Myofascial Trigger Points

Section 1 The background

1 Guide to the book

2 Terminology

3 Epidemiology

3.1 Etiology of disease

3.2 Epidemiology

4 Etiology of myofascial pain syndrome

4.1 Causative factors

4.2 Perpetuating factors of myofascial pain

4.3 Chronification of myofascial pain

5 The anatomy and physiology of the muscles

5.1 Macroscopic construction

5.2 Function

5.3 Neurophysiology

6 Pathophysiology

6.1 Historical development

6.2 Underlying theories of pathophysiology

6.3 Specific pathophysiology

6.4 The extended integrated hypothesis

7 The trigger point as expression of a functional disorder of the locomotor system

7.1 The function of the locomotor system in association with memory

7.2 Pathophysiological role of mTrP

8 Trigger points and myofascial pain - acupuncture points and meridian system

8.1 Trigger points and acupuncture points

8.2 Referred pain and meridians

8.3 Other study results

8.4 Pain and somatovisceral correspondence of trigger and acupuncture points

8.5 Summary 

9 Myofascial trigger points and fascia

9.1 Anatomy – definitions

9.2 Biomechanical function

9.3 Muscle hardening (taut bands)

9.4 Fascia as sensory organ

9.5 Association with trigger points – therapeutic considerations

10 Fibromyalgia syndrome

11 Myofascial trigger points and somatoform pain

11.1 Introduction and clinical information

11.2 Epidemiology

11.3 Etiology and pathogenesis

11.4 Differential diagnosis 

11.5 Therapy 

11.6 Health service assessment

12 Integrated holistic consideration of the muscles

12.1 Introduction 

12.2 Function and purpose of the muscles

12.3 Approach via acupuncture

13 Diagnosis of myofascial pain

13.1 Principles 

13.2 Questioning

13.3 Physical examination

13.4 Specific diagnosis of myofascial trigger points  

13.5 Technical test procedures

13.6 Creating a comprehensive diagnosis with instructions for treatment

14 Differential diagnosis 

14.1 Differential diagnosis according to affected structure and cause

14.2 Differential diagnosis depending on distribution pattern

Section 2 Treatment of myofascial pain

15 Principles of treatment

15.1 Doctor-patient relationship

15.2 Practical hints

15.3 Legal aspects

15.4 Documentation of progress

16 Peculiarities of doctor-patient relationship with chronic pain

17 Selection of suitable treatments

17.1 Standard treatments

17.2 Other (traditional) treatments

18 Manual therapies and physiotherapeutic procedures

18.1 Dejung manual trigger point therapy

18.2 Lewit treatment techniques

18.3 Spray and stretch, cool and extend

18.4 Fascia techniques for the treatment of mTrP

19 Treatment concept – myofascial trigger point therapy

19.1 Manual techniques and dry needling

19.2 Extension, relaxation/stretching, detensioning

19.3 Functional training, ergonomics

20 Physical procedures

20.1 Ultrasound therapy

20.2 Hot and cold treatments

20.3 Electrotherapy

20.4 Cupping

20.5 Transcutaneous electrical nerve stimulation

20.6 Laser therapy

20.7 Shock wave therapy

21 Trigger point infiltration

21.1 Indications and contraindications

21.2 Injectants

21.3 Technique

22 Acupuncture and related procedures

22.1 Dry needling (trigger point acupuncture)

22.2 Classical acupuncture

22.3 Kiiko Matsumoto acupuncture

22.4 Microsystem acupuncture

22.5 Electrostimulation acupuncture

22.6 Laser acupuncture

22.7 Preusser gelopuncture

22.8 Tuina

23 Complementary and alternative therapy methods and naturopathic treatments

23.1 Definitions

23.2 Basic principles

23.3 Treatment procedures

23.4 Integration of complementary and alternative methods in multimodal pain programme

24 Relaxation techniques – body and mind

24.1 Preliminary remarks

24.2 Western relaxation techniques

24.3 Eastern relaxation techniques

25 Systemic pharmacotherapy

25.1 Introduction

25.2 Substance groups

25.3 Treatment strategy

Section 3 Muscles and trigger points

26 Head

26.1 M. masseter

26.2 M. temporalis

26.3 M. pterygoideus medialis

26.4 M. pterygoideus lateralis

26.5 M. digastricus

26.6 M. stylohyoideus

26.7 M. mylohyoideus

26.8 M. geniohyoideus

27 Throat, neck and shoulder region

27.1 M. splenius capitis

27.2 M. splenius cervicis

27.3 Muscles of the cervical M. erector trunci

27.4 Suboccipital muscles

27.5 M. sternocleidomastoideus

27.6 Mm. scaleni

27.7 M. trapezius

27.8 M. levator scapulae

28 Shoulder and upper arm

28.1 M. deltoideus

28.2 M. supraspinatus

28.3 M. infraspinatus

28.4 M. teres minor

28.5 M. latissimus dorsi

28.6 M. teres major

28.7 M. subscapularis

28.8 Mm. rhomboidei major and minor

28.9 M. coracobrachialis

28.10 M. biceps brachii

28.11 M. brachialis

28.12 M. triceps brachii (with M. anconaeus)

29 Elbow, forearm and hand

29.1 Hand extensors

29.2 M. brachioradialis

29.3 Finger extensors

29.4 M. supinator

29.5 M. palmaris longus

29.6 Hand and finger flexors in the forearm

29.7 M. adductor et opponens pollicis

30 Thoracic spine and thorax

30.1 Thoracic autochtonous back extensors

30.2 M. pectoralis major

30.3 M. pectoralis minor

30.4 M. sternalis

30.5 M. serratus posterior superior

30.6 M. serratus anterior

30.7 M. serratus posterior inferior

31 Abdomen

31.1 M. rectus abdominis

31.2 M. obliquus abdominis (externus et internus)

31.3 M. pyramidalis

32 Lumbar spine, pelvis and hip region (pelvic girdle)

32.1 Lumbar autochthonous back muscles

32.2 M. quadratus lumborum

32.3 M. iliopsoas major

32.4 Pelvic floor muscles

32.5 M. gluteus maximus

32.6 M. gluteus medius

32.7 M. gluteus minimus

32.8 M. piriformis

33 Hip, thigh and knee

33.1 M. tensor fasciae latae

33.2 Adductors of the hip joint.

33.3 M. quadriceps femoris

33.4 Ischiocrural muscles

33.5 M. popliteus

34 Lower leg and foot

34.1 M. tibialis anterior

34.2 Mm. peronei (fibulares) longus et brevis

34.3 M. gastrocnemius

34.4 M. soleus

34.5 M. tibialis posterior

34.6 M. extensor hallucis longus and extensor digitorum longus

34.7 M. flexor digitorum longus and flexor hallucis longus