Soft Tissue

Question 1

Trigger point

Answer 1

• hyperirritable locus within a taut band of skeletal muscle, located in the muscle or associated fascia
• can be primary problem or co-morbid

Question 2

Active TrP

Answer 2

causes the patient pain, can be pain at rest

Question 3

Latent TrP

Answer 3

clinically silent with regards to pain, but can cause restriction of movement and weakness of affected muscle. predisposes muscle to acute attack of pain years after original “healing” occurs. can become active

Question 4

TrPs are activated directly by ___ (4)

Answer 4

• acute overload (specific event or movement)
• overwork fatigue (repetitive or sustained contractions)
• direct trauma
• chilling

Question 5

TrPs are activated indirectly by ____ (4)

Answer 5

• other trps (synergistic muscles that are chronically overloaded by the first affected muscle)
• visceral disease
• arthritic joints
• emotional distress

Question 6

TrP irritability can increase by ___ (3)

Answer 6

• leaving a muscle shortened for prolonged period (eg sleeping)
• chilling the muscle
• viral infection

Question 7

TrPs can cause changes in ___ (2)

Answer 7

autonomic changes (diaphoresis, vasoconstriction), proprioception

Question 8

chronic regional pain syndrome (RSD)

Answer 8

-marked changes in ANS – skin becomes thin/waxy, lowered pain/pressure threshold, normal input processed as painful

Question 9

Signs (4)

Answer 9

1. weakness and restriction in the stretch of the affected muscle
2. a taut palpable band in the affected muscle
3. exquisite, focal tenderness to direct pressure
4. a local twitch response elicited through snapping palpation or dry needling

Question 10

Treatment of TrP

Answer 10

• goal is to inactivate, therefore decreasing or eliminating local and referred pain
• manual techniques
• needling with or without injection of medication

Question 11

Tender points

Answer 11

• diagnosis of fibromyalgia – pain at at least 11/18 sites
• tender in absence of any other physical finding
• multiple, occur in specific locations that are symmetrical, do not cause referred pain but often cause a total body increase in sensitivity

Question 12

positional release/strain counterstrain

Answer 12

• Jones noted the impact of positioning on tender points; cataloged a series of positional release postures designed to decrease activity of facilitated segments
• look to decrease sensitivity of muscle spindle to stretch, which impacts excitability of extrafusal fibers
• Jones tender points are mechanical, FMS not