Myofascial Trigger Points. Comprehensive Diagnosis and Treatment

Description

Pain and limited function of the locomotor system are the most common reasons for visiting a doctor or therapist. Muscles play a key part in these presentations as a result of their function and anatomy with current research suggesting that muscle imbalance, muscle tension and painful functional disorders are at the forefront when it comes to acute or chronic symptoms. The clinical correlate with all such symptoms is the myofascial trigger point.

Myofascial Trigger Points: Comprehensive Diagnosis and Treatment examines all aspects of muscle physiology and the pathogenesis of myofascial pain. The book provides valuable advice on diagnosis and differential diagnosis and contains detailed, practice-oriented information and numerous illustrations of the various therapeutic procedures for the treatment of myofascial trigger points.

Prepared by experts from throughout the world, Myofascial Trigger Points: Comprehensive Diagnosis and Treatment will be ideal for all manual therapists, physiotherapists, osteopathic physicians, osteopaths, chiropractors, acupuncturists, massage therapists and naturopaths.

Key Features

• Offers practical and clinically relevant information to all practitioners and therapists working in the field
• Edited by an international expert in pain management and trigger point therapy
• Abundant use of pull-out boxes, line artwork, photographs and tables facilitates ease of understanding
• Carefully prepared by a worldwide team of clinically active and research oriented contributors to provide helpful and clinically relevant information
• Presents the latest research findings for many aspects of trigger point therapy
• Provides a holistic view of patient care including the importance of patient communication and psychological aspects of pain control
• Provides a handy reference for rapid and effective diagnosis and treatment of trigger points
• Highlights the 65 most important muscles in a comprehensive practical style which includes anatomy, symptoms, pain patterns, physical examination and strategies for effective treatment
• Offers an ideal resource for training courses in trigger point injection, osteopathy, manual therapy and acupuncture
• Suitable for osteopathic physicians, osteopaths, chiropractors, manual therapists, acupuncturists and massage therapists as well as general physicians working in primary care, physical medicine, rehabilitation, pain management and internal medicine

Table of Contents

Section 1 The background

1 Guide to the book

2 Terminology

3 Epidemiology

• 3.1 Etiology of disease
• 3.2 Epidemiology

4 Etiology of myofascial pain syndrome

• 4.1 Causative factors
• 4.2 Perpetuating factors of myofascial pain
• 4.3 Chronification of myofascial pain

5 The anatomy and physiology of the muscles

• 5.1 Macroscopic construction
• 5.2 Function
• 5.3 Neurophysiology

6 Pathophysiology

• 6.1 Historical development
• 6.2 Underlying theories of pathophysiology
• 6.3 Specific pathophysiology
• 6.4 The extended integrated hypothesis

7 The trigger point as expression of a functional disorder of the locomotor system

• 7.1 The function of the locomotor system in association with memory
• 7.2 Pathophysiological role of mTrP

8 Trigger points and myofascial pain - acupuncture points and meridian system

• 8.1 Trigger points and acupuncture points
• 8.2 Referred pain and meridians
• 8.3 Other study results
• 8.4 Pain and somatovisceral correspondence of trigger and acupuncture points
• 8.5 Summary

9 Myofascial trigger points and fascia

• 9.1 Anatomy - definitions
• 9.2 Biomechanical function
• 9.3 Muscle hardening (taut bands)
• 9.4 Fascia as sensory organ
• 9.5 Association with trigger points - therapeutic considerations

10 Fibromyalgia syndrome

11 Myofascial trigger points and somatoform pain

• 11.1 Introduction and clinical information
• 11.2 Epidemiology
• 11.3 Etiology and pathogenesis
• 11.4 Differential diagnosis
• 11.5 Therapy
• 11.6 Health service assessment

12 Integrated holistic consideration of the muscles

• 12.1 Introduction
• 12.2 Function and purpose of the muscles
• 12.3 Approach via acupuncture

13 Diagnosis of myofascial pain

• 13.1 Principles
• 13.2 Questioning
• 13.3 Physical examination
• 13.4 Specific diagnosis of myofascial trigger points
• 13.5 Technical test procedures
• 13.6 Creating a comprehensive diagnosis with instructions for treatment

14 Differential diagnosis

• 14.1 Differential diagnosis according to affected structure and cause
• 14.2 Differential diagnosis depending on distribution pattern

Section 2 Treatment of myofascial pain

15 Principles of treatment

• 15.1 Doctor-patient relationship
• 15.2 Practical hints
• 15.3 Legal aspects
• 15.4 Documentation of progress

16 Peculiarities of doctor-patient relationship with chronic pain

17 Selection of suitable treatments

• 17.1 Standard treatments
• 17.2 Other (traditional) treatments

18 Manual therapies and physiotherapeutic procedures

• 18.1 Dejung manual trigger point therapy
• 18.2 Lewit treatment techniques
• 18.3 Spray and stretch, cool and extend
• 18.4 Fascia techniques for the treatment of mTrP

19 Treatment concept - myofascial trigger point therapy

• 19.1 Manual techniques and dry needling
• 19.2 Extension, relaxation/stretching, detensioning
• 19.3 Functional training, ergonomics

20 Physical procedures

• 20.1 Ultrasound therapy
• 20.2 Hot and cold treatments
• 20.3 Electrotherapy
• 20.4 Cupping
• 20.5 Transcutaneous electrical nerve stimulation
• 20.6 Laser therapy
• 20.7 Shock wave therapy

21 Trigger point infiltration

• 21.1 Indications and contraindications
• 21.2 Injectants
• 21.3 Technique

22 Acupuncture and related procedures

• 22.1 Dry needling (trigger point acupuncture)
• 22.2 Classical acupuncture
• 22.3 Kiiko Matsumoto acupuncture
• 22.4 Microsystem acupunture
• 22.5 Electrostimulation acupuncture
• 22.6 Laser acupuncture
• 22.7 Preusser gelopuncture
• 22.8 Tuina

23 Complementary and alternative therapy methods and naturopathic treatments

• 23.1 Definitions
• 23.2 Basic principles
• 23.3 Treatment procedures
• 23.4 Integration of complementary and alternative methods in multimodal pain programme

24 Relaxation techniques - body and mind

• 24.1 Preliminary remarks
• 24.2 Western relaxation techniques
• 24.3 Eastern relaxation techniques

25 Systemic pharmacotherapy

• 25.1 Introduction
• 25.2 Substance groups
• 25.3 Treatment strategy

Section 3 Muscles and trigger points

26 Head

• 26.1 M. masseter
• 26.2 M. temporalis
• 26.3 M. pterygoideus medialis
• 26.4 M. pterygoideus lateralis
• 26.5 M. digastricus
• 26.6 M. stylohyoideus
• 26.7 M. mylohyoideus
• 26.8 M. geniohyoideus

27 Throat, neck and shoulder region

• 27.1 M. splenius capitis
• 27.2 M. splenius cervicis
• 27.3 Muscles of the cervical M. erector trunci
• 27.4 Suboccipital muscles
• 27.5 M. sternocleidomastoideus
• 27.6 Mm. scaleni
• 27.7 M. trapezius
• 27.8 M. levator scapulae

28 Shoulder and upper arm

• 28.1 M. deltoideus
• 28.2 M. supraspinatus
• 28.3 M. infraspinatus
• 28.4 M. teres minor
• 28.5 M. latissimus dorsi
• 28.6 M. teres major
• 28.7 M. subscapularis
• 28.8 Mm. rhomboidei major and minor
• 28.9 M. coracobrachialis
• 28.10 M. biceps brachii
• 28.11 M. brachialis
• 28.12 M. triceps brachii (with M. anconaeus)

29 Elbow, forearm and hand

• 29.1 Hand extensors
• 29.2 M. brachioradialis
• 29.3 Finger extensors
• 29.4 M. supinator
• 29.5 M. palmaris longus
• 29.6 Hand and finger flexors in the forearm
• 29.7 M. adductor et opponens pollicis

30 Thoracic spine and thorax

• 30.1 Thoracic autochtonous back extensors
• 30.2 M. pectoralis major
• 30.3 M. pectoralis minor
• 30.4 M. sternalis
• 30.5 M. serratus posterior superior
• 30.6 M. serratus anterior
• 30.7 M. serratus posterior inferior

31 Abdomen

• 31.1 M. rectus abdominis
• 31.2 M. obliquus abdominis (externus et internus)
• 31.3 M. pyramidalis

32 Lumbar spine, pelvis and hip region (pelvic girdle)

• 32.1 Lumbar autochthonous back muscles
• 32.2 M. quadratus lumborum
• 32.3 M. iliopsoas major
• 32.4 Pelvic floor muscles
• 32.5 M. gluteus maximus
• 32.6 M.&' || 'nbsp;gluteus medius
• 32.7 M. gluteus minimus
• 32.8 M. piriformis

33 Hip, thigh and knee

• 33.1 M. tensor fasciae latae
• 33.2 Adductors of the hip joint.
• 33.3 M. quadriceps femoris
• 33.4 Ischiocrural muscles
• 33.5 M. popliteus

34 Lower leg and foot

• 34.1 M. tibialis anterior
• 34.2 Mm. peronei (fibulares) longus et brevis
• 34.3 M. gastrocnemius
• 34.4 M. soleus
• 34.5 M. tibialis posterior
• 34.6 M. extensor hallucis longus and extensor digitorum longus
• 34.7 M. flexor digitorum longus and flexor hallucis longus

Author Information

By Dominik Irnich, MD, Head of the Multidisciplinary Pain Centre, Department of Anesthesiology, University of Munich, Germany