Abstract
Myofascial trigger point (MTrP) is a major cause of muscle pain, characterized with a hyperirritable spot due to accumulation of sensitized nociceptors in skeletal muscle fibers. Many needling therapy techniques for MTrP inactivation exist. Based on prior human and animal studies, multiple insertions can almost completely eliminate the MTrP pain forthwith. It is an attempt to stimulate many sensitive loci (nociceptors) in the MTrP region to induce sharp pain, referred pain or local twitch response. Suggested mechanisms of needling analgesia include effects related to immune, hormonal or nervous system. Compared to slow-acting biochemical effects involving immune or hormonal system, neurological effects can act faster to provide immediate and complete pain relief. Most likely mechanism of multiple needle insertion therapy for MTrP inactivation is to encounter sensitive nociceptors with the high-pressure stimulation of a sharp needle tip to activate a descending pain inhibitory system. This technique is strongly recommended for myofascial pain therapy in order to resume patient’s normal life rapidly, thus saving medical and social resources.
Highlights
Pressure stimulation of an Myofascial trigger point (MTrP) can elicit pain, referred pain, and local twitch response (LTR), all characteristics of an MTrP. [1, 2] Pain elicited by compression of this spot is familiar to the patient as the usual pain complaint [2]
MTrP injection with various solutions has been applied for inactivation of MTrPs: e.g., traditional MTrP injection with Travel’s technique [1], MTrP injection with botulinum toxin A [28,29,30], MTrP injection with multiple rapid insertions [9, 10, 31], injection of taut band plus MTrP [32], pre-injection blocks prior to MTrP injection [32]
Multiple needle insertion technique is widely accepted for MTrP inactivation, by either MTrP injection or dry needling [1, 9, 25, 42, 45, 46]
Summary
Myofascial trigger point (MTP) was defined by Travell and Simons [1, 2] as most tender (hyperirritable) spot in a palpable taut band of skeletal muscle fibers and basic cause of myofascial pain syndrome. They defined latent MTrP is tender, but not painful spontaneously; active MTrP is painful spontaneously or in response to movement of the involved muscle. Latent MTrPs may develop after age one or later when children grow up with repetitive minor traumas to nerves or muscles [4]. Inactivation of a key MTrP can subsequently eliminate satellite MTrPs [2, 10]
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