MrRippedZilla
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Most of you readers are aware of myofascial trigger points but for those who are not, it basically refers to a sensitive area of the muscle that is claimed to result in local and/or peripheral pain. This model has been accepted by many as fact when it comes to explaining why people experience pain in these areas but, by the end of this article, it will become clear that this simply isn't the case.
No accurate diagnosis = no confirmation of cause
First of all, I'm not dismissing the actual clinical symptoms. We all know that something is going and that the pain people feel is very real. I am questioning the mechanism of action (MOA) that practitioners seem to believe explains these symptoms. Hell I've seen some guys claim that if you have trigger points then you can't make gains and if you don't seek treatment then it might become a permanent, structural condition. You better have some solid data to make such claims.
So, for trigger points to be the real cause they need to be identifiable. In other words, if pain is a symptom then a diagnosis should identify trigger points as the cause.
https://www.researchgate.net/public...on_for_Diagnosis_of_Myofascial_Trigger_Points
- This is a systematic review paper stating that NO data exists to validate the reliability of trigger point diagnosis.
- "On the basis of limited number of studies available, and significant problems with their design, reporting, statistical integrity, and clinical applicability, physical examination cannot currently be recommended as a reliable test for the diagnosis of trigger points.”
https://www.ncbi.nlm.nih.gov/pubmed/18503816
- Another systematic review paper with a similar conclusion.
“The methodologic quality of the studies for the purpose of establishing trigger point reproducibility is generally poor. More high-quality studies are needed to comment on this procedure.”
Yes, the data does have limitations as addressed in both reviews, but the fact still remains that science hasn't provided us with anything to accurately diagnose trigger points as the cause of pain. If something cannot be accurately diagnosed then it is impossible to accurately suggest what it is and how to treat it. Impossible.
Misunderstanding the true cause of pain
The trigger point model suggests that the cause of pain is related to a structural issue (related to the muscle itself) when in fact the data is pretty clear that pain in general can be explained through the biopsychosocial model.
This model explains that pain has little if anything to do with structure and is related more to biological (genes, biochem interactions, etc) and mental (psychological/social) factors. The evidence behind this model is extremely strong and here is just a couple of papers diving into the topic (warning: not for the non-pro researcher):
http://enniscentre.com/Presentations/Gatchel-Biopsychosocial Approach to Chronic Pain.pdf
https://www.researchgate.net/public...to_platform_a_new_concept_for_pain_management
"Well, if pain is not related to structure then how come certain movements help people alleviate it?" I hear you ask.
Rehab through movement is possible due to its impact on the brain (fitting into the biopsychosocial model). It allows us to target certain portions of the brain (cortical representations) that influence our proprioception, sensory output and threat level - all things that play a part in causing pain to begin with. The impact of the brain on pain perception is discussed in more detail here:
https://www.bodyinmind.org/wp-conte...l-Rep-targeting-the-brain-in-rehab-review.pdf
So trigger points causing myofascial pain is bullshit?
That certainly appears to be the case:
https://academic.oup.com/rheumatology/article-lookup/doi/10.1093/rheumatology/keu471
- This awesome paper diving into the topic at hand concluded that both myofascial pain syndrome and trigger points lack a scientific basis despite evidence looking into the topic. In other words, the pathology at hand is based on nothing but presumption. It's bullshit.
- They also suggest their own theoretical model to explain the clinical symptoms that revolves combining the established MOA of pain, interesting findings regarding nerve allodynia (unexpected pain from touch) and experimental data on nerve inflammation. Good read for any physio nerds out there.
Summary
At best, we don't have enough quality data to suggest that trigger points are the cause of pain. It's an unclear topic that needs more research.
At worst, the trigger point model is complete nonsense and shouldn't be used to explain the symptoms of trainees.
Not a lot of real world, applicable, information here but it does lay some groundwork for when I do get around to writing rehab/mobility/whatever type stuff
No accurate diagnosis = no confirmation of cause
First of all, I'm not dismissing the actual clinical symptoms. We all know that something is going and that the pain people feel is very real. I am questioning the mechanism of action (MOA) that practitioners seem to believe explains these symptoms. Hell I've seen some guys claim that if you have trigger points then you can't make gains and if you don't seek treatment then it might become a permanent, structural condition. You better have some solid data to make such claims.
So, for trigger points to be the real cause they need to be identifiable. In other words, if pain is a symptom then a diagnosis should identify trigger points as the cause.
https://www.researchgate.net/public...on_for_Diagnosis_of_Myofascial_Trigger_Points
- This is a systematic review paper stating that NO data exists to validate the reliability of trigger point diagnosis.
- "On the basis of limited number of studies available, and significant problems with their design, reporting, statistical integrity, and clinical applicability, physical examination cannot currently be recommended as a reliable test for the diagnosis of trigger points.”
https://www.ncbi.nlm.nih.gov/pubmed/18503816
- Another systematic review paper with a similar conclusion.
“The methodologic quality of the studies for the purpose of establishing trigger point reproducibility is generally poor. More high-quality studies are needed to comment on this procedure.”
Yes, the data does have limitations as addressed in both reviews, but the fact still remains that science hasn't provided us with anything to accurately diagnose trigger points as the cause of pain. If something cannot be accurately diagnosed then it is impossible to accurately suggest what it is and how to treat it. Impossible.
Misunderstanding the true cause of pain
The trigger point model suggests that the cause of pain is related to a structural issue (related to the muscle itself) when in fact the data is pretty clear that pain in general can be explained through the biopsychosocial model.
This model explains that pain has little if anything to do with structure and is related more to biological (genes, biochem interactions, etc) and mental (psychological/social) factors. The evidence behind this model is extremely strong and here is just a couple of papers diving into the topic (warning: not for the non-pro researcher):
http://enniscentre.com/Presentations/Gatchel-Biopsychosocial Approach to Chronic Pain.pdf
https://www.researchgate.net/public...to_platform_a_new_concept_for_pain_management
"Well, if pain is not related to structure then how come certain movements help people alleviate it?" I hear you ask.
Rehab through movement is possible due to its impact on the brain (fitting into the biopsychosocial model). It allows us to target certain portions of the brain (cortical representations) that influence our proprioception, sensory output and threat level - all things that play a part in causing pain to begin with. The impact of the brain on pain perception is discussed in more detail here:
https://www.bodyinmind.org/wp-conte...l-Rep-targeting-the-brain-in-rehab-review.pdf
So trigger points causing myofascial pain is bullshit?
That certainly appears to be the case:
https://academic.oup.com/rheumatology/article-lookup/doi/10.1093/rheumatology/keu471
- This awesome paper diving into the topic at hand concluded that both myofascial pain syndrome and trigger points lack a scientific basis despite evidence looking into the topic. In other words, the pathology at hand is based on nothing but presumption. It's bullshit.
- They also suggest their own theoretical model to explain the clinical symptoms that revolves combining the established MOA of pain, interesting findings regarding nerve allodynia (unexpected pain from touch) and experimental data on nerve inflammation. Good read for any physio nerds out there.
Summary
At best, we don't have enough quality data to suggest that trigger points are the cause of pain. It's an unclear topic that needs more research.
At worst, the trigger point model is complete nonsense and shouldn't be used to explain the symptoms of trainees.
Not a lot of real world, applicable, information here but it does lay some groundwork for when I do get around to writing rehab/mobility/whatever type stuff
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