Myofascial trigger points (MTP), also known as trigger points, are described as hyperirritable spots in the fascia surrounding skeletal muscle. They are associated with palpable nodules in tight muscles. Myofascial trigger points "knots" are a common source of certain musculoskeletal pain.

The trigger point model states that unexplained pain frequently radiates from these points of local tenderness to broader areas, sometimes distant from the trigger point itself. Practitioners claim to have identified reliable referred pain patterns which associate pain in one location with trigger points elsewhere.

Compression of a trigger point may elicit local tenderness, referred pain, or local twitch response. The local twitch response is not the same as a muscle spasm. This is because a muscle spasm refers to the entire muscle contracting whereas the local twitch response also refers to the entire muscle but only involves a small twitch, no contraction.

Most of us have been introduced to this condition from reading Dr. Travell's books. The main innovation of Travell's work was the introduction of the myofascial pain syndrome concept (myofascial referring to the fascia that surrounds and permeates muscle). This is described as a focal hyperirritability in muscle that can strongly modulate central nervous system functions. Travell and other physicians distinguish this from fibromyalgia, which is characterized by widespread pain and tenderness and is described as a central augmentation of nociception giving rise to deep tissue tenderness that includes muscles. Studies estimate that in 75-95 percent of cases, myofascial pain is a primary cause of regional pain. Myofascial pain is associated with muscle tenderness that arises from trigger points, focal points of tenderness, a few millimeters in diameter, found at multiple sites in a muscle and the fascia of muscle tissue.


Dr. Sellari treats trigger points with deep pressure, soft-tissue massage (manual trigger point therapy), mechanical vibration, pulsed ultrasound, electrostimulation and Low Level Laser Therapy and stretching techniques that invoke reciprocal inhibition within the musculoskeletal system. Dr. Sellari often uses a tool known as the T-Ball to direct pressure directly upon the trigger point, to avoid overuse of his hands. For more severe cases that respond slowly to conservative care, a referral for Trigger-point-injections may be necessary.

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