Advances and instrumentation in diagnosis and treatment of trigger points in human myofascial pain: veterinary implications

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Philip A.M. Rogers MRCVS, Andrew Fischer MD, PhD,
Pekka J. Pontinen MD and Luc A.A. Janssens DMV, PhD 
IVAS Course, Oslo, Norway (1988) 
Postgraduate Course in Veterinary AP, Sydney (1991) 
(revised 1990, 1991, 1993, 1996)
 
 
 
 

ABSTRACT

Normal muscle is not painful on palpation and contains no Trigger Points (TPs). The role of TPs in maintaining myofascial pain and methods of TP therapy are outlined.

 

Chronic myofascial pain is most commonly associated with TPs in muscles, especially around arthritic joints. Long term therapeutic success depends on TPdetection and their elimination.

 

Objective assessment of myofascial pain has medico-legal applications as well as facilitating an accurate monitor of the result of drug, physical or other therapies. Fischer adapted analogue force gauges to facilitate objective assessment of the location and degree of myofascial pain in human patients. The principle is more than 40 years old but has not been documented properly until recently. Repeatability of readings is excellent.

 

a. A pressure threshold meter (pressure range 0-11 kg/cm sq) measures pain threshold at the TPs. Pressure thresholds at TPs are 2-4 kg/cm sq lower than thresholds in healthy muscle. Threshold pressures can be used to confirm the exact locations of TPs and to quantify their sensitivity relative to healthy muscle.

 

b. A pressure tolerance meter (pressure range 0-17 kg/cm sq) measures pain tolerance at standard sites in muscle and bone. Pressure tolerance over muscle and is used to assess overall pain tolerance. Fit athletes and patients trained in self-hypnosis or relaxation therapy usually have higher tolerances than people who are sedentary, unfit or poorly trained in mental control. A low overall tolerance is a poor prognostic sign and may indicate generalised pain of psychosomatic origin.

 

c. A tissue compliance meter (a special force gauge with a sliding plate) measures penetration depth in tissue at probe pressures of 1, 2, 3, 4 and 5 kg/cm sq. Tissue compliance can be used to quantify and demonstrate the degree of muscle tension or spasm.

 

d. A dynamometer (force range 0-27 kg) measures contraction power of the limb muscles. Muscle dynamometry can be used to assess muscle power to flex, extend, abduct and adduct limbs and joints.

 

These concepts do not seem to have been documented in animal patients. They offer a unique possibility to assess myofascial pain, of great potential importance in the investigation of equine and canine lameness and poor racing performance. The pressure threshold gauge could probably be used to measure sensitivity at the diagnostic organ reflex (Shu and Mu) points of classical acupuncture.