1. The myofascial pain syndrome (MPS)

2. Features of MTrPs Motor: disturbed motor function muscle weakness as a result of motor inhibition muscle stiffness restricted range of motion

3. Autonomic: vasoconstriction vasodilatation Features of MTrPs

4. Sensory: local tenderness referral of pain to a distant site peripheral sensitization central sensitization

5. Definition and type of Terms Check handout please

6. Examples of the two directions in which trigger point may referred A). Peripheral projection of pain from suboccipital and infraspinatus trigger points. ( B). Mostly central projection of pain from biceps brachii trigger points with some pain in the region of the distal tendinous attachment of the muscle.

7. Other Muscle Pain Terminology Fibrositis (Gowers, 1904) Fibromyositis (Telling, 1911) Myofasciitis (Albee, 1927) Myofibrositis (Murray, 1929) Perineuritis (Clayton & Livingstone, 1930) Idiopathic myalgia (Gutstein- Good, 1940) Rheumatic myalgia (Good, 1941) Myofascial Pain Syndrome (Travell, 1948) Myodysneuria (Gutstein, 1955) Fibromyalgia (Yunus, 1977)

8. Prevalence Research has shown that MTrPs are commonly associated with facet joint dysfunctions, disc herniation, osteoarthritis, migraine, tension type headache, (Fybromyalgia), visceral disorders etc. Dommerholt, J. and T. Issa, Differential diagnosis: myofascial pain, in Fibromyalgia syndrome; a practitioner's guide to treatment, L. Chaitow, Editor. 2003, Churchill Livingstone: Edinburgh. p. 149-177. A survey of APS (American Pain Society)-members shows that 88.5% consider MPS as a legitimate diagnosis Harden, R.N., et al., Signs and symptoms of the myofascial pain syndrome: a national survey of pain management providers. Clin J Pain, 2000. 16(1): p. 64-72. 80% of 1096 subjects involved in low-velocity activity developed active trigger points (MTrP) Schuller, E., W. Eisenmenger, and G. Beier, Whiplash injury in low speed car accidents. J Musculoskeletal Pain, 2000. 8(1/2): p. 55-67.

9. MTrPs have been identified with: Radiculopathies joint dysfunction disk pathology tendonitis Craniomandibular dysfunction migraines tension-type headaches carpal tunnel syndrome computer-related disorders whiplash associated disorders spinal dysfunction pelvic pain and other urologic syndromes most pain syndromes nocturnal cramps phantom pain etc.

10. Etiology of MTrPs Acute Overuse Direct Trauma Persistent Muscular Contraction (emotional or physical cause), i.e,: poor posture, repetitive motions, stress response Prolonged Immobility Systemic Biochemical Imbalance

11. Diagnostic Criteria taut band: the group of tense muscle fibers extending from a trigger point to the muscle attachments, the tension being caused by contraction knots that are located in the trigger point region

12. Diagnostic Criteria  spot tenderness within the taut band (nociceptive input into the dorsal horn contributing to wind-up and central sensitization)  local twitch response.  referred pain.  Jump sign.

13. Identification Myofascial Trigger Points are identified by physical examination, specifically by palpation There are two palpation techniques: Flat palpation Pincer palpation dependent upon the muscle

14. Manual Trigger Point Therapy Trigger Point Techniques Trigger Point Compression (Technique I) Manual stretching of the taut band in muscle fibre direction (Technique II) Release Techniques: Myofascial Release (Technique III) Intermuscular mobilisation (Technique IV) Stretching Techniques: Therapeutic stretching (Technique V) Self stretching (Technique VI)

15. Manual Trigger Point Therapy Trigger Point Compression (Technique I)

16. Manual Trigger Point Therapy Manual stretching of the taut band in muscle fiber direction (Technique II)

17. Manual Trigger Point Therapy Myofascial Release (Technique III)

18. Manual Trigger Point Therapy Intermuscular mobilisation (Technique IV)

19. Thanks