Introduction

Osteopathy takes a distinct and holistic approach to the management of Myofascial Pain Syndrome (MPS) and trigger points. Based on an in-depth assessment of muscle and fascial tissues, this approach aims to understand the mechanisms underlying the formation of tender points, which can result from excessive tension, trauma or postural dysfunction.

The first step in the osteopathic management of MDS consists of a careful assessment of the patient. Practitioners review medical history, assess posture, and identify areas of pain or tension. This global assessment makes it possible to determine musculoskeletal dysfunctions and design a treatment plan adapted to each patient.

Osteopathic techniques aimed at treating MDS generally include specific methods to release muscular tension, improve blood and lymphatic circulation, as well as restore postural balance. Myofascial release, which involves releasing tension in muscles and fascia, is commonly used. Specific stretches and, sometimes, trigger point techniques are also used to deactivate trigger points, helping to reduce pain and restore normal muscle function.

The osteopathic approach goes beyond treating visible symptoms. It integrates environmental, emotional and behavioral elements likely to influence the manifestation of SDM. Osteopaths take into consideration the patient’s lifestyle, stress level, and other contributing factors to develop a holistic understanding of their condition.

David Simons and Janet Travell have contributed greatly to the advancement of modern knowledge of trigger points. Their work in the 20th century, notably with the publication of “Myofascial pain and dysfunction, The Trigger Point Manual”, laid the foundation for the in-depth understanding of MDS. They were among the first to specifically explore the role of muscle (myo) and fascia in the genesis of pain and dysfunction.

Trigger points, often associated with Myofascial Pain Syndrome (MPS), arise from persistent contractions in the sarcomeres, the functional units of muscles. Normally, these points act like small pumps, alternating between contraction and relaxation to promote blood circulation in the muscle capillaries. However, when the sarcomeres at a trigger point persist in their contraction, blood flow to the immediate area is disrupted. This leads to a lack of oxygen and the accumulation of metabolic waste, thereby irritating the trigger point. In response, the trigger point sends a pain signal to the brain, prompting the muscle to rest (stop using it). Paradoxically, this reaction can worsen pain by intensifying muscle contraction at the trigger point.

Ischemic compression therapy offers an alternative treatment approach for myofascial trigger points. This technique uses either low pressure, applied at the pain threshold, for a prolonged period (about 90 seconds), or higher pressure, maintained at a level midway between the pain threshold and pain tolerance, but applied more briefly (around 30 seconds). The goal of this method is to immediately relieve the pain associated with trigger points and remove their sensitivity.

Ischemic compression aims to induce temporary local ischemia, thereby reducing blood flow to the trigger point region. This has the effect of disrupting the cycle of persistent muscle contraction, allowing the muscle to relax and promoting pain reduction. The technique can also help restore normal blood circulation, removing accumulated metabolic waste.

It is important to note that ischemic compression therapy should be performed by trained healthcare professionals, as incorrect application could result in adverse effects. The method can be integrated into a broader approach to osteopathic management of MDS, aimed at treating the underlying causes, restoring normal muscle function and promoting the overall well-being of the patient.

Trigger points or muscular “knots” are small hypersensitive areas which, with stimulation, systematically produce a reflex mechanism causing distant pain and/or other manifestations in a specific and constant area. ‘one person to another. These points have been documented in a comprehensive and systematic manner by Janet Travell, MD and David Simons, MD.

Identifying the muscle knot can be complex. It is best to start with the perception of the muscle fibers that are contracted. Mastery in spotting the knot comes with practice. When I release the muscle knot, I always ensure that the muscle is in a resting state.

For example, when treating the biceps brachii, I ensure that the arm is flexed at rest (counterstrain technique). I am of the opinion that beginners often tend to put excessive pressure on the muscle. Excessive pressure can decrease the sensitivity of the tactile corpuscles. It’s best to take a gradual approach.

Pain, as well as increased tension, induced by a trigger point are usually projected and felt some distance from the specific point. Pain referral patterns often show up around a joint, where the pain is most likely to prompt you to adjust the activities or conditions that are causing the problem. It is important to note that the combination of symptoms can vary greatly depending on the positions or activities triggering the pain. Therefore, complaints can fluctuate significantly within a day as well as from day to day.

I have noticed that if the patient takes deep breaths, the trigger nodes will release much more quickly. I believe that an oxygen supply helps with relaxation.

Cross section showing two-dimensional palpation of a bundle of tense muscles (black ring) and its trigger point. Two-dimensional palpation is used by muscles that are only accessible from one side, such as the infraspinatus. A At the start of palpation, the skin is pushed back. B The tip of the finger slides over the muscle fiber; A bundle of taut fibers can be recognized from its rope-like texture. C The skin is finally pushed to the other side. The same movement is called rapid palpation when it is performed more quickly. df Cross section illustrating palpation by pinching a bundle of tense muscle fibers (black ring) at the trigger point. Pinch palpation is suitable for muscles that can be grasped with the fingers. This applies, for example, to the sternocleidomastoid muscles (MST), pectoralis major and latissimus dose. D Muscle fibers in the pinch grip between the thumb and fingers. E The narrowness of the stretched fiber bundle is clearly detectable when rolled between the fins. By changing the angle of the fingertip joints, a rocking motion is created which allows for better perception of details. (5) The palpable edge of the bundle of taut fibers is clearly distinguishable as it escapes between the fingertips. Often a local contraction reaction occurs simultaneously
Illustration of a bundle of taut fibers, myofascial trigger points and a local contraction response in a cross section of muscle. (a) Palpation of a bundle of tense fibers (straight lines) surrounded by relaxed muscle fibers (wavy lines). The density of the points reflects the degree of sensitivity to pressure in the bundle of tense fibers. The trigger point is the most pressure-sensitive location in the fiber bundle. (b) By rolling the fiber bundle rapidly under the fingertip at the location of the trigger point, a local twitch reaction is often caused, which is most clearly manifested as the main movement between the trigger point and the fixation of muscle fibers.

The definition of the trigger point according to Janet Travell

Medical therapist Janet G. Travell defined the trigger point as a localized area in a skeletal muscle, characterized by deep and specific sensitivity. This point is identifiable by the presence of a firm, palpable band of muscle, also called muscle hardening. The trigger point is defined by the manifestation of maximal profound hyperalgesia, often accompanied by a positive “jump sign”. The latter results in a visible shortening of the part of the muscle which contains the band when stimulated.

To optimally trigger the jump sign, it is necessary to place the relaxed muscle under moderate passive tension and stimulate the band briskly with the palpating finger. An active trigger point must also be distinguished by its ability to refer symptoms or sensations to a target area, which differentiates it from a latent trigger point. A latent stitch may not be active unless stimulated by stress or tension on surrounding tissues. The specificity of the referring symptoms distinguishes active trigger points from other areas of discrete palpable soft tissue dysfunction.

Causes of Trigger Points

Several factors contribute to the appearance of trigger points. One of the most common triggers is excessive muscle stress. When a muscle is under constant load or tension, it can respond by developing hyperirritable areas. This can occur as a result of muscle overuse, prolonged incorrect posture, or repetitive movements.

Muscle injuries, whether acute or chronic, can also be major causes of trigger points. Direct trauma, such as muscle sprains, can create areas of tension and irritation that can become trigger points. In addition, repetitive microtrauma, often associated with specific sports or professional activities, can contribute to the formation of these tender points.

Postural and muscular imbalances also play a significant role in the appearance of trigger points. Incorrect posture or chronic muscular imbalances can lead to uneven distribution of load on the muscles, favoring the development of hyperirritable areas. Overworked muscles often compensate by creating trigger points to handle the added stress.

Another key factor is the restriction of blood flow to muscle tissue. Poor circulation can lead to a buildup of metabolites, such as lactic acid, leading to irritation of muscle fibers and the formation of trigger points. Circulatory disorders, lack of physical activity, or even body positions that limit blood flow can contribute to this phenomenon.

The causes of trigger points are often multifactorial, involving both physical and psychological factors. Emotional stress and mental tension can manifest physically, causing muscle contractions and contributing to the formation of trigger points. Sedentary lifestyle habits, lack of exercise and sleep disorders can also influence the development of these tender points.

  1. Muscle Overuse: Excessive or repetitive use of a muscle can lead to trigger points. This may be due to intense physical activities, repetitive movements, or muscle overload.
  2. Muscle Tension: Stress and chronic muscle tension can promote the development of trigger points. Tight muscles tend to form areas of abnormal contraction.
  3. Poor Posture: Improper posture, whether sitting, standing or sleeping, can put uneven pressure on certain muscles, encouraging the formation of trigger points.
  4. Muscle Injuries: Injuries, even minor ones, can cause trigger points to form. Injured muscles may respond by developing areas of tension and tenderness.
  5. Anatomical Defects: Some individuals may have anatomical abnormalities that make certain areas more susceptible to the development of trigger points.
  6. Emotional Stress: Emotional stress can manifest physically in the form of muscle tension, contributing to the formation of trigger points.
  7. Poor Lifestyle Habits: Lifestyle habits such as lack of exercise, sedentary lifestyle, smoking, or an unbalanced diet can also play a role in the formation of trigger points.
  8. Underlying Medical Conditions: Certain medical conditions, such as fibromyalgia, chronic fatigue syndrome, or neurological disorders, may increase the likelihood of developing trigger points.

How ischemic pressure relaxes the myofascial knot

Let’s explore how ischemic pressure can contribute to the relaxation of a myofascial knot. Myofascial knots, also called trigger points, are localized areas of tension in muscles and connective tissue, often associated with referred pain and movement restrictions. Applying ischemic pressure, a type of focused pressure that temporarily reduces blood flow to the targeted area, is a technique commonly used by healthcare professionals, including osteopaths, to relieve these muscle tensions.

When ischemic pressure is applied to a myofascial node, it acts in several ways to promote relaxation. First, the temporary compression of blood vessels in the area restricts blood flow to the muscle, creating local ischemia. It may seem counterintuitive, but this temporary decrease in blood supply can induce a series of beneficial physiological responses.

Ischemic pressure helps reduce electrical activity in muscle fibers, thereby causing relaxation of the muscle. By reducing the transmission of nerve signals that cause muscle contraction, ischemic pressure promotes a reduction in tension in the myofascial node. This can result in immediate relaxation and a reduction in associated pain.

At the same time, the temporary reduction of blood flow during the application of ischemic pressure can help normalize the inflammatory response in the area of ​​the myofascial node. Often these tight areas are associated with local inflammation. By temporarily restricting blood supply, ischemic pressure can help reduce inflammation and promote an environment conducive to healing.

Another key component of the ischemic pressure response is trigger point release. These tender points in the muscles, often felt as painful nodules, can cause a variety of symptoms, including referential pain. Ischemic pressure applied in a targeted manner to these trigger points can stimulate a release response, allowing the muscle to return to its normal flexibility and mobility.

Ischemic pressure, when applied correctly, can also help improve blood flow after it is released. When the pressure is lifted, blood flows to the area, bringing essential nutrients and helping to remove accumulated metabolic waste. This promotes muscle healing and recovery, essential for preventing the recurrence of myofascial knots.

  1. Reduced Blood Flow: When ischemic pressure is applied to the myofascial node, it temporarily restricts blood flow to the targeted area. This creates a situation of ischemia, where the blood supply is momentarily reduced.
  2. Relaxation of muscle fibers: Ischemia induced by ischemic pressure contributes to the relaxation of contracted muscle fibers. By reducing blood supply, we promote a reduction in muscle tension.
  3. Dissipation of metabolic waste: Myofascial knots are often associated with an accumulation of metabolic waste in the tissues. Ischemic pressure helps dissipate these wastes by stimulating lymphatic drainage and promoting the elimination of unwanted substances.
  4. Activation of the relaxation response: Ischemic pressure can trigger the relaxation response of the autonomic nervous system. Applying constant pressure to the knot encourages the muscle to move from a state of contraction to a state of relaxation.
  5. Stimulation of sensory receptors: Ischemic pressure stimulates sensory receptors in the treated area. This can change the perception of pain and promote a relaxation response in the nervous system.
  6. Improved mobility: By releasing the myofascial knot, ischemic pressure can improve joint mobility associated with the treated area. This helps restore normal muscle function.

Ischemic pressure can be seen as a form of controlled “temporary strangulation” applied to the muscle. By temporarily reducing blood supply to the targeted area, it induces local ischemia, which means a temporary lack of oxygen and nutrients.

When muscle tissue senses this oxygen deprivation and increased presence of metabolic waste, it responds by releasing chemicals that signal the central nervous system that something is wrong. This triggers a reflex response from the body to relax the muscle, thereby reducing tension and promoting relaxation of the muscle fibers.

How the body’s reflex response is triggered to relax the muscle in response to ischemic pressure.

When ischemic pressure, usually caused by a temporary restriction of blood supply, is detected by the body’s sensory receptors, it triggers a series of reflex responses. Sensory nerve fibers, known as nociceptors, play a crucial role in transmitting these signals to the central nervous system.

The message is carried to the spinal cord, where there is rapid communication with the motor neurons. These motor neurons, in turn, send signals to the affected muscles, triggering a relaxation response. This process is mediated by the release of neurotransmitters, such as acetylcholine, which act on neuromuscular junctions to promote muscle relaxation. In parallel, autonomic reflex responses can be triggered, influencing vasodilation to restore blood perfusion.

The role of the autonomic nervous system, divided into the sympathetic and parasympathetic systems, is also crucial. In response to ischemic pressure, the sympathetic system may be activated, causing a release of adrenaline which stimulates adrenergic receptors in the muscles and promotes their contraction. Conversely, the parasympathetic system tends to promote muscle relaxation by releasing acetylcholine.

It is important to note that the body’s reflex response to ischemic pressure is not solely a matter of protection against tissue damage. It can also be modulated by psychological and emotional factors, highlighting the complex interplay between body and mind in regulating physiological responses.

  1. Stimulation of pain receptors: Ischemic pressure causes stimulation of pain receptors (nociceptors) present in the muscle. These nociceptors are sensitive to changes in muscle tissue, such as ischemia (decreased blood supply) and accumulation of metabolites.
  2. Release of neurotransmitters: In response to stimulation of nociceptors, neurotransmitters, such as substance P, are released. These neurotransmitters transmit pain signals to the central nervous system.
  3. Muscle relaxation reflex: Pain signals from nociceptors trigger a muscle relaxation reflex. This reflex is a protective reaction of the body to minimize potential damage to the affected area. It is mediated by the autonomic nervous system, particularly the parasympathetic component.
  4. Inhibition of muscle fibers: In response to the relaxation reflex, the central nervous system sends inhibitory signals to the motor neurons that innervate the muscle concerned. These signals inhibit the activity of muscle fibers, thus promoting muscle relaxation.
  5. Improved blood flow: Although the initial ischemic pressure temporarily reduces blood supply, the resulting muscle relaxation can improve blood flow after the pressure is lifted. This allows the return of oxygen and nutrients necessary to the muscle.
  6. Reducing tension: Ultimately, this process helps reduce muscle tension, promote relaxation of muscle fibers, and improve flexibility.

Myofascial release technique with ischemic compression

The myofascial release technique with ischemic compression involves several steps to relax myofascial knots and reduce muscle tension. Here is a general description of the steps involved in this technique:

  1. Patient Assessment: Before beginning the technique, the practitioner should perform a thorough assessment of the patient to identify areas of muscle tension, myofascial knots, and trigger points.
  2. Patient positioning: The patient is positioned to optimally expose the area to be treated. This may involve adjusting posture to allow adequate access to the affected muscle.
  3. Positional release: The practitioner uses positional release techniques to place the muscle in a position where it can relax effectively. For example, in the case of biceps brachii treatment, the patient’s arm can be placed in flexion at rest (counterstrain).
  4. Localization of the myofascial node: The practitioner uses palpatory skills to precisely locate the myofascial node. He explores the area looking for areas of tension, muscle hardening and sensitive points.
  5. Application of ischemic pressure: Firm but controlled pressure is applied to the myofascial node. This ischemic pressure aims to temporarily restrict blood circulation in the area, thus promoting the relaxation of muscle fibers.
  6. Maintaining pressure: The practitioner maintains pressure for a specific period of time, usually between 30 seconds and several minutes, depending on patient tolerance and tissue response.
  7. Gradual release: After the period of ischemic compression, the pressure is released gradually. This allows blood to return to the area, bringing oxygen and nutrients to the tissues.
  8. Assessment of Patient Response: The practitioner carefully monitors the patient’s response during and after the procedure, taking note of any changes in sensation, muscle tension, or joint mobility.
  9. Reassessment and adjustment: Depending on the patient’s reaction, the practitioner can reassess the area and adjust the technique as needed. Subsequent sessions may be necessary to thoroughly address persistent areas of tension.

Myofascial Release Techniques

Myofascial release techniques play a crucial role in the field of osteopathy by treating trigger points and relieving myofascial pain syndrome. These specific approaches aim to release accumulated tension in the connective tissues, thereby improving mobility, reducing pain and promoting healing. Explore in detail some of these techniques used in osteopathy:

List
  1. Direct Myofascial Release (DMD):
    • This technique involves the direct application of sustained pressure to areas of muscle tension or trigger points. Practitioners often use their hands, fingers, or specific tools to target specific areas of the fascia.
  2. Indirect Myofascial Release (IMI):
    • Unlike LMD, LMI uses a gentler approach. Practitioners apply light pressure in the opposite direction of the restriction, encouraging tissue relaxation without causing excessive pain.
  3. Active-Global Release (AGR):
    • The RAG actively engages the patient in the release process by asking them to participate in specific movements while the practitioner applies targeted pressure. This promotes the re-education of movements and the release of tension.
  4. Ischemic Compression:
    • This technique involves applying sustained pressure to a specific trigger point for an extended period of time. Ischemic compression aims to reduce blood supply to the area, which can cause the trigger point to relax.
  5. Stripping Myofascial :
    • This technique involves applying sustained pressure along a strip of muscle tissue to release adhesions and improve mobility. The practitioner often uses their hands, elbows, or other parts of the body to perform the stripping.
  6. Myofascial Stretching:
    • Myofascial stretching aims to stretch connective and muscular tissues to improve flexibility and reduce tension. These stretches are often done in a gradual and controlled manner.
  7. Working on Trigger Points:
    • The identification and release of trigger points, which are hypersensitive areas in the muscles associated with pain, are an integral part of myofascial release in osteopathy. Practitioners apply specific pressure to these points to cause relaxation.
  8. Craniosacral Myofascial Release:
    • This technique focuses on releasing tension in the craniosacral system, including the skull, spine and sacrum. It aims to restore cerebrospinal fluid balance and relieve movement restrictions.
  9. Fascial Distortion Model (FDM) :
    • The FDM identifies different fascial “distortions” that correspond to specific types of pain. Practitioners apply targeted techniques to restore form and function to affected tissues, focusing on recognizing distortions.
  10. Visceral Osteopathy:
    • Visceral osteopathy considers the relationships between internal organs and the musculoskeletal system. By treating fascial restrictions around organs, this approach can have positive effects on trigger points and myofascial pain.
  11. Positional Release (Strain and Counterstrain):
    • This technique involves finding a comfortable position for the patient, followed by light manipulation to relieve trigger points. She uses a gentle approach to release tension without causing pain.
  12. Muscle Energy Techniques (MET):
    • Muscle energy techniques involve the controlled contraction and relaxation of muscles in a specific direction. They are used to release tension and improve mobility of muscular and fascial tissues.
  13. Craniosacral Therapy:
    • In addition to craniosacral myofascial release, craniosacral therapy focuses on regulating cranial rhythm and releasing tension in the membranes surrounding the brain and spinal cord.
  14. Cyriax Techniques:
    • Cyriax techniques include the use of deep transverse massage to treat adhesions and restrictions in muscular and fascial tissues.
  15. Exercise Therapy:
    • Osteopaths can prescribe specific exercises to strengthen and stretch muscles, promoting better posture and reduced myofascial tension.
  16. Somato-Emotional Liberation:
    • This approach recognizes the links between muscular tensions and the emotional aspects of the patient. Osteopaths use specific techniques to release emotional tensions stored in the body.
  17. Neuromuscular Technique (NMT) :
    • NMT focuses on managing trigger points using compression, stretching and massage techniques. It aims to normalize nerve signals in the muscles to relieve pain.
  18. Trigger Point Dry Needling (TDN) :
    • Although it can also be practiced by healthcare professionals other than osteopaths, NDT involves the use of needles to treat trigger points. This aims to cause a relaxation response in the muscles.
  19. Manipulation Myotensive :
    • This approach involves the gentle manipulation of muscles and tendons to reduce tension. It can be used to treat specific muscles affected by trigger points.
  20. Myofascial Acupuncture Point Therapy:
    • The osteopath may use specific acupuncture points to treat trigger points, by stimulating points along the acupuncture meridians.
  21. Reflexology:
    • Reflexology applies pressure to specific areas of the feet, hands or ears, linked to reflex zones in the body. This can help release tension and improve circulation.
  22. Active Positional Release (Active Release Technique – ART):
    • ART is a technique that combines active patient movement with manual release of muscle tension. It specifically targets adhesions and restrictions in soft tissues.
  23. Compression Point Therapy:
    • Using targeted pressure on specific points along muscle meridians, this approach aims to release tension and improve blood circulation.
  24. Bowen Technique :
    • The Bowen technique involves gentle, specific movements on muscles, tendons and nerves to encourage the release of tension. Pauses between movement sequences give the body time to react and adjust.
  25. Alexander method:
    • This method aims to improve posture and movement by eliminating harmful postural habits. She uses manual techniques to help patients become aware of and modify their motor patterns.
  26. Integrated Manual Therapeutic Strategies (IMTS):
    • STMI combines different manual approaches, including myofascial release, muscle techniques and joint mobilizations, to comprehensively address muscle tension and fascial restrictions.
  27. Holistic Gymnastics:
    • This approach uses overall movements and exercises to restore muscular balance and improve posture. It may include stretching, muscle strengthening and coordination exercises.
  28. Feldenkrais method:
    • This method focuses on improving body awareness and movement. Practitioners use slow, deliberate movements to help patients identify and change ineffective motor patterns.
  29. Muscle Biofeedback:
    • Muscle biofeedback uses devices to measure and display muscle activity in real time. This allows patients to become aware of muscle tension and release them voluntarily.
  30. Energy Work (Reiki, Qigong):
    • These energetic approaches aim to rebalance the energy in the body. Although they do not directly target trigger points, they can contribute to an overall state of well-being, thereby reducing stress and tension.
  31. Treatment of Muscle Chains:
    • This approach views the body as a series of interconnected muscular chains. Practitioners work on all of these chains to restore muscular balance and improve mobility.
  32. Energy Chain Therapy (Poyet Method):
    • This method considers the body as an interconnected energy system. Practitioners use gentle manual techniques to release tension in energy chains, promoting the flow of energy.
  33. Nervous Mobilizations:
    • Nerve mobilizations aim to release tension around compressed or irritated nerves. This can help reduce pain associated with trigger points related to nerve compression.
  34. Deep Fascia Therapy:
    • By focusing on the deeper layers of the fascia, this approach aims to release adhesions and restore tissue mobility. Techniques may include deep pressure and stretching.
  35. Reflex Point Therapy:
    • This approach uses the stimulation of specific reflex points on the feet, hands or other parts of the body to positively influence the corresponding organs and areas, thus promoting the release of tension.
  36. Postural Integration:
    • Postural integration focuses on correcting postural imbalances that can contribute to trigger points. Practitioners use techniques to realign the body and improve posture.
  37. Gentle Joint Mobilizations (Engström Technique):
    • This technique is characterized by gentle and specific joint mobilizations aimed at improving joint mobility, thus relieving associated muscular tension.
  38. Neuro-Emotional Therapy (NET):
    • The NET explores the relationship between emotions and physical tensions. She uses specific techniques to release negative emotions trapped in the body, which can help relieve trigger points.
  39. Integrated Myotensive Therapy (IMT):
    • IMT combines myofascial release techniques, joint mobilizations and gentle manipulations to comprehensively treat musculoskeletal disorders and trigger points.
  40. Biodynamic Approach:
    • This approach focuses on the regulation of the body’s internal vital forces. Practitioners use gentle techniques to facilitate balancing of the nervous system and energy system.
  41. Global Postural Rehabilitation (GRP):
    • RPG focuses on correcting postural imbalances. Specific exercises and stretches are used to re-educate the muscles and fascia, promoting optimal posture.
  42. Applied Kinesiology:
    • Applied kinesiology uses muscle testing to assess energetic and structural imbalances. Practitioners incorporate myofascial release techniques to correct these imbalances.
  43. Structural Integration Therapy (Rolfing):
    • Rolfing aims to realign the body by working on the fascial structure. Practitioners use specific manipulations to release adhesions and restore structural balance.
  44. Deep Tissue Approach:
    • This approach focuses on manipulating deep connective tissues to release tension and improve mobility. Techniques may include deep pressure and stretching.
  45. Dry Needling Trigger Point Therapy:
    • Although similar to Trigger Point Dry Needling, this approach can be used by osteopaths to treat trigger points by inserting fine needles into the muscles, eliciting a relaxation response.
  46. Active Joint Mobilizations:
    • By actively engaging the patient in specific movements, osteopaths can apply joint mobilizations while working on muscular coordination and tension reduction.
  47. Somatic Emotion Release (SE) Method:
    • SE explores the connection between emotions and bodily sensations. Practitioners help patients release physical tension related to past emotional experiences.
  48. Neurodynamic Approach:
    • This approach focuses on gently manipulating the nerves to improve their mobility and reduce irritation. It can be particularly useful in cases of pain associated with nerve compression.
  49. Manual Therapy of Temporomandibular Joints (TMJ):
    • When trigger points are associated with temporomandibular joint disorders, this therapy focuses on gentle manipulation of the jaw to reduce tension.
  50. Bioenergy:
    • The bioenergetic approach aims to balance energy flows in the body using specific movements, breaths and visualizations to release energetic blockages.
  51. Somato-Emotional Osteopathy:
    • This approach explores the connection between physical tensions and emotional aspects. Osteopaths use techniques to release emotions stored in the tissues, thus promoting the release of trigger points.
  52. Neuro-Fascial Approach (NFT) :
    • The neuro-fascial approach aims to restore balance in the nervous system and fascia. It may include gentle mobilization techniques to reduce restrictions in these systems.
  53. Mobilization of the Muscular Chains (Busquet):
    • This approach targets specific muscle chains in the body, using gentle mobilizations to restore muscle balance and improve mobility.
  54. Functional Integration Therapy (IFT):
    • IFT combines manual techniques with specific exercises to restore muscle function and joint mobility, while working on integrating movement into daily life.
  55. Mézières method:
    • This method focuses on correcting postural imbalances using overall stretches and manual techniques to release tension.

These myofascial release techniques, when applied by qualified osteopathic professionals, offer a holistic approach to treating trigger points and relieving myofascial pain syndrome. They can be integrated into a personalized care plan aimed at improving functionality, reducing pain and promoting the patient’s overall well-being.

Holistic Approaches in Osteopathy

A holistic approach in osteopathy is essential in the treatment of Myofascial Pain Syndrome (MPS), as it recognizes that an individual’s health and well-being are influenced by varied factors, going beyond just the physical aspects. . Let us highlight the importance of a holistic approach by considering environmental, emotional and behavioral factors in the treatment of MDS:

  1. Environmental factors :
    • Environmental conditions, such as workplace, lifestyle, and exposure to external stresses, can have a significant impact on muscle health and the manifestation of MDS. A holistic approach in osteopathy takes these factors into account to develop appropriate treatment strategies.
  2. Emotional stress:
    • Emotional stress is often linked to the onset and worsening of MDS. Negative emotions, difficult life situations or psychosocial factors can contribute to muscle tension. Holistic care takes these emotional aspects into consideration, integrating relaxation and stress management techniques into the treatment plan.
  3. Postural Behaviors and Lifestyle Habits:
    • Postural habits, repetitive movements, and other lifestyle behaviors can be triggers or contributors to MDS. A holistic approach examines these behaviors and offers postural adjustments, ergonomic advice, and lifestyle modifications to prevent recurrence.
  4. Nutrition and Hydration:
    • Proper nutrition and sufficient hydration play a crucial role in muscle health and the healing process. A holistic approach integrates nutritional and fluid advice to promote recovery and support the musculoskeletal system.
  5. Psychosocial Aspects:
    • Interpersonal relationships, social support, and psychological aspects are often linked to the manifestation of myofascial pain. Holistic care involves exploring these aspects to understand the influence of daily life on the patient’s overall health.
  6. Patient Education:
    • A holistic approach to osteopathy includes educating the patient about the nature of their MDS, contributing factors, and means of self-management. This empowers the patient and promotes active participation in their healing process.

Role of diet in SDM

Diet plays a significant role in the manifestation of Myofascial Pain Syndrome (MPS), influencing inflammation levels, cellular nutrition, and muscle health. Exploring these connections helps to understand how a balanced diet can impact MDS and help manage this condition.

  1. Reduction of Inflammation:
    • Certain foods can influence inflammation levels in the body. A diet rich in antioxidants, omega-3 fatty acids (found in fatty fish, nuts and flaxseeds), and polyphenols can help reduce inflammation. Chronic inflammation is often associated with muscle pain, so an anti-inflammatory diet may be beneficial for people with MDS.
  2. Protein intake:
    • Protein is essential for muscle health. Adequate protein intake, from sources such as lean meat, legumes, and dairy products, promotes muscle regeneration and may help alleviate the pain associated with MDS.
  3. Nutrient Balance:
    • A balanced diet, including complex carbohydrates, quality proteins, healthy fats, and a variety of vitamins and minerals, provides the nutrients necessary for optimal muscle function. Certain minerals like magnesium and potassium are particularly important for muscle contraction.
  4. Hydration:
    • Adequate hydration is crucial to maintain flexibility of muscle tissue and promote lubrication of fascia. Lack of hydration can contribute to a feeling of muscle stiffness, exacerbating MDS symptoms.
  5. Weight Control:
    • Maintaining a healthy body weight through a balanced diet helps reduce the load on muscles and joints, thereby minimizing the stress and strain associated with MDS.
  6. Avoiding Pro-Inflammatory Foods:
    • Certain foods, such as processed foods high in added sugars and saturated fats, can promote inflammation. Avoiding these foods may be beneficial for those suffering from MDS.
  7. Individualization of Food:
    • The specific impact of diet may vary from person to person. Some individuals may be sensitive to certain MDS trigger foods. An individualized approach, perhaps with the help of a nutrition professional, can help identify these food sensitivities.

Self-Soothing Exercises for SDM

Self-soothing exercises can be beneficial for patients suffering from Myofascial Pain Syndrome (MPS), in addition to osteopathic sessions. These exercises aim to reduce muscle tension, improve mobility and relieve pain. However, it is important that patients consult their healthcare professional or osteopath before starting any exercise program to ensure their suitability. Here are some simple exercises patients can consider:

  1. Neck Stretches:
    • Gently tilt your head to one side toward your shoulder, holding the position for 15-30 seconds. Repeat on the other side. Add gentle manual traction using the hand on the opposite side to increase the stretch.
  2. Self-Massage with a Tennis Ball:
    • Place a tennis ball between your back and the wall. Gently roll the ball over tight or painful areas, adjusting pressure to your comfort. Focus on the trigger points identified by your osteopath.
  3. Shoulder and Upper Back Stretches:
    • Interlace your fingers in front of you, then extend your arms and turn your palms outward. Stretch your arms forward, rounding your back. Hold for 15-30 seconds to stretch your shoulders and upper back.
  4. Hamstring Self-Stretching:
    • Sitting on the floor, extend one leg in front of you and bend the other knee. Gently tilt your upper body toward the extended leg, keeping your back straight. Hold the position for 15-30 seconds and repeat on the other side.
  5. Deep Breathing and Relaxation:
    • Practice deep breathing to promote muscle relaxation. Inhale deeply through your nose, expanding your diaphragm, then exhale slowly through your mouth. Repeat several times, focusing on relaxation.
  6. Calf Self-Stretching:
    • Standing, place one foot back, keeping your heel on the floor. Bend the knee of the leg slightly forward and hold the position to stretch the calf. Switch sides and repeat.
  7. Mental Relaxation Exercises:
    • Practice mental relaxation techniques such as guided meditation, positive visualization, or mindfulness to reduce stress and muscle tension.
  8. Self-Massage of the Temples and Jaw:
    • Use gentle circular motions to massage the temples and jawline with your fingers. This can help release tensions related to SDM.

Using a hot moist compress

The choice between applying a warm moist compress before or after treating a trigger node often depends on the specific situation and individual preferences. However, here are some general considerations that might help you make a decision:

Before Treatment:

  1. Muscle Preparation: Applying a warm compress before treatment can help prepare the muscle by increasing the local temperature. This can make the tissues more flexible and make it easier to access the trigger knot.
  2. Vasodilation: Heat promotes vasodilation (widening of blood vessels), which can increase blood flow to the targeted area. This can be beneficial in delivering more oxygen and nutrients to muscle tissues.
  3. Muscle Relaxation: Heat can help with muscle relaxation, which can be beneficial before treatment to reduce general tension in the area.

After Treatment:

  1. Reduction of Inflammation: Applying a warm compress after treatment can help reduce potential inflammation resulting from trigger node treatment.
  2. Pain Relief: Heat often has analgesic properties, which can help relieve pain after treatment.
  3. Continued Relaxation: Heat after treatment can maintain muscle relaxation achieved during treatment, promoting a prolonged effect.

General Considerations:

  • Some prefer heat before treatment to prepare the tissues, while others find it more effective to apply heat after treatment to relieve pain and maintain muscle relaxation.
  • Listen to your body: If you find that one method works best for you, that’s probably the best approach.
  • Consult a healthcare professional: If you have specific health issues or concerns, it is always recommended to consult a healthcare professional for personalized advice.

Ultimately, whether you use heat before or after treatment depends on your individual preferences and how your body responds to these methods.

Types of Trigger Points

Active trigger point

Painful at rest and during movements of the muscle which contains it.

An active trigger point, also known as an active trigger point in French, refers to a localized area in a muscle or connective tissue that is in continuous pain. When pressure is applied to this point, it can trigger a sensation of local pain, and this pain can also radiate to other parts of the body. This characteristic of persistent pain distinguishes active trigger points from normal muscle areas and may contribute to chronic or recurring pain symptoms.

  1. Pressure Sensitivity: An active trigger point is usually sensitive to pressure. When pressure is applied to this point, it can trigger a local sensation of pain.
  2. Referral Pain: Pain generated by an active trigger point can radiate to other areas of the body. This means that the pain experienced may be felt distant from the pressure point.
  3. Change in Sensation: Pressure on an active trigger point can cause a local response such as a “jump” of the muscle under the practitioner’s finger.
  4. Possible Causes: Active trigger points may form in response to trauma, repeated muscle tension, repetitive movements, or other factors that can lead to abnormal muscle contractions.
  5. Relationship to Chronic Pain: Active trigger points are often associated with chronic pain. They can contribute to problems such as back pain, headaches, or other musculoskeletal disorders.
  6. Treatment: Treatment for active trigger points may include myofascial release techniques, massage, stretching, acupuncture, or other approaches aimed at deactivating these tender points.

Latent trigger point

Produces pain only when palpated.

A latent trigger point, also called a “latent trigger point” in French, is characterized by local sensitivity to pressure without causing constant pain. Here are some key points to consider:

  1. Pressure Sensitivity: As with active trigger points, latent trigger points are sensitive to pressure. However, this sensitivity may be less apparent and only cause pain when pressure is applied.
  2. Latent Pain: Unlike active trigger points which cause ongoing pain, latent trigger points may not cause persistent pain. They often remain “silent” and only become sensitive when pressure is applied.
  3. Activation Potential: Although latent, these points can be activated, leading to increased sensitivity and possibly local pain. Factors such as stress, increased muscle tension or certain movements can trigger this activation.
  4. Referential Pain: Even in a latent state, these points can contribute to referential pain, radiating pain to other parts of the body when activated.
  5. Preventive Management: Managing latent trigger points may involve preventative approaches aimed at avoiding their activation. Relaxation techniques, regular stretching, and stress management practices can be helpful.

Do not use ischemic compression for the following conditions

It is important to note that ischemic compression should not be used in certain specific medical conditions. Here are some examples of situations where ischemic compression may not be appropriate or may require a more cautious approach:

  1. Circulatory Problems: People with circulatory problems, such as peripheral arterial disease or other vascular disorders, should avoid ischemic compression, as this may further compromise blood flow.
  2. Diabetes: Individuals with diabetes should be cautious with ischemic compression due to the risk of circulatory complications associated with diabetes.
  3. Skin Infections: The use of ischemic compression on infected areas of the skin may worsen the infection and delay healing. It is essential to avoid this technique in such situations.
  4. Neurological Disorders: Individuals with serious neurological disorders may have impaired sensitivity and may not properly feel the pressure applied during ischemic compression. This could lead to undetected injuries.
  5. Skin Cancers: In the presence of skin cancers or suspicious skin lesions, it is best to avoid ischemic compression so as not to compromise the affected area.
  6. Respiratory Problems: In the case of medical conditions affecting breathing or the airways, ischemic compression may be contraindicated, as it could cause additional discomfort.
  7. Hematologic Disorders: People with hematologic disorders, such as bleeding disorders, may be at increased risk of blood clots, and ischemic compression could make this worse.

Conclusion

In conclusion, myofascial release techniques prove to be valuable allies in the management of Myofascial Pain Syndrome (MPS) and trigger points. By exploring these methods within osteopathy in detail, we were able to see the diversity of approaches aimed at restoring balance to the fascia and relieving muscle tension.

The Ischemic Compression technique, in particular, is emerging as a specific and targeted modality for the treatment of trigger points. However, it is crucial to recognize its limitations and apply it judiciously, taking into account individual medical conditions.

As understanding of the complex interactions between fascia, muscles, and trigger points deepens, the integration of diverse approaches becomes imperative. By adopting a holistic approach, practitioners can maximize treatment effectiveness and provide more comprehensive solutions for patients suffering from MDS.

Ultimately, continued research and evolving medical practices will help enrich our understanding of the mechanisms underlying MDS, paving the way for ever more innovative and effective therapeutic approaches. Constant exploration of these areas remains essential to providing individuals suffering from myofascial pain with a better quality of life and lasting relief.