“The Pain from Someplace Else”
Myofascial Pain and Trigger Point
3 Hours Continuing Education
Carolyn McMakin, M.A.,D.C.
CBC, chem screen, sed rate, CPK, MRI, CT, EMG will be normal. Test
thyroid when the history and physical findings indicate that it may be
a problem. One study showed alterations in LD enzymes - LD1 and LD2
were decreased, LD3, 4,5 were increased, another study showed opposite
alterations. Thermograms of skin overlying the trigger point showed
an increase in skin temperature 5-10 cm in diameter. There is a small
area of increased skin conductance, reduced skin resistance, over a trigger
What to look for
- A history of sudden onset following an acute overload stress, such as a
whiplash or lifting injury, or a history of gradual onset with chronic
overuse of the affected muscle.
- Characteristic patterns of pain that are referred from myofascial trigger
points specific to individual muscles. Check your charts.
- Weakness and restriction in the stretch range of the affected muscle.
- A taut, palpable band in the affected muscle.
- Exquisite, focal tenderness to digital pressure in the taught band of muscle
- A local twitch response elicited through palpation of the tender spot.
- Reproduction of the patient’s pain complaint or other symptoms by pressure
on the trigger point.
- Elimination of symptoms when the affected muscles are treated appropriately.
If the symptoms don’t get better - keep looking.
- Exercise, physical therapy, or conditioning makes the pain worse when there
are active trigger points in the muscle, but makes latent trigger points
less prone to reactivation.
- polymyalgia rheumatica,
- giant cell arteritis,
- infection - both viral and bacterial,
- disc bulges/ruptures.