Archive for October, 2007
Myofascial pain| Trigger points| Eccentric exercise
October 26, 2007 7:37 pm
Friday, October 26, 2007
Myofascial pain with formation of trigger points occurs when muscles are subjected to lengthening contractions especially if the motion is repetitive. There is evidence that eccentric exercise (lengthening contraction) provides a useful model for the understanding myofascial trigger points.
Lengthening contractions are usually performed by the spinal extensor muscles, trapezius, rhomboid major and minor, latissimus dorsi, posterior deltoid, triceps, wrist extensor muscles in the upper limb. The lower limb muscles that routinely perform lengthening contractions are gluteus maximus, adductor magnus, quadriceps especially rectus femoris and the ankle dorsi flexors. These are the muscles which are commonly injured on a daily basis through work activities, sports and activities of daily living.
Studies in rats show that reduced mechanical withdrawal threshold occurs the next day after the exercise in both young and old animals. However the recovery is faster in young animals compared to old animals. The recovery in the older rats was at least two days longer than the young rats which recovered within three days. The sensitivity is due to changes in neurons of the dorsal horn of the spinal cord.
After an eccentric contraction, the sensitivity to pain on palpation of the muscles as well as to electrical stimulation is increased. In addition it is also easier to produce the referred pain induced from pressure on trigger points after eccentric contraction. This is due to sympathetic nervous system facilitation of local and referred pain as well as the sensitivity to pain.
In treating myofascial trigger points, eToims: The Twitch Method addresses all these issues. eToims’ principal focus is on finding, locating and stimulating the trigger points in muscles subjected to eccentric contractions. By eToims stimulation of the trigger points, the twitches produce a local exercise effect to the muscle fibers surrounding the trigger points as well as deep stretching effects and improvement of circulation. These combined effects help to heal the trigger points instantaneously.
Muscles subjected to eccentric contractions are retrained with eToims to perform shortening contractions known as concentric contractions. In this manner, there is a return of balance in pull between previously weakened eccentric muscles and the stronger muscles on the opposite aspect of the joint which are routinely subjected to concentric contractions. This immediate resetting of the imbalance in pull of the muscles together with the instantaneous healing of the trigger points lead to pain reduction. Pain relief leads to less sympathetic activity and this can be noted as a reduction in heart rate immediately after an eToims session.
The advantage of eToims over ordinary exercise is that eToims can exercise one muscle at a time when the trigger point is located and stimulated. Routine exercise involves moving many muscles and joints simultaneously and patients with pain are unable to do exercise because the exercise not only cause more pain but also create more active trigger points. Many patients with chronic pain suffer from more pain after exercise or more than usual activity.
© 2007 copyright all rights reserved www.stopmusclepain.com myofascial pain| trigger points|eccentric exercise
Myofascial Pain|trigger points
October 21, 2007 11:00 pmMyofascial trigger point as defined by Travell and Simons includes “a hyperirritable spot, usually within a taut band of skeletal muscle or in the muscle fascia which is painful on compression and can give rise to characteristic referred pain, motor dysfunction, and autonomic phenomena”.
The autonomic phenomenon on palpation of the trigger point consist of skin redness (vasomotor response), sweating (sudomotor response due to pain is characteristically hot and sticky sweat as opposed to thin sweat from nervousness or just being cold ) and goose pimpling (pilomotor response). Usually with pain due to trigger point palpation, the goose pimples do not cross the midline.
When the trigger point is pressed, there is an area of referred pain. This is the feature that differentiates myofascial pain syndrome from fibromyalgia. The tender spots in fibromyalgia do not produce referred pain.This pain is reproduced reliably on palpation of the trigger point in myofascial pain. The referred pain does not coincide with dermatologic or neuronal distributions, but follows a consistent pattern.
Trigger points may develop after an initial injury to muscle fibers. This injury may include a noticeable traumatic event or repetitive microtrauma to the muscles. The trigger point causes pain and stress in the muscle or muscle fiber. As the stress increases, the muscles become fatigued and more susceptible to activation of additional trigger points. When predisposing factors combine with a triggering stress event, activation of a trigger point occurs. This theory is known as the “injury pool theory”.
Gunn’s theory for myofascial pain is that of shortened muscle fibers due to injury to nerve roots leading to denervation of muscle fibers. The denervation is related to aging, blunt trauma insidiously or acutely from whiplash injuries, sports, work and repetitive injuries. The shortened muscle fibers produce pain from compression of intramuscular nerve terminals and small blood vessels. There is also a tugging effect of the tight muscles on its own tendon with a pulling or tugging effect on ligaments, bones and joints. The covering of the bones called periosteum or the annulus fibrosus of the intervertebral discs is painful since they are richly innervated with pain fibers.
Electromyography at the trigger point shows spontaneous electrical activity with presence of endplate potential, and the active loci probably are related closely to motor endplates. T
Treatments used traditionally include spray (freeze) and stretch, physical therapy, transcutaneous electrical stimulation, ultrasound, massage , ichemic compression therapy, trigger point injections with local anesthetics, corticosteroids, botulinum toxin, dry needling and/or acupuncture.
The most effective treatment for myofascial pain syndrome is Electrical Twitch Obtaining Intramuscular Stimulation (eToims). The trigger points have to be systematically searched for and electrically stimulated. The characteristic forceful twitch on trigger point stimulation is strong enough to effect movements of the joint over which the treated muscle crosses. When such twitch forces are elicited, it treats the root cause of the pain which is the shortened muscle. The skin resistance to electrical stimulation is lowest at the trigger point allowing effective stimulation of the intramuscular terminal nerves using the least current. However, the stimulus strength has to be supramaximal to ensure effective stimulation of the trigger point (s).
Pain relief results from the release of the tight muscle fibers on the entrapped intramuscular terminal nerve fibers and blood vessels. The exercise effect which retores circulation to the exercised areas as well as deep stretching effects produce a reduction of the tugging effect on tendons, ligaments, bones and joints.
Unlike medications given orally or through injections, eToims is not a pain suppressant but by treating the root cause of the pain, is curative. There is accompanied increases in range of motion and improvement of function with eToims leading to a better quality of life. There are no side effects from eToims and can be done repetitively over the life time of the patient for treating new trigger points that will continue to be formed due to the presence of ongoing nerve root irritation.
The trigger points that are treated with eToims are permanently gone. However, the ongoing pain is from formation of new trigger points that can occur even with activities of daily living. The regularity of eToims treatments allows the treatments to heal new trigger points as soon as they occur.
When trigger points are allowed to accumulate, it adds to the intensity of the underlying pain. When the muscle tightness is significant and when pain levels are high, the trigger points are difficult to find and stimulate and pain reduction is harder to achieve.
The best time for eToims to achieve maximum effects pain relief or improvement in range of motion and hence function is when the pain levels are low. Many patients who have no pain continue eToims treatments for relieving muscle tightness. Muscle tightness interferes with function and produces discomfort rather than pain. Release of muscle tightness even without pain is an indication for eToims.
© 2007 copyright all rights reserved www.stopmusclepain.com myofascial pain| trigger points
eToims, fibromyalgia, muscle tightness, muscles, myofascial, pain, trigger points, twitch
Neck pain| low back pain| posture
October 13, 2007 12:24 amSaturday, October 13, 2007
Those suffering from chronic neck pain and low back pain will have a poor posture and poor posture will aggravate neck and lower back pain.
Beginning at about age 40, there is loss of height by about half an inch each decade, and this loss of height becomes rapid after age 70. About two inches of height loss can occur between ages 30 and 80 in males, and about three inches in females.
A hunched back can occur because of vertebral fractures due to osteoporosis (bone-loss). However most of the hunched backs or kyphosis is related to poor posture.
Most of the activities of daily living are performed in the front of the body leading to strengthening of the muscles in the front from constant and frequent shortening contractions. This together with a poor posture of keeping the shoulders rounded or hunched with a head forward position during work and activities of daily living, places a tremendous stress on the muscles which extend the spine.
The spinal extensors must perform lengthening contractions to stabilize the spine in a certain posture and this type of contraction is very injurious to the extensor muscles. As aging progresses, the concomitant presence of multiple spinal nerve root irritation that causes neck and lower back pain also gets worse.
The nerve root irritation may not be associated with pain symptoms if the sensory dorsal spinal nerve roots are not irritated. However, due to ongoing irritation of motor ventral nerve roots that supply the muscles, the muscles of the spine and the limbs become weak and tight.
The spinal nerve roots that get commonly irritated with aging includes the C6 and C7 nerve roots in the cervical spine and the L5 and S1 nerve roots in the lower spine. The most important muscles that help extend the spine are the latissimus dorsi (supplied by the C6 and C7 nerve roots) and gluteus maximus supplied by the L5 and S1 nerve roots.
The head forward position also stresses and weakens the trapezius muscles which aid as a spinal extensor muscle. As the spinal extensors become weaker, the tendency to prevent a poor posture gets more diminished.
All of us must be aware and be conscious of our postures. We must correct bad postures by keeping the head erect over the shoulders so that a straight line from the bottom of the ears fall straight down to the angle between the neck and the shoulder slope. The shoulders must be held back as if to the brace the shoulders. Clasping the hands behind the back and lifting them off the back is a great way to actively exercise the latissimus dorsi muscles through out the day.
Lying on your stomach and then lifting your head and shoulders and keeping your arms stretched out in front will exercise the spinal extensors. Bridging will strengthen the gluteus maximus muscles and pelvic tilt exercises will strengthen the gluteus maximus, spine and abdominal muscles. Pelvic tilt exercises are very useful since they can be performed while lying down, sitting, standing or walking.
© 2007 copyright all rights reserved www.stopmusclepain.com Neck pain| Low back pain| Posture
Low back pain| Posture
October 5, 2007 6:55 pm Friday, October 05, 2007
The spine posture plays a significant role in creating lower back pain or maintaining lower back pain. Normally, prior to a voluntary arm movement, there is usually a small spinal movement (preparatory movement) that occurs opposite to the direction of the arm movements.
In patients with lower back pain there is a tendency to reduce spinal motion and this is associated with decreased preparatory motion to arm movements. Thus when the arm actually moves, there is increased displacement of the trunk leading to compromised quality of trunk control and subsequent increase in low back pain. Modification of spinal mechanical load can be beneficial for preventing acute exacerbation of lower back pain.
Also, low back pain subjects exhibit compensatory movements and altered load sharing strategies during the sit-to-stand and stand-to-sit activities. Exercise therapy must be directed to these changes so that the normal movement characteristics of the spine and hips can be restored.
Surface EMG studies indicates significantly preferential activation of anterior core muscles during prone (facedown) bridging exercises and posterior core muscles during supine (face up, lying on back) bridging. Normal subjects were able to hold the bridge exercise for longer durations in both the supine and prone positions than in patients with back pain.
Bridging exercise is easy to learn and can be reliably reproduced by the patients. Prone bridging preferentially challenges core flexors, whereas supine bridging recruits primarily the core extensors. In patients with lower back pain, since the core muscles are weak, teaching them bridging exercises can help in lumbar spine-stabilization and increase the endurance capability.
© 2007 copyright all rights reserved www.stopmusclepain.com Low back pain| Posture
