I.Myofascial Trigger Point Treatment Protocol
Recognition of Myofascial trigger points as a major cause of pain and dysfunction has led to the treatment of this condition across the disciplines of healthcare. Seminars teaching particular techniques and good basic introductions are available to doctors, physical therapists, and massage therapists to name only a few. A small number of authors have even produced excellent self help books. These all have and deserve their place.
It is important that each member of the multidisciplinary health care team understand something of Myofascial trigger points because muscle pain and dysfunction impacts every allied health discipline to some extent. However:
It is the utilization of a distinct protocol of evaluation and treatment that leads to success in treating Myofascial pain and its associated dysfunction.
The following of this protocol is what distinguishes Myofascial Trigger Point Therapy as a distinct discipline. This then is a brief explanation of the protocol.
I. Medical Diagnosis
This is performed by the patient’s doctor. A proper diagnosis will take into account:
medical history
What conditions the patient has had, in what order, and when. How does this relate to the patients present complaint?
elimination of pathology
Any existing pathology must be treated. The muscular system is influenced by all other systems. All health care conditions need to be managed with an eye to the muscular system.
differential diagnosis
This is the job of determining the differences between several conditions that may very well look the same to the untrained eye. Only the doctor is qualified to do this. It often entails referral to other specialists. Neglect of this crucial step often has dire consequences.
II. Patient History
family
Just what is the patient’s family situation. Are they married, divorced, living with family? Are they happy in their current situation? What stresses are they subject to?
vocational
What does the patient do for work? Do they Work? What is their work history and how is it relevant to their current pain complaint?
social
What is the patient’s current social life? What was it before. How does it contribute to or help the current pain complaint.
avocational
What does the patient do in their spare time? Does it help or add to the current pain complain?
illness/accidents
What is the history of the patient’s illnesses and injuries. How do they influence the current pain complain?
III Postural Analysis
The posture assumed by the patient is important for the clues it gives to how the patient’s muscles are functioning. Each posture tells a story. Posture is a major section of the map when deciding where to treat.
IV Pain Pattern Documentation
verbal
The patient both explains and shows with 1 finger where the pain is. Pointing is important because of the vast difference in where individuals believe their anatomy is. There are many definitions of Shoulder, hip, and low back. Just listening is never enough.
Diagrammed
The therapist shades in the painful areas on a body diagram. This diagram is then checked for accuracy with the patient. Now the therapist really knows what the patient means when they say shoulder, hip, or low back.
V Range of Motion Testing
pain site
The muscles that can cause the patients pain complaint are tested.
functional unit
Muscles that function in the same area as the pain causing muscles are also tested.
secondary and compensatory areas
Muscles that compensate for or which can be injured by the already injured muscles are also evaluated.
VI Movement Analysis
This is essential to determining how movement is being affected by trigger points or how the movement is being caused by Myofascial dysfunction. This is the arena of gait analysis, observation and testing of muscle recruitment patterns manually, and if available S_EMG evaluation.
VII Perpetuating Factors
These are conditions or activities that can perpetuate trigger point activities. They
fall into the following categories:
mechanical stresses
nutritional inadequacies
metabolic & endocrine inadequacies
posture: sleeping, sitting, standing
home & work station ergonomics
psychological
Specific Soft Tissue Treatment
trigger point compression
This is the gold standard of manual treatment. Trigger Point Pressure Release has been shown to be more effective than a number of other modalities in decreasing pain and disrupting trigger points.
intermittent cold with stretch
This is a very useful technique in treating trigger points of more recent origin. It can be used by those with a less developed ability to palpate trigger points.
Injection
This must be done by the physician. It is most useful after manual therapies have left behind a few stubborn spots.
other TrP specific techniques
There are a number of techniques that can be effective in treating trigger points. Almost any technique that lengthens the muscle will be helpful.
adjunctive soft tissue techniques
There are other soft tissue dysfunctions that need to be addressed during trigger point therapy. Ignoring them may well perpetuate trigger point activity. There are manual treatment techniques that are used specifically to address these other dysfunctions.
Myofascial Rehabilitation
specific muscle stretch retraining
The patient normally receives a stretching program that is specific to their dysfunction. No other program will do.
specific movement pattern retraining
In chronic conditions patients often need to be taught how to move properly and use the regained abilities of their muscles.
specific muscle strengthening
Most muscles regain strength when the regain length. When this fails after appropriate lengthening and movement retraining the muscle may well require strengthening.
Patient Instruction and Involvement at all Stages of Treatment
If the patient fails to take responsibility for their own health there is no use in therapy. Success occurs when the patient and health care team work together.
TO ELIMINATE ANY ONE OF THESE STEPS IN TREATING MYOFASCIAL PAIN AND DYSFUNCTION CAN LEAD TO TREATMENT FAILURE!