Since early times, massage has been present as one of the most important methods to treat and prevent musculoskeletal disorders, which are considered one of the main causes of disability in the population (Alvarez & Rockwell, 2002). Regarding musculoskeletal conditions, myofascial pain syndrome is “one of the most frequent causes of muscular pain and it is characterized by the presence of myofascial trigger points” (Aguilera et al., 2009, p. 515). Trigger point is defined as a painful and palpable nodule in skeletal muscle that produces referred pain and autonomic phenomena (Fryer & Hodgson, 2005). Literature review has shown that, within different approaches involved in the ...view middle of the document...
Moreover, the aetiology of trigger point is not well defined. However, many pieces of research have been done and the most accepted hypothesis is related to the “existence of dysfunctional endplates leading to a perpetuated shortening of the muscle” (Aguilera et al., 2009, p. 515). It means that trigger point can be a result of bad posture, chronic strain, ergonomic problems, trauma or even stress (Nguyen, 2010). All these factors lead to muscle overload and consequently modification of the neuromuscular endplate. Thus, as a way to respond to this overload, the motor plate releases a large amount of acetylcholine, which will result in sarcomere shortening and continued contraction of the muscle area, leading to local ischemia and hypoxia. The imbalance between energy demand and energy supply causes the release of noxious substances, responsible for pain (Fryer & Hodgson, 2005).
The diagnosis of trigger point is usually done by physical examination and palpation of muscle tissues. During palpation, the physiotherapist must pay attention to the physical signs, such as presence of palpable nodule, referred pain by patient, limitation of range of movement and presence of visible muscle contraction while the pressure is applied on the zone (Peñas, Campo, Carnero & Page, 2005). The degree of pain reported by the patient is not related to the size of the affected muscle but to the stage of the trigger point (Nguyen, 2010). Following this, in order to measure the degree of pain, physiotherapists can use a pain scale while they apply the pressure on the area. Research has shown that after 30 seconds patients report reduction of discomfort or pain (Fryer & Hodgson, 2005).
In view of assisting to identify trigger points, there are charts exhibiting the most common places in the muscles to them, as showed in figure 1. Nevertheless, it must be used only as a guide for the physiotherapist since trigger points can be located at any point of the muscles and sometimes they do not follow a pattern (Nguyen, 2010). Consequently, it is important to highlight that many researchers believe that trigger points’ diagnose is considerably subjective and its reliability is controversial because there are no definitive clinical tests to prove the condition (Fryer & Hodgson, 2005).
2.1 TRIGGER POINT THERAPY
Current literature review has demonstrated several treatment modalities to treat trigger point, decreasing the size of the nodule and level of pain related by patients. These techniques are divided into invasive (as injection therapy) and non-invasive groups (as ultrasound, stretching and ischaemic compression) (Aguilera et al., 2009).
One significant technique used to treat trigger point is ischaemic compression (Nguyen, 2010). According to Fryer and Hodgson (2005), ischaemic compression technique is also referred as ‘manual pressure release’ or ‘trigger point pressure release’ and, as the names suggest, is based on the manual pressure on the painful spot...