Trigger Points and Muscle Chains in Osteopathy

What are trigger points?

A trigger point is a measurable lump that is in an area of extreme irritability in the fascia of the skeletal muscles. Symptoms consist of jump signs, local soreness, local twitches, and transferred pain—which typically manifests as a pain pattern far from the original spot. They can be brought on by direct compression or muscle contraction. When muscles become "knotted", trigger points can be felt physically and can result in incapacitating symptoms that force people to miss work or not be able to enjoy doing the things they love to do. These can also affect patients with less common illnesses like fibromyalgia or myofascial pain syndromes.

Trigger Points are classified on their clinical characteristics:

1. Active

When pressure is applied to active trigger points, other parts of the body become painful and irritated. Some of these referrals may occur quite far from the trigger point; for instance, trigger points in the gluteus may cause pain to radiate all the way down the outside of the leg to the ankle or down the hamstrings and into the calf, simulating sciatic nerve discomfort. When at rest, a trigger point is painful. The location of the trigger-point origin is not where this referred pain is felt; rather, it is felt elsewhere. Many people describe the pain as spreading or radiating.

2. Latent

Latent trigger points are frequently associated with stiffness and joint limitation. This is especially common in older people, and causes pain at the pressure point and does not cause discomfort elsewhere. They can be brought on by a variety of factors, such as bad posture, birth trauma, injury or trauma, or overexertion. Although a latent trigger point does not spontaneously produce pain, it may impede motion or result in muscular weakening. When pressure is placed directly over a trigger point, the patient may only become aware of pain coming from that point. Frequently, a "local twitch reaction" is induced.

What are muscle chains 

Physiological chains constitute the anatomical circuits that govern the static and dynamic body. These physiological muscle chains work together.  They are not specifically local but can work together from across the body.

There are two types of chains.

1. Static or conjunctive chains :

• the musculoskeletal static chain

• the neurovascular static chain

• the static visceral chain

2. Dynamic or muscular chains :

• flexion muscular chains

• extensor muscular chains

• open crossed muscle chains

• closed crossed muscle chains

This is based on Busquet method's theoretical presumptions, the muscular chain test was conducted on migraine symptoms, chronic migraine, and headache-free The Busquet Method integrates the anatomy of the whole body, from head to toe viewing the relationship content- container between the musculoskeletal and the visceral.

As an example of muscle chain discomfort, 15 percent of people worldwide suffer from migraines, which are more common in women than males. It is understood that there is a connection between neck discomfort and migraines because the trigeminal-vascular system is activated by the trigeminal-cervical complex. As a result, it is hypothesized that the cervical spine may help to sustain and prolong migraine attacks. 

The Busquets Method's principles state that these chains are set up to guarantee the lack of discomfort and changes in muscle mobility that might happen as an adaptive process. A potential therapeutic method for a non-pharmacological treatment may be guided by the diagnosis of muscle chain mobility deficit in migraine sufferers.  There are many osteopathic treatments available to help with the correlation of trigger points and muscle chains to address the mobility deficits. 

Osteopathic Treatments

The application of static stretching positions, which are designed to lengthen the shortened muscle chains can help with certain trigger points. Most lesions of the soft tissues, especially those at the muscle level, are due to the lack of elasticity of the connective tissue and fascia. Stretching is one of the most commonly used methods of treatment for such musculoskeletal issues. Common therapy regimens last for two months and consist of two sessions each week that last an average of 60 minutes, but consult with your doctor for specific instructions.

While the anterior muscle chains tend to increase their EMG activity, the posterior muscle chains tend to decrease. All of the analyzed muscle chains saw a rebalancing of electromyographic activity as a result of the administered treatment, proving the effectiveness of stretching as a strategy for treating shortened muscle chains all at once. 

In addition to the above techniques, over-the-counter medications like Tylenol (acetaminophen) or nonsteroidal anti-inflammatory drugs, such as naproxen, ibuprofen, and aspirin, can help with milder types of pain. Acetaminophen and NSAIDs both treat pain brought on by stiffness and muscle pains, and NSAIDs also lessen inflammation (swelling and irritation). A doctor may give muscle relaxants, anti-anxiety medications like Valium, antidepressants like Cymbalta, NSAIDs like Celebrex, or a brief course of harsher painkillers like codeine, hydrocodone, and acetaminophen if over-the-counter medications do not relieve the symptoms.

Finally, Trigger Point injection treatment may help. A tiny needle is inserted into the patient's active Trigger point during this surgery. A local anesthetic, saline, and a corticosteroid may be used in the injection. The Trigger Point is rendered inactive by the injection, which also reduces pain. A brief course of treatment will frequently bring about long-lasting relief. A doctor administers injections, which will typically take a few minutes. In one visit, several areas could receive injections. A dry-needle approach (using no drugs) can be utilized if a patient is allergic to a certain medication.

Trigger points and muscle chains should be considered together when approaching a treatment plan.  Contact Dr. Razvi today for your free consultation to get to the basis of your pain.

https://www.chaines-physiologiques.com/dans-le-monde/physiological-chains-method-busquet/

https://jom.osteopathic.org/abstract/trigger-points-and-muscle-chains-in-osteopathy/

https://www.aafp.org/pubs/afp/issues/2002/0215/p653.html

https://www.essentialosteopathy.co.uk/blog/pain/osteopathic-treatment-trigger-points/