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• NEW VIEWS OF MYOFASCIAL TRIGGER POINTS |
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By David G. Simons, MD
Two studies appearing in the Archives of Physical Medicine
and Rehabilitation, one by Shah and colleagues
and another one by Chen and colleagues, present groundbreaking
findings that can reduce some of the controversy surrounding
myofascial trigger points (MTPs). Both author groups recognize
the ubiquity of this disease and the importance to patients of health
care professionals becoming better acquainted with the cause and
identification of MTPs. The integrated hypothesis is the most
credible and most complete proposed etiology of MTPs. However,
the feedback loop suggested in this hypothesis has a few
weak links, and studies by Shah and colleagues in particular
supply a solid link for one of them. The feedback loop connects
the hypothesized energy crisis with the milieu changes responsible
for noxious stimulation of local nociceptors that causes the local
and referred pain of MTPs. Shah’s reports quantify the presence of
not just 1 noxious stimulant but 11 of them with outstanding
concentrations of immune system histochemicals. The results also
strongly place a solid histochemical base under the important
clinical distinction between active and latent MTPs. The study by
Chen on the use of magnetic resonance elastography (MRE)
imaging of the taut band of an MTP in an upper trapezius muscle
may open a whole new chapter in the centuries-old search for a
convincing demonstration of the cause of MTP symptoms. MRE
is a modification of existing magnetic resonance imaging equipment,
and it images stress produced by adjacent tissues with
different degrees of tension. This report seems to present an MRE
image of the taut band that shows the chevron signature of the
increased tension of the taut band compared with surrounding
tissues.
ABSTRACT. Simons DG. New views of myofascial trigger
points: etiology and diagnosis. Arch Phys Med Rehabil 2008;
89:157-9.
To read the full article, please visit the Archives of Physical Medicine and Rehabilitation website. The January 2008 issue is FREE to the public.
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