Abstract
Objective: To examine the mechanisms that underlie the development of the myofascial trigger point [TrP].Results: The TrP represents chronically dysfunctional muscle, but initiation and persistence of the TrP taut band have not been fully explained. Studies suggest that the initiating factors are excessive mechanical forces generated by muscle. Supramaximal muscle contraction, overloaded eccentric contraction, or repetitive activity are consistent with Simons' hypothesis of an energy crisis as a critical event. Ischemia, hypoxia, and cell damage occur, leading to the release of cytokines, bradykinin, substance P, and calcitonin-gene-related peptide, all of which activate peripheral nociceptors. The taut band, chronically contracted, displays a sympathetic nervous system [SNS] modulated, localized, excessive endplate potential activity that produces a localized, nonpropagated contraction. The net effect is an excess of acetylcholine [ACh] at the motor end plate. This results from a combination of excess sp...
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