Myofascial Trigger Points Then and Now: A Historical and Scientific Perspective

Abstract

The intent of this paper is to discuss the evolving role of the myofascial trigger point (MTrP) in myofascial pain syndrome (MPS) from both a historical and scientific perspective. MTrPs are hard, discrete, palpable nodules in a taut band of skeletal muscle that may be spontaneously painful (i.e. active), or painful only on compression (i.e. latent). MPS is a term used to describe a pain condition which can be acute or, more commonly, chronic and involves the muscle and its surrounding connective tissue (e.g. fascia). According to Travell and Simons, MTrPs are central to the syndrome—but are they necessary? Although the clinical study of muscle pain and MTrPs has proliferated over the past two centuries, the scientific literature often seems disjointed and confusing. Unfortunately, much of the terminology, theories, concepts, and diagnostic criteria are inconsistent, incomplete, or controversial. In order to address these deficiencies, investigators have recently applied clinical, imaging (of skeletal muscle and brain), and biochemical analyses to systematically and objectively study the MTrP and its role in MPS. Data suggest that the soft tissue milieu around the MTrP, neurogenic inflammation, sensitization, and limbic system dysfunction may all play a role in the initiation, amplification, and perpetuation of MPS. The authors will chronicle the advances that have led to the current understanding of MTrP pathophysiology and its relationship to MPS, and review the contributions of clinicians and researchers who have influenced and expanded our contemporary level of clinical knowledge and practice.

Posterior, Lateral, and Anterior Hip Pain Due to Musculoskeletal Origin: A Narrative Literature Review of History, Physical Examination, and Diagnostic Imaging

“…Additionally, myofascial pain syndrome is a common and overlooked cause of pain. 2 Genitourinary, gastrointestinal, and vascular pathology should be excluded when examining a patient with hip pain but are beyond the scope of this review.…”

Using thermal imaging to monitor the treatment of latent myofascial trigger points in the upper trapezius

“…Clinically, two types of trigger points can be identified, active and latent trigger points, the later being far more common [1] but less investigated. Latent trigger points, although physically present, are not associated with spontaneous symptoms but will produce local or referred pain when mechanically stimulated [2,3]. Latent trigger points affect the functional capacity of individuals as both can be associated with muscle dysfunction, muscle weakness and limited range of motion [3].…”

“…Latent trigger points, although physically present, are not associated with spontaneous symptoms but will produce local or referred pain when mechanically stimulated [2,3]. Latent trigger points affect the functional capacity of individuals as both can be associated with muscle dysfunction, muscle weakness and limited range of motion [3]. Latent trigger points are often found in pain-free muscles and can become active trigger points by continuous harmful stimuli, but also by prolonged or non habitual exercise and acute trauma [4] increasing the relevance of appropriate diagnosis and management in the clinical setting.…”

Novel Approaches for Chronic Pain

“…The segmental sensitization consists of the nociceptive stimuli in the sensitized areas with sending the sensitization signal to bombard the dorsal horn in the spinal cord. This causes central nervous system sensitization with resulting of dermatomal and sclerotome hyperalgesia and spreading from the sensory component of the spinal segment to the anterior horn cells, which control the myotome resulting of myotome myofascial trigger points within the territory of the segmental sensitization [5][6][7][8][9][10].…”