Skip to main content

Advertisement

SpringerLink
Log in

Effect of Treatment on Trigger Points

  • Published:
Current Pain and Headache Reports Aims and scope Submit manuscript

Abstract

Patients with muscle pain complaints commonly are seen by clinicians treating pain, especially pain of musculoskeletal origin. Myofascial trigger points merit special attention because its diagnosis requires examinations skills and its treatment requires specific techniques. If undiagnosed, the patients tend to be overinvestigated and undertreated, leading to chronic pain syndrome. Patients with myofascial pain syndrome present primarily with painful muscle(s) and restricted range of motion of the relevant joint. Palpable painful taut bands are named trigger points and are the main and pathognomonic finding on physical examination. Eliciting local twitch response and referred pain requires experience and examination skills. It may be useful to classify the patient as having acute or chronic, and as having primary or secondary, myofascial pain so the decision on the details of treatment can be curtailed to the needs of each patient. Effective treatment modalities are local heat and cold, stretching exercises, spray-and-stretch, needling, local injection, and high-power pain threshold ultrasound.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1

Similar content being viewed by others

References

Papers of particular interest, published recently, have been highlighted as: • Of importance •• Of major importance

  1. Wheeler AH: Myofascial pain disorders: theory to therapy. Drugs 2004, 64:45–62.

    Article  CAS  PubMed  Google Scholar 

  2. • Caramês J, Carvalhão F, Real Dias MC: Myofascial trigger point disease: a multidisciplinary disorder [in Portuguese]. Acta Reumatol Port 2009, 34:38–43. This study showed that conventional ultrasound application is not effective in the treatment of myofascial trigger points.

    PubMed  Google Scholar 

  3. •• Shah JP, Gilliams EA: Uncovering the biochemical milieu of myofascial trigger points using in vivo microdialysis: an application of muscle pain concepts to myofascial pain syndrome. J Bodyw Mov Ther 2008, 12:371–384. This study reinforces the findings that suggest trigger points initiate changes in the peripheral and central nervous systems

    Article  PubMed  Google Scholar 

  4. Fricton JR, Steenks MH: Diagnosis and management of myofascial pain [in Dutch]. Ned Tijdschr Tandheelkd 1996, 103:249–253.

    CAS  PubMed  Google Scholar 

  5. Fricton JR: Myofascial pain syndrome. Neurol Clin 1989, 7:413–427.

    CAS  PubMed  Google Scholar 

  6. Simons DG: Review of enigmatic MTrPs as a common cause of enigmatic musculoskeletal pain and dysfunction. J Electrmyogr Kinesiol 2004, 14:95–107.

    Article  Google Scholar 

  7. Han SC, Harrison P: Myofascial pain syndrome and trigger-point management. Reg Anesth 1997, 22:89–101.

    Article  CAS  PubMed  Google Scholar 

  8. Graff-Radford SB: Myofascial pain: diagnosis and management. Curr Pain Headache Rep 2004, 8:463–467.

    Article  PubMed  Google Scholar 

  9. Alvarez DJ, Rockwell PG: Trigger points: diagnosis and management. Am Fam Physician 2002, 65:653–660.

    PubMed  Google Scholar 

  10. • Yap EC: Myofascial pain: an overview. Ann Acad Med Singapore 2007, 36:43–48. This review recommends accurate identification of precipitating and perpetuating factors and sensitized spinal segments before planning the treatment. This review also showed that patients have actively participated in the treatment plan to restore flexibility and balanced biomechanics of the musculoskeletal system to prevent recurrences.

    PubMed  Google Scholar 

  11. Gerwin RD: Classification, epidemiology, and natural history of myofascial pain syndrome. Curr Pain Headache Rep 2001, 5:412–420.

    Article  CAS  PubMed  Google Scholar 

  12. Fricton JR, Kroening R, Haley D, Siegert R: Myofascial pain syndrome of the head and neck: a review of clinical characteristics of 164 patients. Oral Surg Oral Med Oral Pathol 1985, 60:615–623.

    Article  CAS  PubMed  Google Scholar 

  13. Gerwin RD: Myofascial pain syndrome in the upper extremity. J Hand Ther 1997, 10:130–136.

    CAS  PubMed  Google Scholar 

  14. • Manolopoulos L, Vlastarakos PV, Georgiou L, et al.: Myofascial pain syndromes in the maxillofacial area: a common but underdiagnosed cause of head and neck pain. Int J Oral Maxillofac Surg 2008, 37:975–984. This study showed that using pharmacological and behavioral techniques to enhance central inhibition may have a role in the treatment of myofascial trigger points

    Article  PubMed  Google Scholar 

  15. Esenyel M, Caglar N, Aldemir T: Treatment of myofascial pain. Am J Phys Med Rehabil 2000, 79:48–52.

    Article  CAS  PubMed  Google Scholar 

  16. Doggweller-Wiygul R: Urologic myofascial pain syndromes. Curr Pain Headache Rep 2004, 8:445–451.

    Article  Google Scholar 

  17. Simons DG, Travell JG, Simons LS: Myofascial Pain and Dysfunction: The Trigger Point Manual, vol 1: Upper Half of Body, edn 2. Baltimore: Lippincott Williams & Wilkins; 1998.

    Google Scholar 

  18. Rivner MH: The neurophysiology of myofascial pain syndrome. Curr Pain Headache Rep 2001, 5:432–440.

    Article  CAS  PubMed  Google Scholar 

  19. Gerwin RD: A study of 96 subjects examined both for fibromyalgia and myofascial pain. J Musculoskeletal Pain 1995, 3(Suppl 1):11.

    Google Scholar 

  20. Nice DA, Riddle DL, Lamb RL, et al.: Intertester reliability of judgment of the presence of trigger points in patients with low back pain. Arch Phys Med Rehabil 1992, 73:893–898.

    CAS  PubMed  Google Scholar 

  21. Njoo KH, Van der Does E: The occurrence and inter-rater reliability of myofascial trigger points in the quadratus lumborum and gluteus medius: a prospective study in non-specific low back pain patients and controls in general practice. Pain 1994, 58:317–323.

    Article  CAS  PubMed  Google Scholar 

  22. Wolfe F, Simons DG, Fricton J, et al.: The fibromyalgia and myofascial pain syndromes: a preliminary study of tender points and trigger points in persons with fibromyalgia, myofascial pain syndrome and no disease. J Rheumatol 1992, 19:944–951.

    CAS  PubMed  Google Scholar 

  23. Russell IJ: Reliability of clinical assessment measures for the classification of myofascial pain syndrome. J Musculoskelet Pain 1999, 7:309–324.

    Article  Google Scholar 

  24. Gerwin RD, Shannon S, Hong CZ, et al.: Interrater reliability in myofascial trigger point examination. Pain 1997, 69:65–73.

    Article  CAS  PubMed  Google Scholar 

  25. Sciotti VM, Mittak VL, DiMarco L, et al.: Clinical precision of myofascial approach when other treatment failed. Phys Med Rehabil Clin N Am 1997, 8:23–53.

    Google Scholar 

  26. Hong C-Z, Chen Y-N, Twehous D, Hong D: Pressure threshold for referred pain by compression on the trigger point and adjacent areas. J Musculoskeletal Pain 1996, 4:61–79.

    Article  Google Scholar 

  27. • Tough EA, White AR, Richards S, Campbell J: Variability of criteria used to diagnose myofascial trigger point syndrome: evidence from a review of literature. Clin J Pain 2007, 23:276–286. This review shows that there is no consistent pattern to the choice of diagnostic criteria or their combinations among the studies and clinicians. This may lead to inconsistencies among the studies on the myofascial pain syndrome.

    Google Scholar 

  28. Mense S, Simons DG, Russell IJ: Muscle Pain: Understanding Its Nature, Diagnosis, and Treatment. Philadelphia: Lippincott Williams & Wilkins; 2001.

    Google Scholar 

  29. Wreje U, Brorsson B: A multicenter randomized controlled trial of injections of sterile water and saline for chronic myofascial pain syndrome. Pain 1995, 61:441–444.

    Article  CAS  PubMed  Google Scholar 

  30. Hubbard DR, Berkoff GM: Myofascial trigger points show spontaneous needle EMG activity. Spine (Phila Pa 1976) 1993, 18:1803–1807.

    Article  CAS  PubMed  Google Scholar 

  31. Simons DG, Hong C-Z, Simons LS: Nature of myofascial trigger points: active loci. J Musculoskel Pain 1995, 3(Suppl 1):62.

    Google Scholar 

  32. Simons DG, Hong C-Z, Simons LS: Spontaneous electrical activity of trigger points. J Musculoskel Pain 1995, 3(Suppl 1):124.

    Google Scholar 

  33. Simons DG, Hong C-Z, Simons LS: Spike activity in trigger points. J Musculoskel Pain 1995, 3(Suppl 1):125.

    Google Scholar 

  34. Simons DG, Hong C-Z, Simons LS: Prevalence of spontaneous electrical activity at trigger spots and at control sites in rabbit skeletal muscle. J Musculoskel Pain 1995, 3:35–48.

    Article  Google Scholar 

  35. Hong C-Z, Torigoe Y: Electrophysiologic characteristics of localized twitch response in responsive bands of rabbit skeletal muscle fibers. J Musculoskel Pain 1994, 2:17–43.

    Article  Google Scholar 

  36. Acquadro MA, Borodic GE: Treatment of myofascial pain with botulinum A toxin. Anesthesiology 1994, 80:705–706

    Article  CAS  PubMed  Google Scholar 

  37. Cheshire WP, Abashian SW, Mann JD: Botulinum toxin in the treatment of myofascial pain syndrome. Pain 1994, 59:65–69.

    Article  CAS  PubMed  Google Scholar 

  38. Yue SK: Initial experience in the use of botulinum toxin A for the treatment of myofascial related muscle dysfunctions. J Musculoskel Pain 1995, 3(Suppl 1):22.

    Google Scholar 

  39. • Kuan TS: Current studies on myofascial pain syndrome. Curr Pain Headache Rep 2009, 13:365–369. This review discusses the effects of interactions between excessive acetyl choline release, sarcomere shortening, and release of sensitizing substances that together sustain the positive cycle of pain in the trigger points.

    Article  PubMed  Google Scholar 

  40. Simons DG, Stolov WC: Microscopic features and transient contraction of palpable bands in canine muscle. Am J Phys Med 1976, 55:65–88.

    CAS  PubMed  Google Scholar 

  41. Reitinger A, Radner H, Tilscher H, et al.: Morphologic study of trigger points. Manuelle Med 1996, 34:256–262.

    Google Scholar 

  42. Quintner JL, Cohen ML: Referred pain of peripheral nerve origin: an alternative to the “myofascial pain” construct. Clin J Pain 1994, 10:243–251.

    Article  CAS  PubMed  Google Scholar 

  43. Vecchiet L, Vecchiet J, Giamberardino MA: Referred muscle pain: clinical and pathophysiologic aspects. Curr Rev Pain 1999, 3:489–498.

    PubMed  Google Scholar 

  44. Bahr R, Blumberg H, Jänig W: Do dichotomizing afferent fibers exist which supply visceral organs as well as somatic structures? A contribution to the problem of referred pain. Neurosci Lett 1981, 24:25–28.

    Article  CAS  PubMed  Google Scholar 

  45. Mense S: Considerations concerning the neurological basis of muscle pain. Can J Physiol Pharmacol 1991, 69:610–616.

    CAS  PubMed  Google Scholar 

  46. Mense S: Nociception from skeletal muscle in relation to clinical muscle pain. Pain 1993, 54:241–289.

    Article  CAS  PubMed  Google Scholar 

  47. Mense S: Referral of muscle pain: new aspects. Am Pain Soc J 1994, 3:1–9.

    Google Scholar 

  48. Mense S: Biochemical pathogenesis of myofascial pain. J Musculoskel Pain 1996, 4:145–162.

    Article  Google Scholar 

  49. Coderre TJ, Katz J, Vaccarino AI, Melzack R: Contribution of central neuroplasticity to pathological pain: review of clinical and experimental evidence. Pain 1993, 52:259–285.

    Article  CAS  PubMed  Google Scholar 

  50. Mense S: Pathophysiologic basis of muscle pain syndromes. Phys Med Rehabil Clin North Am 1997, 8:23–53.

    Google Scholar 

  51. • Brezinschek HP: Mechanisms of muscle pain: significance of trigger points and tender points. Z Rheumatol 2008, 67:653–654, 656–657. This paper showed that elevated levels of proinflammatory substances are present in the trigger point region that contribute to the pain through inflammatory and neural mechanisms.

  52. •• Lartigue AM: Patient education and self-advocacy. Myofascial pain syndrome: treatments. J Pain Palliat Care Pharmacother 2009, 23:169–170. This article addresses the importance of patient education and participation in the success of treatment plan.

    Article  PubMed  Google Scholar 

  53. Cummings TM, White AR: Needling therapies in the management of myofascial trigger point pain: a systematic review. Arch Phys Med Rehabil 2001, 82:986–992.

    Article  CAS  PubMed  Google Scholar 

  54. Yap EC: Myofascial pain: an overview. Ann Acad Med Singapore 2007, 36:43–48.

    PubMed  Google Scholar 

  55. Graff-Radford SB: Regional myofascial pain syndrome and headache: principles of diagnosis and management. Curr Pain Headache Rep 2001, 5:376–381.

    Article  CAS  PubMed  Google Scholar 

  56. •• Hong CZ: Treatment of myofascial pain syndrome. Curr Pain Headache Rep 2006, 10:345–349. This paper stresses the importance of determining and treating the underlying etiologic factors that have led to the activation of trigger points to achieve permanent inactivation.

    Article  PubMed  Google Scholar 

  57. Rothstein JM: Current, critical in-depth reviews of treatment literature by the Philadelphia Panel for Evidence Based Clinical Practice. Phys Ther 2001, 81:1620–1773.

    CAS  PubMed  Google Scholar 

  58. Simons DG, Mense S: Diagnosis and therapy of myofascial trigger points [in German]. Schmerz 2003, 17:419–424.

    Article  CAS  PubMed  Google Scholar 

  59. Lavelle ED, Lavelle W, Smith HS: Myofascial trigger points. Med Clin North Am 2007, 91:229–239.

    Article  PubMed  Google Scholar 

  60. Lavelle ED, Lavelle W, Smith HS: Myofascial trigger points. Anesthesiol Clin 2007, 25:841–851.

    Article  PubMed  Google Scholar 

  61. Vernon H, Schneider M: Chiropractic management of myofascial trigger points and myofascial pain syndrome: a systematic review of the literature. J Manipulative Physiol Ther 2009, 32:14–24.

    Article  PubMed  Google Scholar 

  62. Gerwin RD: A review of myofascial pain and fibromyalgia—factors that promote their persistence. Acupunct Med 2005, 23:121–134.

    Article  PubMed  Google Scholar 

  63. • Peloso P, Gross A, Haines T, et al.: Medicinal and injection therapies for mechanical neck disorders. Cochrane Database Syst Rev 2007, 18:CD000319. This review showed that there is strong evidence for the effectiveness of lidocaine injections.

  64. Borg-Stein J, Simons DG: Focused review: myofascial pain. Arch Phys Med Rehabil 2002, 83(3 Suppl 1):S40–S47, S48–S49.

    Google Scholar 

  65. Criscoulo CM: Interventional approaches to the management of myofascial pain syndrome. Curr Pain Headache Rep 2001, 5:407–411.

    Article  Google Scholar 

  66. Baldry P: Superficial versus deep dry needling. Acupuncture Med 2002, 20:78–81.

    Article  Google Scholar 

  67. • Scott NA, Guo B, Barton PM, Gerwin RD: Trigger point injections for chronic non-malignant musculoskeletal pain: a systematic review. Pain Med 2009, 10:54–69. This review confirmed the effectiveness of trigger point injections as a proven treatment.

    Article  PubMed  Google Scholar 

  68. Ho KY, Tan KH: Botulinum toxin A for myofascial trigger point injection: a qualitative systematic review. Eur J Pain 2007, 11:519–527.

    Article  CAS  PubMed  Google Scholar 

  69. Lang AM: Botulinum toxin therapy for myofascial pain disorders. Curr Pain Headache Rep 2002, 6:355–360.

    Article  PubMed  Google Scholar 

  70. Birch S, Jamison RN: Controlled trial of Japanese acupuncture for chronic myofascial neck pain: assessment specific and nonspecific effects of treatment. Clin J Pain 1998, 14:248–255.

    Article  CAS  PubMed  Google Scholar 

  71. Chu J: Dry needling (intramuscular stimulation) in myofascial pain related to lumbar radiculopathy. Eur J Phys Med Rehabil 1995, 5:106–121.

    Google Scholar 

  72. Melzack R: Myofascial trigger points: relation to acupuncture and mechanism of pain. Arch Phys Med Rehabil 1981, 62:114–117.

    CAS  PubMed  Google Scholar 

  73. Chu J, Schwartz I: The muscle twitch in myofascial pain relief: effects of acupuncture and other needling methods. Electromyogr Clin Neurophysiol 2002, 42:307–311.

    CAS  PubMed  Google Scholar 

  74. Esenyel M, Caglar N, Aldemir T: Treatment of myofascial pain. Am J Phys Med Rehabil 2000, 79:48–52.

    Article  CAS  PubMed  Google Scholar 

  75. •• Aguilera FJ, Martin DP, Masanet RA, et al.: Immediate effect of ultrasound and ischemic compression techniques for the treatment of trapezius latent myofascial trigger points in healthy subjects: a randomized controlled study. J Manipulative Physiol Ther 2009, 32:515–520. This study showed that ultrasound applied over trigger points is an effective treatment and leads to a decrease in the basal electrical activity of the trigger point and an increase in the active range of motion.

    Article  PubMed  Google Scholar 

  76. Gam AN, Warming S, Larsen LH, et al.: Treatment of myofascial trigger-points with ultrasound combined with massage and exercise: a randomized controlled trail. Pain 1998, 77:73–79.

    Article  CAS  PubMed  Google Scholar 

  77. •• Srbely JZ, Dickey JP: Randomized controlled study of the antinociceptive effect of ultrasound on trigger point sensitivity: novel application in myofascial therapy? Clin Rehabil 2007, 21:411–417. This study showed that ultrasound can be used as an effective tool in the treatment of myofascial trigger points.

    Article  PubMed  Google Scholar 

  78. •• Srbely JZ, Dickey JP, Lowerison M, et al.: Stimulation of myofascial trigger points with ultrasound induces segmental antinociceptive effects: a randomized controlled study. Pain 2008, 139:260–266. This study proves the immediate effects of ultrasound on the pain pressure threshold of the trigger points.

    Article  PubMed  Google Scholar 

  79. Majlesi J, Unalan H: High-power pain threshold technique in the treatment of active myofascial trigger points: A randomized, double-blind, case-control study. Arch Phys Med Rehabil 2004, 85:833–836.

    Article  PubMed  Google Scholar 

  80. •• Bahadir C, Majlesi J, Unalan H: The effect of high-power pain threshold ultrasound therapy on the electrical activity of trigger points and local twitch response on electromyography. A preliminary study. J Musculoskeletal Pain 2009, 17:162–172. This study showed the immediate effects of ultrasound applied in pain threshold intensities on the trigger points to decrease the electrical activity of the trigger points immediately.

    Article  Google Scholar 

Download references

Disclosures

No potential conflicts of interest relevant to this article were reported.

Author information

Authors and Affiliations

  1. Department of Physical Medicine and Rehabilitation, Cerrahpaşa Faculty of Medicine, Istanbul University, Çatalçeşme Sk, Şükür Apt, Bostancı, Istanbul, Turkey

    Javid Majlesi & Halil Unalan

Authors
  1. Javid Majlesi
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Halil Unalan
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Javid Majlesi.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Majlesi, J., Unalan, H. Effect of Treatment on Trigger Points. Curr Pain Headache Rep 14, 353–360 (2010). https://doi.org/10.1007/s11916-010-0132-8

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s11916-010-0132-8

Keywords

Search

Navigation