NOTES ON MYOFASCIAL TRIGGER POINTS
4th June 2013
We have just provided the Kinetic Control myofascial trigger point course in the Netherlands and in Finland. We have been discussing the influence of myofascial trigger point treatments on movement control retraining and especially on the recruitment of stabiliser muscles such as upper trapezius and psoas major.
The treatment or stimulation of myofascial trigger points does not routinely “release” or “switch off” all muscles. If all muscles were inhibited and switched off by myofascial trigger point treatments, this clearly would be a problem for stabiliser muscles that are already inhibited by pain and posturally elongated. As a consequence of chronic or recurrent musculoskeletal pain, stabiliser muscles fail recruitment efficiency tests of movement direction control (dissociation) and inner range holding. We have observed for many years that stimulating or treating active myofascial trigger points in stabiliser muscles, consistently improves recruitment efficiency immediately in these muscles when retested.
The new hypothesis being proposed about the clinical effect of myofascial trigger point treatments is that stimulation of myofascial trigger point has the effect of normalising or “resetting” myofascial neurophysiology. It is proposed that myofascial trigger point stimulation can down-regulate the neurophysiology of an overactive, excessively recruited multi-joint mobiliser muscle, resulting in an increase in extensibility and less dominance in its recruitment patterns when active with stabiliser synergists. Likewise, it is proposed that myofascial trigger point stimulation can up-regulate an inhibited, under recruited, inefficient stabiliser muscle, resulting in an increase in recruitment efficiency in non-fatiguing postural control tasks and in non-fatiguing functional movement.
Psoas major is a stabiliser muscle and is elongated and inhibited in many people with sway back postures and lumbar, sacroiliac, or hip joint pain. Many of these people report that their psoas feels tight and that it feels relaxed after a myofascial trigger point treatment. How can this be explained in light of the current understanding of muscle neurophysiology? First, let's consider where the ‘feeling’ of tightness comes from. The feeling of tightness or stretch sensation mainly comes from the fascia surrounding the muscle, not the muscle itself.
When an elongated, inefficient psoas major feels tight, its superficial fascias are under ‘stretch-strain’ and contribute to the sensation of “tightness’. Consequently, after myofascial trigger point stimulation an elongated, inhibited psoas major improves its recruitment. The improved contractile recruitment unloads some of the ‘stretch-strain’ from the superficial fascias and the sensation of tightness is relieved. This process also provides the best explanation as to why patients feel the relief of tension in upper trapezius from myofascial trigger point stimulation. The majority of these people with neck pain and headaches have ‘dropped’ shoulders and elongated upper trapezius muscles.
Treatment or stimulation of myofascial trigger points should always be immediately followed up with active recruitment retraining. After treating myofascial trigger points in a short, overactive, up-regulated multi-joint mobiliser muscle, we should provide an inhibitory exercise or stretch for the patient to do at home in order to prolong the effect of the treatment. After treating myofascial trigger points in an elongated, inefficient, down-regulated stabiliser muscle, we should provide a facilitatory recruitment exercise for the patient to perform at home to reinforce the treatment effect.
The treatment or stimulation of myofascial trigger points as several benefits for the managing musculoskeletal pain. Stimulation of myofascial trigger points can directly influence some of the presenting peripheral neurogenic pain symptoms, but it can also directly affects recruitment neurophysiology to optimise therapists’ treatment strategies in movement control retraining