TRIGGER POINT: TRIGGER POINT By Amrit kaur Asst professor Ndmvp college of physiotherapy nashik CONTENT: CONTENT DEFINITION CAUSES CHARACTERISTICS TYPES PATHOPHYSIOLOGY TREATMENT PowerPoint Presentation: A myofascial trigger point is defined as "a hyperirritable spot, usually within a taut band of skeletal muscle or in the muscle fascia, that is painful on compression and that can give rise to characteristic referred pain, tendereness , and autonomic phenomena" CAUSES: CAUSES Direct stimuli acute overload Overwork fatigue Chilling Gross trauma Pain reference zone Indirect stimuli Heart, gall bladder and other visceral disease Arthritic joints CHARACTERISTICS: CHARACTERISTICS STAR Sensitivity (or tenderness) Tissue texture changes Asymmetry Range of motion reduced TYPES: TYPES CENTRAL TRIGGER POINT A hyperirritable spot in skeletal muscle that is associated with a hypersensitive palpable nodule in a taut band. ATTACHMENT TRIGGER POINT A trigger point at the musculotendinous junction and/or at the osseous attachment of the muscle that identifies the enthesopathy caused by unrelieved tension characteristic of the taut band that is produced by a central trigger point. CENTRAL TRIGGER POINT: CENTRAL TRIGGER POINT Forms in the center of the muscle Due to dysfunctional endplate activity A metabolic crisis occur and actelycholine is excessively released at the synapse, usually associated with the overuse or strain, leading to release of calcium. The resulting ischemia in the area creates an oxygen/ nutrient deficit and a local energy crisis PowerPoint Presentation: Without available ATP, the calcium, which are keeping the gates open for Ach to keep flowing, cannot be removed. A chemically sustained contracture occur. A contracture knot forms. The remaining sarcomeres of that fiber are stretched, creating the taut band, which is usually palpable. ATTACHMENT TRIGGER POINT: ATTACHMENT TRIGGER POINT Forms at juncture of myofascial and tendinous or periosteal tissues. Tension from taut band on periosteal or connective tissue leads to concentration of muscular stress leads to inflammation,with strong tendency towards subsequent fibrosis and calcific deposition . TREATMENT CHOICES FOR CENTRAL POINTS: TREATMENT CHOICES FOR CENTRAL POINTS Elongation of the tissue to full length. Deep friction massage Reciprocal inhibition and post isometric relaxation. Heat Ultrasound Digital ischemic pressure TREATMENT TECHNIQUES FOR ATTACHMENT TRIGGER POINT: TREATMENT TECHNIQUES FOR ATTACHMENT TRIGGER POINT Ice Gliding technique Elongation of the tissue REFRENCES : REFRENCES Baldry p: Accupuncture trigger point and musculoskeletal pain, 1993: churchill livingstones, Edinburg. Chaitlow L, Bradley D, Gilbert C: clinical application of neuromuscular techniques: vol 2; churchill livingstones, Edinburg.