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Myofasziale Triggerpunkte

Pathophysiologie, Klinik und Therapie

Myofascial trigger points

Pathophysiology, clinical aspects and therapy

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Zusammenfassung

Myofasziale Triggerpunkte sind eine der häufigsten Ursachen von Schmerzen im muskuloskeletalen System. Sie sind gekennzeichnet durch eine palpable knötchenhafte Verdickung im Skelettmuskel innerhalb eines Hartspannstrangs sowie einem Übertragungsschmerzareal. Die Ätiologie der myofaszialen Triggerpunkte ist nicht völlig geklärt. Wahrscheinlich liegt ihnen ein Wechselspiel zwischen lokalen Muskelspannungserhöhungen in der Nähe von neuromuskulären Endplatten und einer entzündlichen Komponente zugrunde. Haltungsanomalien und Fehlstereotypien spielen ätiopathogenetisch ebenfalls eine Rolle. Für die Behandlung von Triggerpunkten stehen viele Techniken zur Verfügung. Systematische Untersuchungen zur Priorisierung oder Sequenz der verschiedenen Behandlungsansätze fehlen. Pragmatischen Gesichtspunkten folgend sollte zunächst nichtinvasiven Verfahren wie der lokalen postisometrischen Relaxation der Vorzug gegeben werden, gefolgt von trockenem Nadeln und Ultraschall. Überwiegt die Komponente der neurogenen Entzündung, kann die Injektion von Lokalanästhetika oder Botulinumtoxin erwogen werden. Jede Triggerpunktherapie ist dabei in manualmedizinische Konzepte mit Verkettungsdenken einzubinden.

Abstract

Myofascial trigger points are one of the most common causes of pain in the musculoskeletal system. They are characterized by a palpable nodule-like thickening in skeletal muscle within a taut band and a pain projection area. The etiology of myofascial trigger points is not fully understood but they are probably based on an interaction of increased local muscle tension close to neuromuscular junctions and an inflammatory component. Postural abnormalities and abnormal movement patterns also play a role. For the treatment of trigger points many techniques are available but systematic studies to prioritize or sequence the different treatment approaches are lacking. Following pragmatic considerations preference should first be given to non-invasive techniques, such as local postisometric relaxation, followed by dry needling and ultrasound. If the neurogenic inflammation component predominates the use of a local anesthetic or botulinum toxin can be considered. Each trigger point therapy should be integrated in manual-medical concepts including consideration of possible chain reactions.

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  1. Ärztegesellschaft für Manuelle Medizin (ÄMM)/Berliner Akademie für Osteopathische Medizin (BAOM), Berlin, Deutschland

    J. Buchmann

  2. Klinik für Neurologie und Psychiatrie des Kindes- und Jugendalters, Universität Rostock, Gehlsheimer Str. 20, 18055, Rostock, Deutschland

    J. Buchmann

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Buchmann, J. Myofasziale Triggerpunkte. Manuelle Medizin 51, 123–130 (2013). https://doi.org/10.1007/s00337-013-1019-7

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