Myofascial Trigger Point and Treatment

What separates Kulp Physical Therapy and Massage from other physical therapy clinics is our unique treatment of the myofascial trigger point. The Myofascial trigger point can be defined as a abnormal muscle condition characterized by a taut band (a hardened strip of muscle) with a hyperirritable nodule (the trigger point). It has three other characteristics in its definition, 1) It has a local or referred sensation, 2) This trigger point, and it's pain or abnormal sensation is recognized by the patient as part of their symptom, 3) and there is a restricted range of motion within the muscle. These are the primary features of a myofascial trigger point. There are other major characteristics that may accompany a trigger point. These include a twitch response, (contraction of the muscle when stimulated), muscle weakness, muscle stiffness, a jump sign, abnormal peripheral and central nervous system sensitivity which include allodynia, (pain from a sensation that is not normally painful), hyperalgesia, (increased pain response to normal painful stimulus).

Common causes of myofascial trigger points include direct trauma to the muscle, and repetitive muscle contraction. A variety of medical conditions can cause the myofascial trigger point including hormonal, nutritional, (including vitamin and mineral deficiencies) and infectional diseases. Ergonomic factors and structural factors can also be a cause. Ergonomic factors include abnormal postures and postural stressors, repetitive activities, activity related stresses (keyboarding) and recreational activities. Structural factors include scoliosis, leg length discrepancies, pelvic and sacroiliac dysfunctions and joint dysfunctions, (vertebral and extremity).

Now that we understand what a trigger point is, let's talk about how to treat this muscle condition. First you need to undergo an evaluation by the physical therapist, which includes both medical and physical histories. The physical therapist will then evaluate your musculoskeletal status looking at your posture, range of motion of your joints, strength of your muscles, and how you move your limbs and body.

Special tests may also be conducted to help the therapist into diagnosing your disorder, and how a myofascial trigger point is involved. The evaluation of the trigger point starts with palpation either by a flat or pincer palpation technique. This skill of the therapist is inherently important in defining whether you have a trigger point or just a sore spot on your muscle. (Kulp Physical Therapy and Massage has 2 physical therapists who have achieved manual certification in the technique of trigger point treatment. They have over 31 years experience in treating patients with these muscle conditions). Now that we've identified where your trigger points are the physical therapist will look to other muscles in the functional unit that controls the specific movements that this particular muscle that has a trigger point is associated with. Once all your trigger points have been identified, the physical therapist will treat them. Treatment will include direct compression of the trigger point, which will start to immediately reduce the trigger point. Once the trigger point is reduced the physical therapist will then stretch out the muscle in a way that is unique trigger point treatment and necessary in more effectively eliminating the trigger point. Now that your trigger points are reduced, the physical therapist will teach you stretching and conditioning exercises that you will do at home to keep your trigger point reduced. Modalities may also be used to enhance blood flow back into the muscle thus bringing health back in the muscle. The physical therapist will also talk to you about perpetuating factors that need to be reduced in order to keep the trigger point from redeveloping.

Kulp Physical Therapy and Massage is the only physical therapy practice in western New York with Travell Manually Certified Physical Therapist. Janet Travell, M.D. was a pioneer in the understanding of myofascial trigger points and their treatment. The Myopain Institute, (, is the foremost international myofascial training center in the United States and has continued Janet Travell's philosophies. Contact the Myopain website for additional articles on Myofascial trigger points.