Search:     


Myofascial Pain Syndrome (MPS) and the role of the Occupational Therapist in Trigger Point (TP) Therapy

Voluntary (skeletal) muscle is the largest single organ of the human body and accounts for 40% or more of body weight. The Nomina Anatomica reported by the International Anatomical Nomenclature Committee under the Berne Convention lists 200 paired muscles, or a total of 400 muscles.

Any of these 400 muscles can develop myofascial trigger points (TPs) that refer pain and other distressing symptoms, usually to a remote location. These TPs are very common, since contractile muscles tissues and the overlying fascia are extremely subject to the wear and tear of activities of daily living (ADL). They often become a distressing part of nearly everyone's life at one point or another.

Etiology:

Whatever the etiological factors are, it seems that trigger point development may be a progressive process, with a stage of neuromuscular dysfunction of muscle hyperirritability that is sustained by numerous perpetuating or contributing factors. This is then followed by a stage of organic dystrophic changes in the muscle bands with the presence of trigger points.

TPs and ADL:

It is quite impossible to list specific activities that heighten the chances of muscles developing TPs. Suffice it to say that activities that are highly repetitive in nature, work that puts the body in awkward or prolonged static postures and lifestyles that are sedentary or stressful are likely to bring about TPs. A few examples of such activities / lifestyles include production assembly line type of work, driving, household chores, marking assessments, being a couch potato or having stresses that are likely to cause muscles to tighten as in needing to meet tight deadlines constantly.

Over a period of time, as mentioned earlier, muscles and their overlying structures are subjected to wear and tear. And consequently, tension headaches, stiffness in the neck, shoulders and other joints develop. Collectively, they are known as myofascial
pain syndrome.

Definitions:

Myofascial pain syndrome is defined as a muscular pain disorder involving regional pain referred by trigger points localized within the myofascial structures or distant from the pain sites.

Trigger points or TPs have been classified empirically as active and "latent". An active TP has been defined as an area of tenderness on palpation in the taut band of a muscle, causing referred pain similar to the patient's spontaneous pain complaint. Additionally, a local twitch response should also be visible on manual palpation of the tender spot. A latent trigger point has all of the above characteristics, except for absence of the referred pain.

Clinical features:

Symptoms of myofascial pain syndrome include regional pain, mostly in the neck, shoulders, upper extremities, facial area, low back, and also in the extremities. Studies have shown that besides pain, other symptoms included headaches, dizziness, poor sleep, edema, stiff joints, tinnitus, fatigue, paresthesia, nausea and even constipation. Furthermore, tension, emotional stress, lack of or over rigorous exercise aggravated these pain symptoms.

Therapeutic / Rehabilitative Assessment & Management (Trigger Point Therapy):

1. Demographics : gender and age
2. Medical History
3. Work & social history : e.g. job description, leisure & sports (recognition of contributing factors)
4. Ergonomic advice : postural correction, adopting correct postures for certain tasks, tasks rotation and variation, appropriate duration and postures for PC usage, organization of work station and office ergonomics
5. Evaluation of myofascial pain : location of trigger points, range of motion of involved joints
6. Heat therapy : hotpacks applied to the muscles e.g. neck, shoulders and upper back for a period of time to alleviate soreness and muscle tension to increase range of motion
7. Stress Management : relaxation techniques such as progressive muscle relaxation, deep / diaphragmatic breathing exercises, exploration of stress factors, leisure exploration and job modification
8. Counterstimulation : ischaemic muscular compression (some liken it to acupressure), massage, muscle stretching and movement of body parts through active and passive range of motion. Other forms of counterstimulation include a) spray-and-stretch, such as fluorimethane followed by passive stretching of the involved muscle b) trigger point injection with local anesthetics such as 3% chlorpromazine and 5% procaine

Relief is more likely to be lasting when the patient moves all of the treated muscles through several cycles of their full range of motion. The goal is to restore the muscle to normal length, posture, and full joint range of motion.

Preventing the redevelopment of a trigger point includes maintaining the exercise program and controlling all contributing factors that initiate and perpetuate the development and persistence of trigger points and the resulting chronic pain.

For some patients, working with the occupational therapist on just regulating or controlling the contributing factors such as stress levels, practicing tasks rotation and variation, leisure exploration and eventual participation are sufficient to alleviate symptoms.


- BACK TO LIBRARY