1. Introduction to Myofascial Trigger Points, Myotherapy Technique,

2. Characteristics of a Myofascial Trigger Point
A hyperirritable spot in skeletal muscle that is associated with a hypersensitive palpable nodule in a taut band.
The spot is painful on compression and can give rise to characteristic referred pain, referred tenderness, motor dysfunction and autonomic phenomena.
Types of myofascial trigger points:
Active, associated, attachment, central, key, latent, primary, and satellite.
Any myofascial trigger point are different to cutaneous, ligamentous, periosteal, or any other nonmuscular trigger point.
(p. 5, Travell, J.G. , Simons, L.S. & Simons, D.G., 1999)

3. Common Clinical Manifestations
Spot Tenderness
Jump Sign
A general pain response of the patient, who winces, may cry out, and may withdraw in response to pressure applied on a trigger point.
Pain Recognition
Familiar pain that the patient has been experiencing
Palpable Taut Band
Referred Pain
Pain that travels or is situated at a distance from the trigger point
Twitch Response
Spontaneous contraction of local muscle fibres
(pp. 1-7, Travell, J.G. , Simons, L.S. & Simons, D.G., 1999)

4. Active Trigger Point
A focus of hyperirritability in a muscle or its fascia that is symptomatic with respect to pain
It causes a pattern of referred pain at rest and/or on motion that is specific for that muscle.
(p. 1, Travell, J.G. , Simons, L.S. & Simons, D.G., 1999)

5. Active Trigger Point
An active trigger point is tender, prevents full lengthening of the muscle, weakens the muscle, usually refers pain on direct compression, mediates a local twitch response of its taut muscle fibers when adequately stimulated, causes tenderness in the pain reference zone, and often produces specific referred autonomic phenomena, generally in its pain reference zone.
To be distinguished from a latent myofascial trigger point.
(p. 1, Travell, J.G. , Simons, L.S. & Simons, D.G., 1999)

6. Latent Trigger Point
A focus of hyperirritability in muscle or its fascia that is clinically inactive with respect to spontaneous pain: it is painful when palpated.
A latent trigger point may have all the other clinical characteristics of an active trigger point, from which it is to be distinguished.
(p. 4, Travell, J.G. , Simons, L.S. & Simons, D.G., 1999)

7. Central Trigger Point
A myofascial trigger point that is closely associated with dysfunctional endplates and is located near the centre of muscle fibres. (p. 2, Travell, J.G. , Simons, L.S. & Simons, D.G., 1999)

8. Attachment Trigger Point
A trigger point at the musculotendinous junction and/or at the osseous attachment of the muscle that identifies the enthesopathy (any disease process at the musculotendinous junction) caused by unrelieved tension characteristic of the taut band that is produced by a central trigger point. (p. 2, Travell, J.G. , Simons, L.S. & Simons, D.G., 1999)

9. Primary Trigger Point
A central myofascial trigger point that was apparently activated directly by acute or chronic overload, or repetitive overuse of the muscle in which it occurs and was not activated as a result of trigger-point activity in another muscle. (p. 6, Travell, J.G. , Simons, L.S. & Simons, D.G., 1999)

10. Key Trigger Point
A trigger point responsible for activating one or more satellite trigger points. Clinically, a key trigger point is identified when inactivation of that trigger point also inactivates the satellite trigger point. (p. 4, Travell, J.G. , Simons, L.S. & Simons, D.G., 1999)

11. Satellite Trigger Point
A central myofascial trigger point that was induced neurogenically or mechanically by the activity of a key trigger point. Distinguishing the mechanism responsible for the key-satellite relationship can rarely be resolved by examination alone.
The relationship usually is confirmed by simultaneous inactivation of the satellite when the key trigger point is inactivated.
A satellite trigger point may develop in the zone of reference of the key trigger point, in an antagonist countering the increased tension of the key trigger point, or in a muscle linked apparently only neurogenically to the key trigger point. (p. 6, Travell, J.G. , Simons, L.S. & Simons, D.G., 1999)

12. Myotherapy
Myotherapy is a form of physical therapy used to treat or prevent soft tissue pain and restricted joint movement caused by musculoskeletal dysfunction.
The philosophy of Myotherapy is founded on Western medical principles including anatomy, physiology and biomechanics.
You don’t need a referral from a doctor to make an appointment with a Myotherapist.

13. Myotherapy
Myotherapy can be used to treat a wide range of musculoskeletal disorders including:
Overuse injury such as tennis elbow or shin splints
Tension headache
Pain caused by poor posture
Some types of chronic back pain
Some types of joint pain, such as shoulder impingement syndrome
Muscle strains.

14. Myotherapy Techniques
Myotherapy techniques refers to the manual application of specialized digital pressure and strokes, most commonly applied by finger or thumb contact.
These digital contacts can have either a diagnostic (assessment) or therapeutic objective and the degree of pressure employed varies between these two modes of application
pp , Chaitow, L., DeLany, J., 2008

15. Myotherapy Techniques
Myotherapy aims
Deactivate Myofascial Trigger Points
Prepare for other therapeutic methods, such as exercise or manipulation (soft tissue)
Relax and normalise tense fibrotic muscular tissue
Enhance lymphatic and general circulation and drainage
Simultaneously offer the practitioner diagnostic information.
pp , Chaitow, L., DeLany, J., 2008

16. Myotherapy Treatments
Treatment depends on the diagnosis.
Myotherapy uses a range of techniques including: Massage, involving sports and remedial techniques
Gently moving the patient’s affected body part through its range of motion (passive stretching)
Hot or cold therapy (Hydrotherapy)
Transcutaneous electrical nerve stimulation (TENS) therapy
Trigger point therapy (acupressure)
Myofascial dry needling

17. References
Chaitow, L & DeLany, J.W (2002): Clinical Application of Neuromuscular Techniques (Vol. 1 & 2). London: Churchill Livingstone.
Simons, D. G., Travell, J. G., Simons, L. S., & Travell, J. G. (1999). Travell & Simons' myofascial pain and dysfunction : the trigger point manual (2nd ed. Vol. 1). Baltimore: Williams & Wilkins