ChiroACCESS Clinical Review



Myofascial Pain Syndromes: Prevention

This information is provided to you for use in conjunction with your clinical judgment and the specific needs of the patient.

Lead Author(s): 

Dwain M. Daniel, D.C.

  

How this evidence was rated:

Strength of Recommendation Taxonomy (SORT)



Published on

September 2, 2007

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During the 1930s and 40s, 3 researchers, working independently in Germany, Australia, and the United States, established myofascial trigger points (MTrPs) as commonly occurring pain generators (1). Of these Janet Travell, M.D., emerged as the best known proponent of treating and reducing MTrPs in order to eliminate muscular pain in many patients. David Simons, M.D., collaborated with Travell for well over 20 years and has now assumed the role of chief proponent and investigator of myofascial pain syndrome. Although MTrPs have been identified and studied for nearly 70 years and many physicians and researchers acknowledge their role in pain, universal acceptance is still lacking (2). For the most part the scientific literature relating to risk factors and prevention has been limited to expert opinion, tradition and consensus. The source for most of the risk factors and prevention strategies mentioned below are from the Travell & Simons seminal text, The Trigger Point Manual (3) and repeated by numerous other authors (4-7) in the scientific literature (Gerwin Article, Edwards Article).

In order to understand risk factors, it may be helpful to understand the evolving hypothesis relating to the etiology of MTrPs. The second edition of The Trigger Point Manual (2) proposed a new model that postulated the neuromuscular junction as key to the formation of MTrPs. According to this hypothesis, excessive release of acetylcholine at the motor endplate causes spontaneous electrical activity which ultimately results in the development of MTrPs. Subsequent work proposed a motor, sensory and autonomic component and expanded the endplate hypothesis (8). According to this hypothesis a variety of factors can result in increased release of acetylcholine and should be considered as risk factors.

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References

1. 

Wilson VP. Janet G. Travell, MD: a daughter's recollection. Tex Heart Inst J 2003;30(1):8-12.



2. 

Bohr T. Problems with myofascial pain syndrome and fibromyalgia syndrome. Neurology 1996 Mar;46(3):593-7.



3. 

Travell J, Simons D. Travell & Simons' myofascial pain and dysfunction : the trigger point manual Volume 1. Upper half of body. 2 ed. Baltimore: Williams & Wilkins; 1999.



4. 

Alvarez DJ, Rockwell PG. Trigger points: diagnosis and management. Am Fam Physician 2002 Feb 15;65(4):653-60.



5. 

Edwards J. The importance of postural habits in perpetuating myofascial trigger point pain. Acupunct Med 2005 Jun;23(2):77-82.



6. 

Gerwin RD. A review of myofascial pain and fibromyalgia--factors that promote their persistence. Acupunct Med 2005 Sep;23(3):121-34.



7. 

Treaster D, Marras WS, Burr D, Sheedy JE, Hart D. Myofascial trigger point development from visual and postural stressors during computer work. J Electromyogr Kinesiol 2006 Apr;16(2):115-24.



8. 

McPartland JM. Travell trigger points--molecular and osteopathic perspectives. J Am Osteopath Assoc 2004 Jun;104(6):244-9.



9. 

Edwards J. The importance of postural habits in perpetuating myofascial trigger point pain. Acupunct Med 2005 Jun;23(2):77-82.



10. 

Fernandez-de-Las-Penas C, Cuadrado ML, Pareja JA. Myofascial trigger points, neck mobility, and forward head posture in episodic tension-type headache. Headache 2007 May;47(5):662-72.



11. 

Moore MK. Upper crossed syndrome and its relationship to cervicogenic headache. J Manipulative Physiol Ther 2004 Jul;27(6):414-20.



12. 

Henneman E, Sojen G, Carpenter DO. Excitability and inhibitability of motorneurons of different sizes. Journal of Neurophysiology 1965;28:599-620.



13. 

Treaster D, Marras WS, Burr D, Sheedy JE, Hart D. Myofascial trigger point development from visual and postural stressors during computer work. J Electromyogr Kinesiol 2006 Apr;16(2):115-24.



14. 

Chen C, Chen JT, Kuan TS, Hong CZ. Decrease in pressure pain thresholds of latent myofascial trigger points in the middle finger extensors immediately after continuous piano playing. J Musculoskeletal Pain 2007;8(3):83-92.



15. 

Anderson JH, Kaergaard A, Rasmssen K. Myofascial pain in different occupational groups with monotonus repetitive work (Abstract). Journal of Musculoskeletal Pain 1995;3 (Suppl1):57.



16. 

Dommerholt J, Bron C, Franssen J. Myofascial trigger points: An evidnce-informed review. Journal of Manual and Manipulative Therapy 2006 Jan 1;14(4):203-21.



17. 

Dommerholt J, Bron C, Franssen J. Myofascial trigger points: An evidnce-informed review. Journal of Manual and Manipulative Therapy 2006 Jan 1;14(4):203-21.



18. 

Gerwin RD. A review of myofascial pain and fibromyalgia--factors that promote their persistence. Acupunct Med 2005 Sep;23(3):121-34.



19. 

Thompson B. Neuromuscular massage therapy perspective. Journal of Bodywork and Movement Therapies 2001 Jan 1;5(4):229-34.



20. 

Simons DG. Understanding effective treatments of myofascial trigger points. Journal of Bodywork and Movement Therapies 2002 Jan 1;6(2):95-107.