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^{TRIGGER POINT THERAPY}

^{Myofascial Trigger point can cause intense pain and reduce quality of life.}

^{What are trigger points?}

^{A trigger point is simply tight muscle which is pain and spasm The stiffness or tight may feel a pea buried deep in the muscle It maintains a hard contraction on the muscle fibers connected to it, thus causing a tight band that can also be felt in the muscle These trigger points in muscles can result in restrictions on movements – for example the neck may not be able to turn freely and fully.}

^{Common physical pain or myofascial muscles pain conditions includes:}

^headaches
^{neck pain}
^{stiff neck}
^{lower back pain}
^{knee pain}
^{work injury}
^{frozen shoulder}
^{shoulder pain}
^fibromyalgia
^stiffness
^{knee pain}
^{carpal tunnel syndrome}
^{myofascial pain}

^{What does this referred pain feel like?}

^{Americian Physicians Travell Janet and David coined referred pain caused by trigger points is usually steady, dull and aching It is often a deep pain It may occur at rest, or only on movement The intensity of this pain varies from mild discomfort to severe and chronic myofascial pain.}

^{Are trigger points the same as a muscle spasm, strain or tear?}

^{No, a trigger point is not the same as a muscle spasm A spasm involves a violent contraction of the whole muscle A strain or stress involves physical damage to the muscle or tendon fibres. In contrast, a trigger point is a contraction or hardening in only a fascial or soft tissues structure.}

^{Are Trigger points common?}

^{Myofascial trigger points are among the most common and et often neglected and inadequately managed i.e. causes of musculoskeletal pain seen in medical practice. Unfortunately, many general practitioners do not know about trigger points, as trigger points do not show on X-rays or scans}

^{What other symptoms may trigger points cause?}

^{Apart from pain, trigger points may cause numbness, tingling, weakness, or lack of normal range of movement. Myofascial pain can also cause trigger point pain down to your back,shoulde neck and arm and legs.}

^{How did I know where to find trigger points?}

^{Fortunately, referred pain occurs in predictable patterns, which have been clearly mapped out in The Trigger Point Manual by David Simons, MD, and Janet Travell, MD. Using their maps, a trigger point massage therapist or myotherapist would know which areas to search for the trigger points that characteristically send pain to the place where you are hurting.The skilled hands of a trigger massage therapist can locate trigger points to deactivate or release the pain using physical manual techniques.to achieve pain relief.}

^{Could more than one trigger point be causing my problem?}

^{Trigger points tend to gang together So in practice, it is common to find more than one trigger point in the tight muscle, and more than one muscle whose trigger points refer pain to the area where you are hurting.All the trigger points need to be hunted out and treated by a trigger point massage therapist before you will gain full pain relief}

^{What causes trigger points to develop?}

^{All of us develop tight bands in our muscles as we age, but for various reasons, some people have more than others. Some of these tight bands go on to develop trigger points in them, when one or more ‘precipitating factors' arise For example, a trigger point may develop following an acute muscular strain such as during a car accident, a fall, a sprain or fracture, or during excessive or unusual exerciseTrigger points may also develop from poor posture because of poor sitting, working or sleeping habits This is because poor, imbalanced posture causes chronic overload of the muscles. In addition, trigger points may arise due to repetitive work strain or stress.}

^{Could poor general health worsen trigger points?}

^{Particularly if your trigger point pain has been persisting for a while, it is very likely that one or more of the following ‘perpetuating factors' is present:}

^{Mechanical stresses such as strain , poor posture, work stress}
^{Nerve root pressure, eg sciatica}
^{Chronic internal diseases, and some prescription medications}
^{Nutritional deficiencies, especially vitamins C, B-complex and iron deficiencies}
^{Hormonal imbalances – low thyroid hormone levels, premenstrual or menopausal}
^{Infections – bacterial, viral or yeast}
^{Allergies – particularly to wheat and dairy products}
^{Poor oxygenation of tissues – aggravated by tension, stress, inactivity, poor sleep, smoking, etc}
^{Chronic fatigue syndrome and fibromyalgia also predispose one to develop trigger points}

^{These factors MUST be detected and corrected if specific treatment of the trigger points is to be successful or lasting Your trigger point massage therapist will spend some time sorting these out with you}

^{How long will it take for the pain take to go away?}

^{With trigger points of recent onset, a skilled trigger point massage therapist is often able to bring about significant pain relief in just minutesAs for acute problems, most can be eliminated within 5 to 10 treatment sessionsHowever, longer-standing chronic conditions are more complex and less responsive to treatment Nonetheless, some of these problems can be cleared in as little as six weeks: IF you persist with treatment by a trigger point massage therapist, and IF you fix the perpetuating factors that the therapist identified}

^{What is the treatment approach?}

^{The myotherapist will adopt Doctor Janet Travell myofascial trigger point therapy approach to diagnose and treat trigger points. This approach de-emphasises medications,pain killers , therapy in favour of natural physical manual therapy.}

^{Intake consultation}
^{Pain Mapping}
^{Physical Examination}
^{Trigger Point Examination}
^{Report of Examination}
^{Myofascial Trigger Point Treatment}
^{Myofascial Release or Manual Therapy}
^{Personalised Stretching}
^{Correction of Perpectuating Factors i.e. biochemical,poor structure}
^{Patient Education programe}
^{Evalution and follow-up}

^{The myofascial trigger point massage therapist has to become part of the healing process for patient. he myotherapist will listen closely to the patient's description of pain and confirm their reality.}

^{The myotherapist will also work with other health care professional in the medical community as a team to manage patients' pain conditions The interdisciplinary nature of this approach would effectively relief patients' pain and improve functions}

^{How does trigger point massage therapy work?}

^{The therapy works in three ways:}

^{Trigger point massage therapy breaks into the self-sustaining vicious circle that has kept the muscle contracted}
^{Trigger point massage therapy increases the circulation, which has been restricted in the immediate area by the contracted fibres, thus enabling oxygen and nutrients to flow to the spot}
^{Trigger point massage therapy directly stretches the trigger point's knotted muscle fibres}

^{What follow-up treatment do patients require?}

^{Patients who have received trigger point massage therapy are encouraged to:}
^{Continue with trigger point massage therapy until they experience complete relief of their pain and other symptoms}
^{Perform physical exercise within their capability – but refrain from strenous exercises that “push the limits”}
^{Observe a proper, nutritious diet}
^{Address stress factors such as those associated with work or family Reducing stress will decrease muscle tension}
^{Perform the prescribed self-stretches for therapeutic purposes}
^{Maintain a good, balanced posture}

^{Is there anything more that you need to do after trigger point massage therapy has relieved the pain symptoms?}

^{Yes After a session of trigger point massage therapy, it is VERY important to:}
^{Apply a hot pack covered with a dampened flannel or towel to the treated area for a few minutes}
^{Gradually and gently stretch the treated muscle through its full range of movement three times, with a pause to breathe deeply and consciously relax between each cycle}

^{What about exercise?}

^{Exercise should be regarded as a prescription, and the kind of exercise prescribed by your trigger point massage practitioner depends largely on how active your trigger points are at that timeOnce the trigger points are inactivated and constant rest pain fades, then a carefully graded exercise programme is needed to increase muscle endurance and strength}

^{This involves muscle lengthening exercises before working up to shortening exercises Post-exercise soreness and stiffness should not last longer than three days If they do, the programme needs to be alteredThen, a regular conditioning programme – such as swimming or cycling – is recommended, at least twice a week}

^{Would the trigger points get better if you just rested up?}

^{Yes and no. Studies have shown that with a short period of rest and the avoidance of whatever activated the trigger point, the pain symptoms may disappear over a few weeks This makes people believe their problems have gone awayBut, if you examine the muscle properly you will find that it is still tight, stiff and weak, and still tender when pressed on In other words, the trigger points are still there; they are just lying dormant and not causing referred pain at that time}

^{The bad news is that they can be very easily reactivated to cause pain again, by acutely overloading the muscle in a new or repetitive task, working or sleeping in an awkward position, chilling the muscle, or during emotional stress, fatigue, or viral infectionsTrigger point massage therapy is needed for trigger points to be effectively released}

^{Summary - Trigger Point Therapy}

^{Most people need help to deal with their myofascial trigger point pain are real.}^{Trigger point massage therapy is a remarkable field of health care to diagnose and treat myofascial trigger points .}