What is the Physiology of a Myofascial Trigger Point and how does a bodyworker treat them

by Martin Kingston
http://www.massage-therapy-london.co.uk
+44 20 8400 9712 / +44 7710 314432

This article appeared in the newsletter for BodyworkersLondon.com

THIS ARTICLE REFLECTS THE PRIVATE VIEWS OF THE AUTHOR AND SHOULD NOT BE CONSIDERED A MEDICAL REFERENCE..

A "myofascial trigger point" is
· an often palpable, lentil-sized "contracture knot" in skeletal muscle, in the belly, within a longitudinal "tight band" stretching to the musculotendinous boundary;
· which when stressed, either by stretching, pressure or by sympathetic ANS activity, causes sensory disturbance (pain/numbness/tingling/visceral dysfunction) locally and at another place on the body, recognised and repeatable. This other place is not a radicular facilitation, where an irritated nerve fires its related dermatomes or organs. It is a facilitated area recognised in osteopathy, where an afferent nerve can irritate not only related nerves close by where it enters the spinal column, but also by sending messages up the column can cause general sensitisation of already irritable structures. So a patient may complain to their bodyworker of the trigger point, the referred area, and also say "it is worse when I feel stressed".

The causes of trigger points are often a general or specific stress on the body - an overstressed or strained muscle caused by dysfunction. They are a symptom, and root causes should be checked before treating.

Whatever the stressor, the "Energy Crisis Hypothesis" assumes that within a muscle a contracture knot may form when actin/myosin filaments are unable to release for physical not electrical reasons: there is no action potential keeping a contraction going. In fact, there is no ATP available to release myosin by removing Ca++ ions from the cell. This would be caused by a local ischemia. Treatment with intermittent ischemic compression will pump the area and get fluids moving, enabling release. However, titin filaments can keep the actin/myosin bound up, unless the compression is followed by a prolonged stretch (c. 20 seconds plus).

How is the Facilitation created and set up to create a feedback loop? A comprehensive hypothesis will assume the ischemia does not remove wastes of anaerobic respiration, which stimulate local nociceptors. These set up the initial stress response. Facilitation creates a sympathetic stimulation of the area, further stressing the contracture knot.

Treatment by a bodyworker should be to find the original stressor, and remove it. If that is not possible (occupational reasons, for instance), find the original trigger trigger point, that sets up the initial stress, and to treat it. First with intermittent ischaemic pressure, to remove wastes and treat the contracture knot. Leon Chaitow advises subsequent Positional Release then PIR MET, as part of the INIT sequence, and all authorities recommend a prolonged stretch of the area. The INIT sequence aims to treat first the contracture, then the PRT & MET to get all filaments even length in the taut band. The final stretch should release the titin filaments, so the contracture knot will not revert in a short while.

Treatment should be also to reduce general stress levels, as part of interrupting the feedback loop.