Orthopedic & Muscular System: Current Research
Open Access
ISSN: 2161-0533
+44-77-2385-9429
ISSN: 2161-0533
+44-77-2385-9429
Dawn T Gulick
Widener University, USA
Posters-Accepted Abstracts: Orthop Muscular Syst
Myofascial trigger points (MTrP) are a focus of hyperirritability in muscle or fascia. MTrPs can be a significant source of pain. A large percentage of patients with shoulder dysfunction, patellofemoral pain and medial longitudinal arch pain present with MTrPs. Ingraham described MTrP as a â??clump of contracted sarcomeres living in a swamp of garbage molecules and waste metabolites.â? There are histochemical milieus of eight substances in MTrPâ??s that are not in normal, pain-free muscle. MTrPs are known to be in a vicious cycle of increased contractile activity with an increase in metabolic rate that leads to an increase in metabolites that fire the nociceptors to produce local and referred pain. Furthermore, sustained contractions decrease blood flow and ATP availability which interferes with the effectiveness of the calcium pump. This cyclic response begs the question, â??How do we treat MTrPs?â? Interventions geared towards restoring blood flow, removing metabolites and restoring ATP availability would be most efficacious. This presentation addresses numerous modalities. Topical agents such as lidocaine and diclofenac have been found to reduce pain (30-40%). Ischemic compression (30-60 seconds) has been found to increase the pain pressure threshold (PPT). Given the depth of MTrPs, 3 MHz ultrasound is the most appropriate mode. Class IV LASER has been shown to significantly increase tissue heating and enhance ATP levels. Last but not least, instrument-assisted soft tissue techniques (IASTT) using techniques such as sweeping, swiveling and fanning have been shown to reduce PPT. Yet, a multi-modal approach may be most efficacious.
Email: dtgulick@widener.edu