Trigger Point treatments should not be done forextended periods of time.
Most basic neuromuscular techniques are
effective in relieving TP’s.
These may include:
- Positional Release
- Direct manipulation of proprioceptors
- MET’s
- Direct manipulation of the TP
T i P i Th
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Trigger Point Therapy
Treatment cont.
Once the TP has been located a method to reduce
the hypersensitivity should be employed.
In cases of extreme hyperirritability the most non-
invasive methods should be tried first.
T i P i t Th
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Trigger Point Therapy
Regardless of the method, the goal is to lengthen
the contracted fibers.
Lengthening the fibers results in an increase in
circulation to the effected fibers helping them to
normalize.
The most common method to lengthen the
contracted tissues is direct pressure. This
pressure maybe applied and held for a period of
time or the pressure maybe applied with a
stroking technique.
T i P i t Th
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Trigger Point Therapy
A certain amount of experience and practice is
necessary to develop an appropriate technique.
Pressure should be applied gradually with
attention paid to the response to the clientsbehaviors. Communication is important.
The practitioners sensitivity to tissue changes is
the most appropriate guide to the pressure
applied.
T i P i t Th
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Trigger Point Therapy
Begin applying pressure until one or more of
these signs are noticeable:
-Twitch response
- Recreation of the pain or the developmentof referred pain
-Pilomotor reflex
-Communication with the client indicates
the pain level a 5-6
Trigger Point Therapy
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Trigger Point Therapy
The pressure may be increased if the therapist
feels the tissue softening or the spasm releasing.
Once the referred pain has diminished or the pain
level has decreased to 0-1, release the pressure.
This application may be repeated 2-3times.
Trigger Point Therapy
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Trigger Point Therapy
An alternative method utilizing direct pressure is
to stroke over the TP.
Once the TP is palpated back-up ½ to 1 inch,
apply pressure as previously noted and strokeover the TP passing ½ to 1 inch slowly.
This may be repeated 2-3 times.
Trigger Point Therapy
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Trigger Point Therapy
Caution:
When utilizing direct pressure techniques be
aware of the referred pain patterns associated
with the Trigger Point you are working on.
It is rare that a you will find Trigger Points that
create the same pain as a compressed nerve.
Know the potential areas for endangerment and
respect them.
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