Myofascial trigger points

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webslave
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Myofascial trigger points

Post by webslave »

Not a new paper, but worth posting anyway.

Anesthesiol Clin. 2007 Dec;25(4):841-51, vii-iii.
Myofascial trigger points.

Lavelle ED, Lavelle W, Smith HS.
Department of Anesthesiology, Albany Medical Center, 43 New Scotland Avenue, Albany, NY 12208, USA.


Abstract

Painful conditions of the musculoskeletal system, including myofascial pain syndrome, constitute some of the most important chronic problems encountered in a clinical practice. A myofascial trigger point is a hyperirritable spot, usually within a taut band of skeletal muscle, which is painful on compression and can give rise to characteristic referred pain, motor dysfunction, and autonomic phenomena. Trigger points may be relieved through noninvasive measures, such as spray and stretch, transcutaneous electrical stimulation, physical therapy, and massage. Invasive treatments for myofascial trigger points include injections with local anesthetics, corticosteroids, or botulism toxin or dry needling. The etiology, pathophysiology, and treatment of myofascial trigger points are addressed in this article.

PMID: 18054148 [PubMed - indexed for MEDLINE]
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superuse
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Re: Myofascial trigger points

Post by superuse »

STD, prostatitis, or your pelvic floor?

October 8th, 2009

Peter, a married 36-year-old salesman, regularly enjoys mountain and road biking, snowboarding, surfing, and working out in the gym. With the recent economic downturn he had more free time and increased the frequency and intensity of his physical activities. He started an “abs-of-steel” contest with his wife over the course of 8 weeks and he started biking more frequently (daily). He enjoyed his new exercise regime and the break from his typical high-stress workweek.

The 500 abdominal crunches he did daily paid off and he won the abs contest with his wife. However, his elation at his physical achievements started to wane as he started feeling self-conscious standing in front of the urinal, because it took longer than normal to initiate his stream. With sexual activity, his orgasm also started taking longer and longer to achieve, and his wife began to complain about this. Then the economy started to pick up and Peter felt increasing pressure and stress at work. In an attempt to release some steam he started riding his bike to work. After several months of this, he experienced intermittent post-ejaculatory pain in his genitals, urinary frequency, and burning with urination.

Peter’s primary care physician diagnosed him with Prostatitis. The doctor did not think it was necessary to take a culture because Peter’s presentation was a “textbook case” and precipitously sent Peter home with a round of antibiotics. His symptoms did not improve and in fact worsened, progressing from intermittent to constant. He went to an urologist who did take a culture and told Peter it was negative. Since it sounded like Prostatitis he gave Peter another round of stronger antibiotics over a three-month period.

Peter’s symptoms did not improve. He had more genital pain, urinary dysfunction and became suspicious that his wife was cheating on him and that he had perhaps contracted a venereal disease. He went to another physician who concurred this was likely true and had Peter undergo a battery of tests. To Peter’s relief and dismay the tests returned negative. What was the cause of these alarming symptoms?

Peter was beside himself with stress and pain. He went to another urologist who performed a pelvic floor examination and accurately diagnosed him with Chronic Pelvic Pain Syndrome. Peter was then referred to a physical therapist specializing in myofascial pelvic pain disorders.

Once in PT, Peter learned he never had an infection. The excessive amount of abdominal exercises that Peter did caused a myofascial trigger point in his “six-pack” muscle group, which caused referred pain to his genitals and urinary dysfunction. Peter’s excessive bike riding caused compression to his pelvic floor muscles and exacerbated these symptoms. Because myofascial pain increases with stress, the increased pressure from work also resulted in an increase in severity of symptoms.

After 6 months of physical therapy Peter’s symptoms resolved, he had a new perspective on his physical activities and he had his life back.

From this site
A typical male with pelvic floor problems-- bike and obsession with exercise (most notably the common ab and core work) in addition to snowboarding and the gym.

Initial false diagnosis of with prostatitis or infection and round after round of antibiotics-- the usual. Sometimes this obsession with infection goes on for years with men.

Increase in stress at work led to more bike riding (stress compensation mechanism) compounding the problem. Increased stress from work (or fear of unemployment) along with stress from pelvic pain produced a feedback loop and viscous pain cycle.

Happy ending , wish it was far more common (or easy).
Age:43 | Onset Age:36 | Symptoms: First urinary and backside, golf ball feeling, now ok (no heavy exercise) . Major onset seemed to be with heavy coughing spell , felt "tearing" or nerve pain in rectum/prostate. | Helped By:Hot showers,sleep.Worsened By: Type A obsessiveness ... Stressing, what-if thinking, weights.
Not a doctor. -

The usual... anxiety prone programmer (my case), accountant, lawyer or self employed sitting 50 hrs/week combined with compulsively exercising on a bike,weights or running to compensate for stress. Also aka "graduate student syndrome" New email sigma556@hotmail
DMcU
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Re: Myofascial trigger points

Post by DMcU »

This might be helpful to those who have just joined the site and need a 'breakdown' of everything, including the fact that most cases are abacterial. I think it's true to say we all 'freaked out', like Peter, thinking the worse and tensing up more as a result and this acceptance alone is a huge comfort.
Age: 25 Onset: 23. | Symptoms: Burning in urethra, urinary frequency/urgency, 'golf ball' in butt syndrome, muscle tension form pelvis to calves, constipation, IBS, testicular pain/inflam, bladder pain when nearly full, difficulty relaxing muscles (coccygeal, levator ani etc.), pain and muscles tension in anus/perineum. Helped by: quercetin, relaxation, baths, heat packs applied to perineum. Worsened by: Stress, driving, sitting, jogging, caffeine etc.
Sherradin
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Re: Myofascial trigger points

Post by Sherradin »

Its no different for some women. I wonder how many gym junkie girls like I was are in the downward spiral of confusion and fear gobbling macrodantin. Its a good article. But getting the end result took me across the world. Still most doctors would not make the connection nor most PTs.
CPP since 2005. Prior to CPP always overly fit and active. I am female. Had two natural births: singleton 1998 and twins 2000. 2002 emergency back surgery - L5S1 herniation. Then recurring UTIs. Usual antibiotic overload. Then constant debilitating burning bladder and reaction to many foods. Australian Pain Clinic 2007. Turning point was Dec 2009 Attended Wise Clinic in Santa Rosa USA.
Was helped by strict diet but now eating normally after years of restricted diet - wonderful. Helped by: stretching,relaxation, yoga, trigger point, warm baths. Worsened by: stress, sitting, abdominal or glute exercises and salicylates
Medication: Now off all pain clinic meds no more Endone or Elavil only Lyrica 50 mg as Dec 2010 just reherniated L5S1disc and had discectomy. Its taken years but I feel I am over it.
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