Skip to main content

Advertisement

SpringerLink
Log in

Clinical Implication of Latent Myofascial Trigger Point

  • Myofascial Pain (R Gerwin, Section Editor)
  • Published:
Current Pain and Headache Reports Aims and scope Submit manuscript

Abstract

Myofascial trigger points (MTrPs) are hyperirritable points located within a taut band of skeletal muscle or fascia, which cause referred pain, local tenderness and autonomic changes when compressed. There are fundamental differences between the effects produced by the two basic types of MTrPs (active and latent). Active trigger points (ATrPs) usually produce referred pain and tenderness. In contrast, latent trigger points (LTrPs) are foci of hyperirritability in a taut band of muscle, which are clinically associated with a local twitch response, tenderness and/or referred pain upon manual examination. LTrPs may be found in many pain-free skeletal muscles and may be “activated” and converted to ATrPs by continuous detrimental stimuli. ATrPs can be inactivated by different treatment strategies; however, they never fully disappear but rather convert to the latent form. Therefore, the diagnosis and treatment of LTrPs is important. This review highlights the clinical implication of LTrPs.

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

Similar content being viewed by others

References

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

  1. Cakit BD, Taskin S, Nacir B, et al. Comorbidity of fibromyalgia and cervical myofascial pain syndrome. Clin Rheumatol. 2010;29(4):405–11.

    Article  PubMed  Google Scholar 

  2. Simons DG. Review of enigmatic MTrPs as a common cause of enigmatic musculoskeletal pain and dysfunction. J Electromyogr Kinesiol. 2004;14(1):95–107.

    Article  PubMed  Google Scholar 

  3. Zhang Y, Ge HY, Kimura Y, et al. Attenuated skin blood flow response to nociceptive stimulation of latent myofascial trigger points. Arch Phys Med Rehabil. 2009;90:325–32.

    Article  PubMed  Google Scholar 

  4. Simons D, Travell J, Simons L. Myofascial pain and dysfunction: the trigger point manual. Baltimore: Williams And Wilkins; 1999.

    Google Scholar 

  5. Bennett R. Myofascial pain syndromes and their evaluation. Best Pract Res Clin Rheumatol. 2007;21(3):427–45.

    Article  PubMed  Google Scholar 

  6. Hong CZ, Simons DG. Pathophysiologic and electrophysiologic mechanisms of Myofascial Trigger Points. Arch Phys Med Rehabil. 1998;79:863–72.

    Article  PubMed  CAS  Google Scholar 

  7. Gerwin RD, Dommerholt J, Shah JP. An expansion of Simons' integrated hypothesis of trigger point formation. Curr Pain Headache Rep. 2004;8:468–75.

    Article  PubMed  Google Scholar 

  8. McPartland JM, Simons DG. Myofascial trigger points: translating molecular theory into manual therapy. J Man Manipulative Ther. 2006;14:232–9.

    Article  Google Scholar 

  9. Gunn C. Radiculopathic pain: diagnosis and treatment of segmental irritation or sensitization. J Musculoskelet Pain. 1997;5:119–34.

    Article  Google Scholar 

  10. Simons DG, Hong CZ, Simons L. End plate potentials are common to mid fiber myofascial trigger points. Am J Phys Med Rehabil. 2002;81:212–22.

    Article  PubMed  Google Scholar 

  11. • Ge HY, Arendt Nielsen L. Latent myofascial trigger points. Curr Pain Headache Rep. 2011;15(5):386–92. This article highlights the potential mechanisms associated with LTrPs.

    Article  PubMed  Google Scholar 

  12. • Trampas A, Kitsios A, Sykaras E, et al. Clinical massage and modified Proprioceptive Neuromuscular Facilitation stretching in males with latent myofascial trigger points. Phys Ther Sport. 2010;11(3):91–8. This article include some teratment protocols for LTrPs.

    Article  PubMed  Google Scholar 

  13. • 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(7):515–20. This is a good literature that shows time, duration and application of ischemic compression.

    Article  PubMed  Google Scholar 

  14. Grieve R, Clark J, Pearson E, et al. The immediate effect of soleus trigger point pressure release on restricted ankle joint dorsiflexion: a pilot randomised controlled trial. J Bodyw Mov Ther. 2011;15:42–9.

    Article  PubMed  Google Scholar 

  15. Ge HY, Arendt-Nielsen L, Madeleine P. Accelerated muscle fatigability of latent myofascial trigger points in humans. Pain Med. 2012;13(7):957–64.

    Article  PubMed  Google Scholar 

  16. Ge HY, Zhang Y, Boudreau S, et al. Induction of muscle cramps by nociceptive stimulation of latent myofascial trigger points. Exp Brain Res. 2008;187(4):623–9.

    Article  PubMed  Google Scholar 

  17. • Xu YM, Ge HY, Arendt-Nielsen L. Sustained nociceptive mechanical stimulation of latent myofascial trigger point induces central sensitization in healthy subjects. J Pain. 2010;11(12):1348–55. This article include evidence that sustained nociceptive mechanical stimulation of LTrPs produce mechanical hyperalgesia.

    Article  PubMed  Google Scholar 

  18. •• Lucas KR, Rich PA, Polus BI. Muscle activation patterns in the scapular positioning muscles during loaded scapular plane elevation: the effects of Latent Myofascial Trigger Points. Clin Biomech (Bristol, Avon). 2010;25(8):765–70. This is very important article that shows LTrPs changes muscle activation patterns.

    Article  Google Scholar 

  19. Sola AE, Rodenberger ML, Gettys BB. Incidence of hypersensitive areas in posterior shoulder muscles; a survey of two hundred young adults. Am J Phys Med. 1955;34:585–90.

    PubMed  CAS  Google Scholar 

  20. Sciotti VM, Mittak VL, DiMarco L, et al. Clinical precision of myofascial trigger point location in the trapezius muscle. Pain. 2001;93:259–66.

    Article  PubMed  CAS  Google Scholar 

  21. Wade R. Trigger points in the upper trapezius or normal subtrapezial anatomy? Physiother Can. 2001;53:219–22.

    Google Scholar 

  22. Fischer AA. Pressure algometry over normal muscles. Standard values, validity and reproducibility of pressure threshold. Pain. 1987;30:115–26.

    Article  PubMed  CAS  Google Scholar 

  23. •• Lucas KR, Rich PA, Polus BI. How common are latent myofascial trigger points in the scapular positioning muscles. J Musculoskelet Pain. 2008;16:279–86. This is very important article that shows prevelance of LTrPs.

    Article  Google Scholar 

  24. Celik D, Kaya Mutlu E. The relationship between latent trigger points and depression levels in healthy subjects. Clin Rheumatol. 2012;31(6):907–11.

    Article  PubMed  Google Scholar 

  25. Bron C, Franssen J, Wensing M, Rob AB. Interrater reliability of palpation of myofascial trigger points in three shoulder muscles. J Man Manip Ther. 2007;15:203–15.

    Article  PubMed  Google Scholar 

  26. Fernandez-de-las-Penas C, Alonso-Blanco C, Fernandez-Carnero J, Miangolarra-Page JC. The immediate effect of ischemic compression technique and transverse friction massage on tenderness of active and latent myofascial trigger points: a pilot study. J Bodyw Mov Ther. 2006;10:3–9.

    Article  Google Scholar 

  27. Lew PC, Lewis J, Story I. Inter-therapist reliability in locating latent myofascial trigger points using palpation. Man Ther. 1997;2(2):87–90.

    Article  PubMed  Google Scholar 

  28. Chesterton LS, Sim J, Wright CC, et al. Interrater reliability of algometry in measuring pressure pain thresholds in healthy humans, using multiple raters. Clin J Pain. 2007;23(9):760–6.

    Article  PubMed  Google Scholar 

  29. Kamen G et al. Electromyographic kinesiology. In: Robertson DGE, editor. Research Methods in Biomechanics. Champaign: Human Kinetics Publ; 2004.

    Google Scholar 

  30. Hubbard DR, Berkoff GM. Myofascial trigger points show spontaneous needle EMG activity. Spine (Phila Pa 1976). 1993;18(13):1803–7.

    Article  CAS  Google Scholar 

  31. Ibarra JM, Ge HY, Wang C, et al. Latent myofascial trigger points are associated with an increased antagonistic muscle activity during agonist muscle contraction. J Pain. 2011;12(12):1282–8.

    Article  PubMed  Google Scholar 

  32. Kimura Y, Ge HY, Zhang Y, et al. Evaluation of sympathetic vasoconstrictor response following nociceptive stimulation of latent myofascial trigger points in humans. Acta Physiol. 2009;196:411–7.

    Article  CAS  Google Scholar 

  33. Muller W, Stratz T. Local treatment of tendinopathies and myofascial pain syndromes with the 5-HT3 receptor antagonist tropisetron. Scand J Rheumatol Suppl. 2004;119:44–8.

    Article  PubMed  CAS  Google Scholar 

  34. Gerwin R. Botulinum toxin treatment of myofascial pain: a critical review of the literature. Curr Pain Headache Rep. 2012;16(5):413–22.

    Article  PubMed  Google Scholar 

  35. Cummings TM, White AR. Needling therapies in the management of myofascial trigger point pain: a systematic review. Arch Phys Med Rehabil. 2001;82(7):986–92.

    Article  PubMed  CAS  Google Scholar 

  36. Vulfsons S, Ratmansky M, Kalichman L. Trigger point needling: techniques and outcome. Curr Pain Headache Rep. 2012;16(5):407–12.

    Article  PubMed  Google Scholar 

  37. Chen JT, Chung KC, Hou CR, et al. Inhibitory effect of dry needling on the spontaneous electrical activity recorded from myofascial trigger spots of rabbit skeletal muscle. Am J Phys Med Rehabil. 2001;80(10):729–35.

    Article  PubMed  CAS  Google Scholar 

  38. Fryer G, Hodgson L. The effect of manual pressure release on myofascial trigger points in the upper trapezius muscle. J Bodyw Mov Ther. 2005;9(4):248–55.

    Article  Google Scholar 

  39. Kuan TS, Wu CT, Chen S, et al. Manipulation of the cervical spine to release pain and tightness caused by myofascial trigger points. Arch Phys Med Rehabil. 1997;78:1042.

    Google Scholar 

  40. Ruiz-Saez M, Fernandez-de-las-Penas C, Blanco CR, et al. Changes in pressure pain sensitivity in latent myofascial trigger points in the upper trapezius muscle after a cervical spine manipulation in pain-free subjects. J Manip Physiol Ther. 2007;30:578–83.

    Article  Google Scholar 

  41. • Oliveira-Campelo NM, Rubens-Rebelatto J, Martí N-Vallejo FJ, et al. The immediate effects of atlanto-occipital joint manipulation and suboccipital muscle inhibition technique on active mouth opening and pressure pain sensitivity over latent myofascial trigger points in the masticatory muscles. J Orthop Sports Phys Ther. 2010;40(5):310–7. This is a good article shows the immediate effect of joint manipulation on pressure pain sensitivity over LTrPs.

    PubMed  Google Scholar 

  42. Jones LN. Strain and counterstrain. Newark: American Academy of Osteopathy; 1981.

    Google Scholar 

  43. Dardzinski JA, Ostrov BE, Hamann LS. Myofascial pain unresponsive to standard treatment. Successful use of a strain and counterstrain technique with physical therapy. J Clin Rheumatol. 2000;6:169–74.

    Article  PubMed  CAS  Google Scholar 

  44. Atienza-Meseguer A, Fernández-de-las-Peñas C, Navarro Poza JL, et al. Immediate effects of the strain/counter-strain technique in local pain evoked by tender points in the upper trapezius muscle. Clin Chiropr. 2006;9:112–8.

    Article  Google Scholar 

  45. Rodríguez Blanco C, de las Peñas CF, Hernández Xumet JE, et al. Changes in active mouth opening following a single treatment of latent myofascial trigger points in the masseter muscle involving post-isometric relaxation or strain/counterstrain. J Bodyw Mov Ther. 2006;10:197–205.

    Article  Google Scholar 

  46. Ibáñez-García J, Alburquerque-Sendín F, Rodríguez-Blanco C, et al. Changes in masseter muscle trigger points following strain-counterstrain or neuro-muscular technique. J Bodyw Mov Ther. 2009;13(1):2–10.

    Article  PubMed  Google Scholar 

  47. Wang YH, Ding XL, Zhang Y, et al. Ischemic compression block attenuates mechanical hyperalgesia evoked from latent myofascial trigger points. Exp Brain Res. 2010;202(2):265–70.

    Article  PubMed  Google Scholar 

  48. Hong CZ, Chen YC, Pon CH, Yu J. Immediate effects of various physical medicine modalities on pain threshold of an active myofascial trigger point. J Musculoskelet Pain. 1993;1:3–58.

    Article  Google Scholar 

  49. Chaitow L. Muscle energy techniques. 2nd ed. Edinburgh: Churchill Livingstone; 2001.

    Google Scholar 

  50. Lewit K, Simons DG. Myofascial pain: relief by postisometric relaxation. Arch Phys Med Rehabil. 1984;65:452–6.

    PubMed  CAS  Google Scholar 

  51. Baldry PE. Neurophysiological pain-suppressing effects of acupuncture and TENS. In: Baldry PR, editor. Acupuncture, Trigger Points and Musculoskeletal Pain. Edinburgh: Churchill Livingstone; 2005.

    Google Scholar 

  52. Hsueh TC, Cheng PT, Kuan TS, Hong CZ. The immediate effectiveness of electrical nerve stimulation and electrical muscle stimulation on myofascial trigger points. Am J Phys Med Rehabil. 1997;76:471–6.

    Article  PubMed  CAS  Google Scholar 

  53. Hou CR, Tsai LC, Cheng KF, Chung KC, Hong CZ. Immediate effects of various physical therapeutic modalities on cervical myofascial pain and trigger-point sensitivity. Arch Phys Med Rehabil. 2002;83:1406–14.

    Article  PubMed  Google Scholar 

  54. • Gemmell H, Hilland A. Immediate effect of electric point stimulation (TENS) in treating latent upper trapezius trigger points: a double blind randomised placebo-controlled trial. J Bodyw Mov Ther. 2011;15(3):348–54. This is the first study showing the electric point stimulation effects of LTrPs.

    Article  PubMed  Google Scholar 

  55. • Rodríguez-Fernández AL, Garrido-Santofimia V, Güeita-Rodríguez J, Fernández-de-Las-Peñas C. Effects of burst-type transcutaneous electrical nerve stimulation on cervical range of motion and latent myofascial trigger point pain sensitivity. Arch Phys Med Rehabil. 2011;92(9):1353–8. This article offers an important information for using TENS for treatment of LTrPs.

    Article  PubMed  Google Scholar 

  56. Majlesi J, Unalan H. High-power pain threshold ultrasound technique in the treatment of active myofascial trigger points: a randomized, double-blind, case–control study. Arch Phys Med Rehabil. 2004;85(5):833–6.

    Article  PubMed  Google Scholar 

  57. Srbely JZ, Dickey JP. Randomized controlled study of the antinociceptive effect of ultrasound on trigger point sensitivity: novel applications in myofascial therapy. Clin Rehabil. 2007;21(5):411–7.

    Article  PubMed  Google Scholar 

  58. • Sarrafzadeh J, Ahmadi A, Yassin M. The effects of pressure release, phonophoresis of hydrocortisone, and ultrasound on upper trapezius latent myofascial trigger point. Arch Phys Med Rehabil. 2012;93(1):72–7. This article include some teratment protocols for LTrPs.

    Article  PubMed  Google Scholar 

  59. 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(1):14–24.

    Article  PubMed  Google Scholar 

Download references

Compliance with Ethics Guidelines

Conflict of Interest

Dr. Derya Celik reported no potential conflicts of interest relevant to this article.

Dr. Ebru Kaya Mutlu reported no potential conflicts of interest relevant to this article.

Human and Animal Rights and Informed Consent

This article does not contain any studies with human or animal subjects performed by any of the authors.

Author information

Authors and Affiliations

  1. Faculty of Health Sciences, Division of Physiotherapy and Rehabilitation, Istanbul University, Istanbul, Turkey

    Derya Celik & Ebru Kaya Mutlu

  2. Saglık Bilimleri Fakultesi, Fizyoterapi ve Rehabilitasyon Bolumu, Istanbul Universitesi, Demirkapı Cad. Karabal Sok, 34740, Bakırkoy, Istanbul, Turkey

    Derya Celik & Ebru Kaya Mutlu

Authors
  1. Derya Celik
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Ebru Kaya Mutlu
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Derya Celik.

Additional information

This article is part of the Topical Collection on Myofascial Pain

Rights and permissions

Reprints and permissions

About this article

Cite this article

Celik, D., Mutlu, E.K. Clinical Implication of Latent Myofascial Trigger Point. Curr Pain Headache Rep 17, 353 (2013). https://doi.org/10.1007/s11916-013-0353-8

Download citation

  • Published:

  • DOI: https://doi.org/10.1007/s11916-013-0353-8

Keywords

Search

Navigation