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Published in: Current Pain and Headache Reports 5/2011

01-10-2011

Latent Myofascial Trigger Points

Authors: Hong-You Ge, Lars Arendt-Nielsen

Published in: Current Pain and Headache Reports | Issue 5/2011

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Abstract

A latent myofascial trigger point (MTP) is defined as a focus of hyperirritability in a muscle taut band that is clinically associated with local twitch response and tenderness and/or referred pain upon manual examination. Current evidence suggests that the temporal profile of the spontaneous electrical activity at an MTP is similar to focal muscle fiber contraction and/or muscle cramp potentials, which contribute significantly to the induction of local tenderness and pain and motor dysfunctions. This review highlights the potential mechanisms underlying the sensory-motor dysfunctions associated with latent MTPs and discusses the contribution of central sensitization associated with latent MTPs and the MTP network to the spatial propagation of pain and motor dysfunctions. Treating latent MTPs in patients with musculoskeletal pain may not only decrease pain sensitivity and improve motor functions, but also prevent latent MTPs from transforming into active MTPs, and hence, prevent the development of myofascial pain syndrome.
Literature
1.
go back to reference Simons DG, Travell JG, Simons LS. Travell & Simons' Myofascial pain and dysfunction: the trigger point manual. Baltimore: Williams & Wilkins; 1999. p. 1–10. Simons DG, Travell JG, Simons LS. Travell & Simons' Myofascial pain and dysfunction: the trigger point manual. Baltimore: Williams & Wilkins; 1999. p. 1–10.
2.
go back to reference •• Gerwin R. Myofascial pain syndrome: here we are, where must we go. J Musculoskelet Pain 2010;18:329–47. This is a comprehensive review of the current understanding of myofascial pain syndrome. CrossRef •• Gerwin R. Myofascial pain syndrome: here we are, where must we go. J Musculoskelet Pain 2010;18:329–47. This is a comprehensive review of the current understanding of myofascial pain syndrome. CrossRef
3.
go back to reference Simons DG, Hong CZ, Simons LS. Endplate potentials are common to midfiber myofacial trigger points. Am J Phys Med Rehabil. 2002;81:212–22.PubMedCrossRef Simons DG, Hong CZ, Simons LS. Endplate potentials are common to midfiber myofacial trigger points. Am J Phys Med Rehabil. 2002;81:212–22.PubMedCrossRef
4.
go back to reference Hubbard DR, Berkoff GM. Myofascial trigger points show spontaneous needle EMG activity. Spine. 1993;18:1803–7.PubMedCrossRef Hubbard DR, Berkoff GM. Myofascial trigger points show spontaneous needle EMG activity. Spine. 1993;18:1803–7.PubMedCrossRef
5.
go back to reference Sikdar S, Shah JP, Gebreab T, et al. Novel applications of ultrasound technology to visualize and characterize myofascial trigger points and surrounding soft tissue. Arch Phys Med Rehabil. 2009;90:1829–38.PubMedCrossRef Sikdar S, Shah JP, Gebreab T, et al. Novel applications of ultrasound technology to visualize and characterize myofascial trigger points and surrounding soft tissue. Arch Phys Med Rehabil. 2009;90:1829–38.PubMedCrossRef
6.
go back to reference Dumitru D, King JC, Stegeman DF. Endplate spike morphology: a clinical and simulation study. Arch Phys Med Rehabil. 1998;79:634–40.PubMedCrossRef Dumitru D, King JC, Stegeman DF. Endplate spike morphology: a clinical and simulation study. Arch Phys Med Rehabil. 1998;79:634–40.PubMedCrossRef
7.
go back to reference Heuser J, Miledi R. Effect of lanthanum ions on function and structure of frog neuromuscular junctions. Proc R Soc Lond B Biol Sci. 1971;179:247–60.PubMedCrossRef Heuser J, Miledi R. Effect of lanthanum ions on function and structure of frog neuromuscular junctions. Proc R Soc Lond B Biol Sci. 1971;179:247–60.PubMedCrossRef
8.
go back to reference Brown WF, Varkey GP. The origin of spontaneous electrical activity at the end-plate zone. Ann Neurol. 1981;10:557–60.PubMedCrossRef Brown WF, Varkey GP. The origin of spontaneous electrical activity at the end-plate zone. Ann Neurol. 1981;10:557–60.PubMedCrossRef
10.
go back to reference Ellaway P, Taylor A, Durbaba R, et al. Role of the fusimotor system in locomotion. Adv Exp Med Biol. 2002;508:335–42.PubMedCrossRef Ellaway P, Taylor A, Durbaba R, et al. Role of the fusimotor system in locomotion. Adv Exp Med Biol. 2002;508:335–42.PubMedCrossRef
11.
go back to reference •• Xu YM, Ge HY, Arendt-Nielsen L. Sustained nociceptive mechanical stimulation of latent myofascial trigger point induces central sensitization in healthy subjects. J Pain 2010;11:1348–55. This is the first study showing that focal muscle cramps play an important role in the induction of local muscle pain and central sensitization related to latent MTPs.PubMedCrossRef •• Xu YM, Ge HY, Arendt-Nielsen L. Sustained nociceptive mechanical stimulation of latent myofascial trigger point induces central sensitization in healthy subjects. J Pain 2010;11:1348–55. This is the first study showing that focal muscle cramps play an important role in the induction of local muscle pain and central sensitization related to latent MTPs.PubMedCrossRef
12.
go back to reference Ge HY, Zhang Y, Boudreau S, et al. Induction of muscle cramps by nociceptive stimulation of latent myofascial trigger points. Exp Brain Res. 2008;187:623–9.PubMedCrossRef Ge HY, Zhang Y, Boudreau S, et al. Induction of muscle cramps by nociceptive stimulation of latent myofascial trigger points. Exp Brain Res. 2008;187:623–9.PubMedCrossRef
13.
go back to reference Serrao M, Arendt-Nielsen L, Ge HY, et al. Experimental muscle pain decreases the frequency threshold of electrically elicited muscle cramps. Exp Brain Res. 2007;182:301–8.PubMedCrossRef Serrao M, Arendt-Nielsen L, Ge HY, et al. Experimental muscle pain decreases the frequency threshold of electrically elicited muscle cramps. Exp Brain Res. 2007;182:301–8.PubMedCrossRef
14.
go back to reference Kuan TS, Hsieh YL, Chen SM, et al. The myofascial trigger point region: correlation between the degree of irritability and the prevalence of endplate noise. Am J Phys Med Rehabil. 2007;86:183–9.PubMedCrossRef Kuan TS, Hsieh YL, Chen SM, et al. The myofascial trigger point region: correlation between the degree of irritability and the prevalence of endplate noise. Am J Phys Med Rehabil. 2007;86:183–9.PubMedCrossRef
15.
go back to reference Birdsong WT, Fierro L, Williams FG, et al. Sensing muscle ischemia: coincident detection of acid and ATP via interplay of two ion channels. Neuron. 2010;68:739–49.PubMedCrossRef Birdsong WT, Fierro L, Williams FG, et al. Sensing muscle ischemia: coincident detection of acid and ATP via interplay of two ion channels. Neuron. 2010;68:739–49.PubMedCrossRef
16.
go back to reference Gautam M, Benson C, Sluka K: Increased response of muscle sensory neurons to decreases in pH after muscle inflammation. Neuroscience 2010. Gautam M, Benson C, Sluka K: Increased response of muscle sensory neurons to decreases in pH after muscle inflammation. Neuroscience 2010.
17.
go back to reference Seo HS, Roh DH, Yoon SY, et al. Peripheral acid-sensing ion channels and P2X receptors contribute to mechanical allodynia in a rodent thrombus-induced ischemic pain model. J Pain. 2010;11:718–27.PubMedCrossRef Seo HS, Roh DH, Yoon SY, et al. Peripheral acid-sensing ion channels and P2X receptors contribute to mechanical allodynia in a rodent thrombus-induced ischemic pain model. J Pain. 2010;11:718–27.PubMedCrossRef
18.
go back to reference Taguchi T, Kozaki Y, Katanosaka K, et al. Compression-induced ATP release from rat skeletal muscle with and without lengthening contraction. Neurosci Lett. 2008;434:277–81.PubMedCrossRef Taguchi T, Kozaki Y, Katanosaka K, et al. Compression-induced ATP release from rat skeletal muscle with and without lengthening contraction. Neurosci Lett. 2008;434:277–81.PubMedCrossRef
19.
go back to reference Mizumura K, Murase S, Taguchi T. Animal models of myofascial trigger points. J Musculoskelet Pain. 2010;18:361–6.CrossRef Mizumura K, Murase S, Taguchi T. Animal models of myofascial trigger points. J Musculoskelet Pain. 2010;18:361–6.CrossRef
20.
go back to reference Shah JP, Danoff JV, Desai MJ, et al. Biochemicals associated with pain and inflammation are elevated in sites near to and remote from active myofascial trigger points. Arch Phys Med Rehabil. 2008;89:16–23.PubMedCrossRef Shah JP, Danoff JV, Desai MJ, et al. Biochemicals associated with pain and inflammation are elevated in sites near to and remote from active myofascial trigger points. Arch Phys Med Rehabil. 2008;89:16–23.PubMedCrossRef
21.
go back to reference Wang YH, Ding XL, Zhang Y, et al. Ischemic compression block attenuates mechanical hyperalgesia evoked from latent myofascial trigger points. Exp Brain Res. 2010;202:265–70.PubMedCrossRef Wang YH, Ding XL, Zhang Y, et al. Ischemic compression block attenuates mechanical hyperalgesia evoked from latent myofascial trigger points. Exp Brain Res. 2010;202:265–70.PubMedCrossRef
22.
go back to reference Simons D, Mense S. Understanding and measurement of muscle tone as related to clinical muscle pain. Pain. 1998;75:1–17.PubMedCrossRef Simons D, Mense S. Understanding and measurement of muscle tone as related to clinical muscle pain. Pain. 1998;75:1–17.PubMedCrossRef
23.
go back to reference Silverman SL, Harnett J, Zlateva G, et al. Identifying fibromyalgia-associated symptoms and conditions from a clinical perspective: a step toward evaluating healthcare resource utilization in fibromyalgia. Pain Pract. 2010;10:520–9.PubMedCrossRef Silverman SL, Harnett J, Zlateva G, et al. Identifying fibromyalgia-associated symptoms and conditions from a clinical perspective: a step toward evaluating healthcare resource utilization in fibromyalgia. Pain Pract. 2010;10:520–9.PubMedCrossRef
24.
go back to reference Yunus MB, Aldag JC. Restless legs syndrome and leg cramps in fibromyalgia syndrome: a controlled study. BMJ. 1996;312:1339.PubMed Yunus MB, Aldag JC. Restless legs syndrome and leg cramps in fibromyalgia syndrome: a controlled study. BMJ. 1996;312:1339.PubMed
25.
go back to reference Jansen PH, van Dijck JA, Verbeek AL, et al. Neuromuscular hyperexcitability features in patients suffering from musculoskeletal pain: a neuroepidemiologic survey. Funct Neurol. 1992;7:31–4.PubMed Jansen PH, van Dijck JA, Verbeek AL, et al. Neuromuscular hyperexcitability features in patients suffering from musculoskeletal pain: a neuroepidemiologic survey. Funct Neurol. 1992;7:31–4.PubMed
26.
go back to reference Trampas A, Kitsios A, Sykaras E, et al. Clinical massage and modified Proprioceptive Neuromuscular Facilitation stretching in males with latent myofascial trigger points. Phys Ther Sport. 2010;11:91–8.PubMedCrossRef Trampas A, Kitsios A, Sykaras E, et al. Clinical massage and modified Proprioceptive Neuromuscular Facilitation stretching in males with latent myofascial trigger points. Phys Ther Sport. 2010;11:91–8.PubMedCrossRef
27.
go back to reference Grieve R, Clark J, Pearson E, et al. The immediate effect of soleus trigger point pressure release on restricted ankle joint dorsiflexion: a pilot randomised controlled trial. J Bodyw Mov Ther. 2011;15:42–9.PubMedCrossRef Grieve R, Clark J, Pearson E, et al. The immediate effect of soleus trigger point pressure release on restricted ankle joint dorsiflexion: a pilot randomised controlled trial. J Bodyw Mov Ther. 2011;15:42–9.PubMedCrossRef
28.
go back to reference Aguilera FJM, Martín DP, Masanet RA, et al. Immediate effect of ultrasound and ischemic compression techniques for the treatment of trapezius latent myofascial trigger points in healthy subjects: a randomized controlled study. J Manipulative Physiol Ther. 2009;32:515–20.PubMedCrossRef Aguilera FJM, Martín DP, Masanet RA, et al. Immediate effect of ultrasound and ischemic compression techniques for the treatment of trapezius latent myofascial trigger points in healthy subjects: a randomized controlled study. J Manipulative Physiol Ther. 2009;32:515–20.PubMedCrossRef
29.
go back to reference Draper DO, Mahaffey C, Kaiser D, et al. Thermal ultrasound decreases tissue stiffness of trigger points in upper trapezius muscles. Physiother Theory Prac. 2010;26:167–72.CrossRef Draper DO, Mahaffey C, Kaiser D, et al. Thermal ultrasound decreases tissue stiffness of trigger points in upper trapezius muscles. Physiother Theory Prac. 2010;26:167–72.CrossRef
30.
go back to reference Simons DG. Review of enigmatic MTrPs as a common cause of enigmatic musculoskeletal pain and dysfunction. J Electromyogr Kinesiol. 2004;14:95–107.PubMedCrossRef Simons DG. Review of enigmatic MTrPs as a common cause of enigmatic musculoskeletal pain and dysfunction. J Electromyogr Kinesiol. 2004;14:95–107.PubMedCrossRef
31.
go back to reference Gerwin RD. The taut band and other mysteries of the trigger point: an examination of the mechanisms relevant to the development and maintenance of the trigger point. J Musculoskelet Pain. 2008;16:115–21.CrossRef Gerwin RD. The taut band and other mysteries of the trigger point: an examination of the mechanisms relevant to the development and maintenance of the trigger point. J Musculoskelet Pain. 2008;16:115–21.CrossRef
32.
go back to reference Ge HY, Serrao M, Andersen OK, et al. Increased H-reflex response induced by intramuscular electrical stimulation of latent myofascial trigger points. Acupunct Med. 2009;27:150–4.PubMedCrossRef Ge HY, Serrao M, Andersen OK, et al. Increased H-reflex response induced by intramuscular electrical stimulation of latent myofascial trigger points. Acupunct Med. 2009;27:150–4.PubMedCrossRef
33.
go back to reference Maquet D, Croisier J, Dupont C, et al. Fibromyalgia and related conditions: electromyogram profile during isometric muscle contraction. Joint Bone Spine. 2010;77:264–7.PubMedCrossRef Maquet D, Croisier J, Dupont C, et al. Fibromyalgia and related conditions: electromyogram profile during isometric muscle contraction. Joint Bone Spine. 2010;77:264–7.PubMedCrossRef
34.
go back to reference Falla D, Lindstrøm R, Rechter L, et al. Effect of pain on the modulation in discharge rate of sternocleidomastoid motor units with force direction. Clin Neurophysiol. 2010;121:744–53.PubMedCrossRef Falla D, Lindstrøm R, Rechter L, et al. Effect of pain on the modulation in discharge rate of sternocleidomastoid motor units with force direction. Clin Neurophysiol. 2010;121:744–53.PubMedCrossRef
35.
go back to reference • Hoyle JA, Marras WS, Sheedy JE, et al. Effects of postural and visual stressors on myofascial trigger point development and motor unit rotation during computer work. J Electromyogr Kinesiol 2011;21:41–48. This is the first study showing a lower rate of differential activation of surface EMG activities over MTP regions than normal muscle regions.PubMedCrossRef • Hoyle JA, Marras WS, Sheedy JE, et al. Effects of postural and visual stressors on myofascial trigger point development and motor unit rotation during computer work. J Electromyogr Kinesiol 2011;21:41–48. This is the first study showing a lower rate of differential activation of surface EMG activities over MTP regions than normal muscle regions.PubMedCrossRef
36.
go back to reference Gerdle B, Gronlund C, Karlsson S, et al. Altered neuromuscular control mechanisms of the trapezius muscle in fibromyalgia. BMC Musculoskelet Disord. 2010;11:42.PubMedCrossRef Gerdle B, Gronlund C, Karlsson S, et al. Altered neuromuscular control mechanisms of the trapezius muscle in fibromyalgia. BMC Musculoskelet Disord. 2010;11:42.PubMedCrossRef
37.
go back to reference Ge HY, Nie H, Madeleine P, et al. Contribution of the local and referred pain from active myofascial trigger points in fibromyalgia syndrome. Pain. 2009;147:233–40.PubMedCrossRef Ge HY, Nie H, Madeleine P, et al. Contribution of the local and referred pain from active myofascial trigger points in fibromyalgia syndrome. Pain. 2009;147:233–40.PubMedCrossRef
38.
go back to reference • Lucas KR, Rich PA, Polus BI. Muscle activation patterns in the scapular positioning muscles during loaded scapular plane elevation: the effects of latent myofascial trigger points. Clin Biomech 2010;25:765–70. This study provides further evidence on the disordered muscle activation pattern associated with latent MTPs.CrossRef • Lucas KR, Rich PA, Polus BI. Muscle activation patterns in the scapular positioning muscles during loaded scapular plane elevation: the effects of latent myofascial trigger points. Clin Biomech 2010;25:765–70. This study provides further evidence on the disordered muscle activation pattern associated with latent MTPs.CrossRef
39.
go back to reference Farina D, Leclerc F, Arendt-Nielsen L, et al. The change in spatial distribution of upper trapezius muscle activity is correlated to contraction duration. J Electromyogr Kinesiol. 2008;18:16–25.PubMedCrossRef Farina D, Leclerc F, Arendt-Nielsen L, et al. The change in spatial distribution of upper trapezius muscle activity is correlated to contraction duration. J Electromyogr Kinesiol. 2008;18:16–25.PubMedCrossRef
40.
go back to reference Potvin JR, O'Brien PR. Trunk muscle co-contraction increases during fatiguing, isometric, lateral bend exertions: possible implications for spine stability. Spine. 1998;23:774–81.PubMedCrossRef Potvin JR, O'Brien PR. Trunk muscle co-contraction increases during fatiguing, isometric, lateral bend exertions: possible implications for spine stability. Spine. 1998;23:774–81.PubMedCrossRef
41.
go back to reference Mense S. How do muscle lesions such as latent and active trigger points influence central nociceptive neurons. J Musculoskelet Pain. 2010;18:348–53.CrossRef Mense S. How do muscle lesions such as latent and active trigger points influence central nociceptive neurons. J Musculoskelet Pain. 2010;18:348–53.CrossRef
42.
go back to reference • Srbely JZ, Dickey JP, Bent LR, et al. Capsaicin-induced central sensitization evokes segmental increases in trigger point sensitivity in humans. J Pain 2010;11:636–43. This is the first study showing the facilitative effect of central sensitization on trigger point sensitivity.PubMedCrossRef • Srbely JZ, Dickey JP, Bent LR, et al. Capsaicin-induced central sensitization evokes segmental increases in trigger point sensitivity in humans. J Pain 2010;11:636–43. This is the first study showing the facilitative effect of central sensitization on trigger point sensitivity.PubMedCrossRef
43.
go back to reference • Tsai CT, Hsieh LF, Kuan TS, et al. Remote effects of dry needling on irritability of the myofascial trigger point in the upper trapezius muscle. Am J Phys Med Rehabil 2010;89:133–40. This study demonstrates the effect of a distally located latent MTP on the pain and motor dysfunctions associated with a proximally located active MTP.PubMedCrossRef • Tsai CT, Hsieh LF, Kuan TS, et al. Remote effects of dry needling on irritability of the myofascial trigger point in the upper trapezius muscle. Am J Phys Med Rehabil 2010;89:133–40. This study demonstrates the effect of a distally located latent MTP on the pain and motor dysfunctions associated with a proximally located active MTP.PubMedCrossRef
44.
go back to reference Hsieh YL, Kao MJ, Kuan TS, et al. Dry needling to a key myofascial trigger point may reduce the irritability of satellite MTrPs. Am J Phys Med Rehabil. 2007;86:397–403.PubMedCrossRef Hsieh YL, Kao MJ, Kuan TS, et al. Dry needling to a key myofascial trigger point may reduce the irritability of satellite MTrPs. Am J Phys Med Rehabil. 2007;86:397–403.PubMedCrossRef
45.
go back to reference Srbely JZ, Dickey JP, Lee D, et al. Dry needle stimulation of myofascial trigger points evokes segmental anti-nociceptive effects. J Rehabil Med. 2010;42:463–8.PubMedCrossRef Srbely JZ, Dickey JP, Lee D, et al. Dry needle stimulation of myofascial trigger points evokes segmental anti-nociceptive effects. J Rehabil Med. 2010;42:463–8.PubMedCrossRef
46.
go back to reference • Fernandez-Carnero J, Ge HY, Kimura Y, et al. Increased spontaneous electrical activity at a latent myofascial trigger point after nociceptive stimulation of another latent trigger point. Clin J Pain 2010;26:138–43. This study demonstrates that nociceptive stimulation of a latent MTP increases motor unit activities of a remote latent MTP.PubMedCrossRef • Fernandez-Carnero J, Ge HY, Kimura Y, et al. Increased spontaneous electrical activity at a latent myofascial trigger point after nociceptive stimulation of another latent trigger point. Clin J Pain 2010;26:138–43. This study demonstrates that nociceptive stimulation of a latent MTP increases motor unit activities of a remote latent MTP.PubMedCrossRef
47.
go back to reference Affaitati G, Costantini R, Fabrizio A, et al. Effects of treatment of peripheral pain generators in fibromyalgia patients. Eur J Pain. 2010;15:61–9.CrossRef Affaitati G, Costantini R, Fabrizio A, et al. Effects of treatment of peripheral pain generators in fibromyalgia patients. Eur J Pain. 2010;15:61–9.CrossRef
48.
go back to reference Ge HY, Wang Y, Danneskiold-Samsoe B, et al. The predetermined sites of examination for tender points in fibromyalgia syndrome are frequently associated with myofascial trigger points. J Pain. 2010;11:644–51.PubMedCrossRef Ge HY, Wang Y, Danneskiold-Samsoe B, et al. The predetermined sites of examination for tender points in fibromyalgia syndrome are frequently associated with myofascial trigger points. J Pain. 2010;11:644–51.PubMedCrossRef
49.
go back to reference Gerwin RD. Fibromyalgia tender points at examination sites specified by the american college of rheumatology criteria are almost universally myofascial trigger points. Curr Pain Headache Rep. 2011;15:1–3.PubMedCrossRef Gerwin RD. Fibromyalgia tender points at examination sites specified by the american college of rheumatology criteria are almost universally myofascial trigger points. Curr Pain Headache Rep. 2011;15:1–3.PubMedCrossRef
50.
go back to reference Arendt-Nielsen L, Nie H, Laursen MB, et al. Sensitization in patients with painful knee osteoarthritis. Pain. 2010;149:573–81.PubMedCrossRef Arendt-Nielsen L, Nie H, Laursen MB, et al. Sensitization in patients with painful knee osteoarthritis. Pain. 2010;149:573–81.PubMedCrossRef
Metadata
Title
Latent Myofascial Trigger Points
Authors
Hong-You Ge
Lars Arendt-Nielsen
Publication date
01-10-2011
Publisher
Current Science Inc.
Published in
Current Pain and Headache Reports / Issue 5/2011
Print ISSN: 1531-3433
Electronic ISSN: 1534-3081
DOI
https://doi.org/10.1007/s11916-011-0210-6

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