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Pag. 1 Faculty of Physical Education & Rehabilitation Department of Human Physiology & Sports Medicine VUB Congress 2007 Andre Farasyn Ph.D. PT DO Referred.

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Presentation on theme: "Pag. 1 Faculty of Physical Education & Rehabilitation Department of Human Physiology & Sports Medicine VUB Congress 2007 Andre Farasyn Ph.D. PT DO Referred."— Presentation transcript:

1 Pag. 1 Faculty of Physical Education & Rehabilitation Department of Human Physiology & Sports Medicine VUB Congress 2007 Andre Farasyn Ph.D. PT DO Referred muscle pain is primarily peripheral in origin: “The barrier-dam theory”

2 Pag An infitration… 2. …on a muscular “Trigger Point”… 3. …activates a referred pain... INTRODUCTION..... Kellgren, 1937 Referred muscle pain

3 Pag. 3 Overview of different possible mechanisms of referred muscle pain: INTRODUCTION Referred muscle pain

4 Pag. 4 F E D B A C 1. Mechanical pressure… 2. …on a muscular “Trigger Point”… 3. activates (A & B) via spinal reflex… 4. …(C) …a bodily area of referred pain other stimuli (E & F) co-activates… 5. …and in turn activates (D) the CNS Hypothesis of Travell & Simons (1998)‏ INTRODUCTION Referred muscle pain

5 Pag. 5 New hypothesis for the phenomenon of referred muscle pain Andre Farasyn Referred muscle pain is primarily peripheral in origin: “The barrier-dam theory” Medical hypotheses 2007;68:

6 Pag. 6 B A 1. Mechanical pressure… 2. …on a “Trigger Point” … 5. secondly activates the afferent “postlocal” nerve (B) …downstream…and in turn via spinal transduction… 4...the creation of a referred pain zone..(sec)… 3...disturbes firstly the afferent “prelocal” nerve (A) …upstream: with the consequence of… 6. …actives the CNS Just like a barrier-dam… Referred muscle pain is primarily peripheral in origin: “The barrier-dam theory” New hypothesis: Farasyn A.: “The barrier-dam theory”

7 Pag. 7 E B A C Co-activates parallel sensitive nerves (E => C) creating adjacent zones of referred pain… Referred muscle pain is primarily peripheral in origin: “The barrier-dam theory” New hypothesis: Farasyn A.: “The barrier-dam theory”

8 Pag. 8 Discussion & Conclusion Confirmation needed in experimental referred muscle pain provocation tests Referred muscle pain is primarily peripheral in origin: “The barrier-dam theory” New hypothesis: Farasyn A.: “The barrier-dam theory”

9 Pag. 9 Fig. from Gray’s Anatomy (1919 )‏ Examples of referred muscle pain syndromes: 2. Tension headache 1. Repeated strain injury 3. Bilateral (non-specific) low back pain 4. Pseudo-ischialgia Referred muscle pain is primarily peripheral in origin: “The barrier-dam theory”

10 Pag Repeated strain injury M. Infraspinatus Trigger Point =…according to segmental innervation when stimulated… Examples of referred muscle pain syndromes: Hypothesis of Travell & Simons (1998)‏

11 Pag Repeated strain injury M. Infraspinatus Trigger Point =…not the brain is the misleader, but the human interpretation… Examples of referred muscle pain syndromes: Hypothesis of Travell & Simons (1998)‏

12 Pag. 12 Examples of referred muscle pain syndromes: = …what happens upstream of the peripheral sensitive nerve entrapment … New hypothesis: Farasyn A.: “The barrier-dam theory” 1.Repeated strain injury M. Infraspinatus Trigger Point

13 Pag. 13 Fig. from Benninghoff & Goerttler, Tension headache Examples of referred muscle pain syndromes: 1. The N. Occipitalis major = …peripheral sensitive nerve entrapment syndromes of… 2. T he N. occipitalis minor (C2-3)‏ 3. T he N. Auricularis magnus

14 Pag. 14 Fig. from Benninghoff & Goerttler, Tension headache Examples of referred muscle pain syndromes: = …peripheral sensitive nerve entrapment syndromes of… 4. The N. Supraclavicularis & N. Transversus colli

15 Pag. 15 Fig. from Gray’s Anatomy (1919 )‏ 3. Bilateral low back pain Examples of referred muscle pain syndromes: = …peripheral sensitive nerve entrapment syndromes of…

16 Pag Pseudo-ischialgia Examples of referred muscle pain syndromes: =…peripheral sensitive nerve entrapment syndromes…

17 Pag. 17 The primary pathogenesis of referred pain is presumed… Conclusion: Referred muscle pain is primarily peripheral in origin: “The barrier-dam theory”  to be a peripheral sensitization with additionally a central modulation and ….not vice versa….  probably nothing else than a simple local peripheral sensitive nerve entrapment syndrome….

18 Pag. 18 Recommandations Referred muscle pain is primarily peripheral in origin: “The barrier-dam theory” In the future we need to generate a greater interest in:  muscle tenderness research and …..  exploring electrographical & myometrical measurements of peripheral sensitive nerve entrapment syndromes.

19 Pag. 19 Thank you for your attention…! Referred muscle pain is primarily peripheral in origin: “The barrier-dam theory”


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