Trigger Points and Myofascial Pain Syndrome
Myofascial pain syndrome (MPS) describes a variety of conditions characterized by sensory, motor, and autonomic symptoms caused by myofascial trigger points.
Myofascial pain syndrome (MPS) describes a variety of conditions characterized by sensory, motor, and autonomic symptoms caused by myofascial trigger points. According to Travell & Simons’ “Myofascial Pain and Dysfunction”, myofascial trigger point (TrP) is a hyper-irritable focus within a taut band of skeletal muscle, located in the muscular tissue and /or its associated fascia. The spot is painful on compression, and can evoke characteristic referred pain and autonomic phenomena.
There are numbers of theories trying to explain the formation of TrPs. Among those, Travell’s initial trauma theory stated that a taut band in a muscle was necessary as a precursor to TrP development. Taut bands are common in asymptomatic people and once they are present, they are at risk of TrP development. Risk factors of trigger point development include the followings:
Symptoms and signs:
TrPs are either active or latent. Even though latent TrPs are clinically silent with respect to pain, they may cause restriction of movement and weakness of the affected muscles that can be made evident during clinical musculoskeletal examination. However, once a TrP is turned active, it will cause a variety of symptoms including:
Interestingly, TrPs are also well-known for its bizarre clinical presentations and should be one of the differential diagnoses for all symptoms with unexplained etiology. For example, a patient with TrP in their neck muscles can present to their doctors with headache or excessive tearing only without the neck pain; a patient with TrP in abdominal muscles can present with unexplained stomachache or pelvic pain despite after sophisticated investigations including endoscopy, laparoscopy and computer tomography.
The diagnosis of MPS is always clinical. MPS can be established if a single or multiple taut bands are palpable in the muscles that produce a local and/or characteristic referred pain pattern as well as a local twitch response. At the same time, musculoskeletal physicians will explore the underlying biomechanical and ergonomic causative factors of your MPS.
Treatment of MPS can include a combination of the followings:
肌筋膜疼痛綜合症是由肌筋膜內激痛點引發的綜合症，其中包括感覺、運動和自律神經方面的多種症狀。根據 Travell & Simons 所著的《肌筋膜痛及功能障礙》一書所描述，肌筋膜激痛點是一個超敏感的病灶，通常位於骨骼肌和/或其相關筋膜中的繃緊帶內；其有壓痛，也可產生特徵性轉移痛和自律神經反應現象。
有多種學說試圖解釋激痛點的形成，其中 Travell 的始動創傷學說認為肌內繃緊帶是形成激痛點的先決條件。繃緊帶也常見於無症狀的人群，一旦繃緊帶形成，便有產生激痛點的風險。風險因素包括：