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Flashcards in Trigger Points/ Tender Points Deck (51):

What is a trigger point?

- Hyperirritable locus within a taut band of skeletal muscle located in the muscular tissue or its associated fascia


What are the 2 types of trigger points?

- Active (Pain without palpation)
- Latent (Clinically silet, but restricts, weakens muscle, and predisposes it to acute attacks of pain)


Upon who is trigger point mapping based?



Is a Trigger Point a primary or secondary condition?

Can be either


What are 4 direct causes of trigger points?

- Acute overload (a specific event or movement)
- Overwork/ overuse fatigue
- Direct trauma
- Chilling


What are the 2 causes of overwork fatigue?

- Repetitive contractions
- Sustained contractions


What are 4 indirect causes of trigger points?

- Overloaded synergistic muscles from primary muscle dysfunction
- Visceral disease
- Arthritic joints
- Emotional distress


How much do trigger points vary?

- Extremely variable due to activity
- Latent can turn into active


How do TrPs limit the movement of muscle?

- Develop guarding habits that limit movement


What type of autonomic changes may appear in the presence of Trigger Points?

- Diaphoresis
- Vascontriction
- Changes in proprioception
- Hair loss
- etc...


What are the 6 clinical signs used to diagnose a trigger point?

- Weakness and restriction in the stretch of an affected muscle
- A palpable taut band in the affected muscle
- Severe focal tenderness to digital pressure
- Twitch response following snapping or dry needling
- Reproduction of pain
- Elimination of symptoms targeting specific muscle


What is the goal of trigger point therapy?

- Inactivate trigger point decreasing referred pain


What are 3 methods of trigger point treatment?

- Manual technique
- Needling w/ or w/o medicaiton
- Dry needling


How much pressure should be applied through digital palpation to assess trigger points?

- Approximately 4 kg


How many tender points need to be present for a diagnosis of fibromyalgia?

- 11 of 18 sites


What are the 18 sites of tender points?

- Bilateral at suboccipital muscle insertions
- Bilateral anterior aspects of the intertransverse spaces at C5 - C7
- Bilateral trapezius at midpoints and upper boarders
- Bilateral medial supraspinaltus
- Bilateral second rib at the 2nd costochondral junctions lateral to junctions of upper surfaces
- Bilaterally 2 cm distal to humeral epicondyles
- Bilateral outer quadrants of buttocks in anterior fold of muscle
- Bilateral greater trochanter near trochanteric prominence
- Bilateral medial fat pad proximal to the joint line of knee


Are tender or trigger points exclusively muscle?

- Trigger points


Who developed the counterstrain/ positional release method?

- Jones


What is the theory behind positional release?

- Decreases sensitivity of the muscle spindle to stretch, which decreases the excitability of extrafusal muscle fibers


Does a trigger point or tender point illicit a local twitch response?

- Trigger points


Does a trigger point or tender point illicit a local tenderness on palpation?

- Both


Can a trigger point or tender point be singular?

Only a trigger point


Does a tender point or trigger point occur in specific locations?

Tender point


Does a trigger point or tender point cause a specific referred pain pattern?

Trigger point


Does a trigger point or tender point increase the body's overall sensitivity to pain?

Tender point


What is the referred pain pattern of the SCM?

- Occiput/ occipital headaches
- Ear
- Eye
- Cheek
- Frontal area/ frontal headaches
- Throat
- Sternum


What are 3 autogenic symptoms of the SCM?

- Tinnitus
- Blurred vision
- Postural dizziness


What type of grip is used when performing TrP therapy on the SCM?

- Pincer


What should be avoided when performing TrP therapy on the SCM?

- The carotid artery and jugular vein


What are the stretch positions that follow TrP therapy of the SCM?

Clavicular head: Neck extension, side bending, and rotation to the opposite side
Sternal: Neck extension, side-bending to the opposite side, rotation to the same side of the stretched muscle


What is the positive stretch sign of the SCM?

- Pain at occipital base and upper c-spine of side opposite stretch


What muscle is usually involved in TrPs of the SCM?

- The scalenes


What postural imbalance is typically present if the Scalenes and TrPs develop trigger points?

T-spine/ forward neck posture


Besides posture, what else may lead to TrPs of the SCM?

- Whiplash injury


What occupations may lead to development of SCM trigger points?

- Those that require constant or repetitive forward neck bending


What sleeping modification can be made to prevent SCM TrPs?

- Pillow positioning


What is a common HEP for SCM TrPs?

- Maintain shoulder in depression (hold onto table
- Use MFS positions


What is the referred pain pattern for the Scalenes?

- Neck
- Pectoral region
- Medial border of scapula
- Front and back of arm
- Radial surface of the forearm
- Index finger and thumb


What grip is used for TrPs in the Scalenes?

- Thumb or four fingesr
- Palpated against transverse processes


What is the stretch for the Scalenes following TrP treatment?

- Neck side-bending with moderate extension
- Stabilize scapula by holding onto chair


What is the positive stretch sign for the scalenes?

- Pain on ipsilateral cervical spine


What are 3 mechanisms of injury for the Scalenes?

- Whiplash
- Over respiration
- Muscular imbalance between the SCM and scalenes causing forward neck posture


What is the referred pain pattern for the suboccipitals?

- Occipital headaches
- Deep headaches
- Pain behind the eye


What stretch technique is coupled with TrP of the suboccipitals?

- Suboccipital decompression technique
- Chin tuck with upper cervical traction


What is the positive stretch sign for the suboccipitals?

- There is none


What are 3 mechanisms of injury for the suboccipitals?

- Forward head posture with posterior rotation of the occiput
- Prone position for a prolonged period with hands support the head (watching TV or reading a book)
- Excessive use of binoculars or eye glasses that require adjustment may cause a short hyperextension of the neck


What is the referred pain pattern of the upper trapezius?

- Posterolateral neck
- Behind ear
- Temporal area/ temporal headaches
- To zygomatic arches


What is the stretch coupled with TrP therapy of the upper trapezius?

- Neck flexion
- Side-bending towards opposite side
- Slight rotation to ipsilateral side


What is the positive stretch sign of the upper trapezius?

- Pain at the opposite side during a stretch


What is the HEP stretch for the patient for an upper trapezius TrP?

- Pt sitting and holding ipsilateral shoulder in depression by gripping under the table with their hand
- Use other hand to flex, contralaterally sidebend, and ipsilaterally rotate the neck to the same side


What are 3 mechanisms of injury of the upper trapezius muscle?

- Stabilizing phone between head and shoulder
- Carrying heavy bags with strap over shoulder
- Armchairs or wheelchairs with high arm supports or no supports