Myofascial Trigger Points Then and Now: A Historical and Scientific Perspective.
The intent of this article is to discuss the evolving role of the myofascial trigger point (MTrP) in myofascial pain syndrome (MPS) from both a historical and scientific perspective. MTrPs are hard, discrete, palpable nodules in a taut band of skeletal muscle that may be spontaneously painful (i.e., active) or painful only on compression (i.e., latent). MPS is a term used to describe a pain condition that can be acute or, more commonly, chronic and involves the muscle and its surrounding connective tissue (e.g. fascia). According to Travell and Simons, MTrPs are central to the syndrome-but are they necessary? Although the clinical study of muscle pain and MTrPs has proliferated over the past two centuries, the scientific literature often seems disjointed and confusing. Unfortunately, much of the terminology, theories, concepts, and diagnostic criteria are inconsistent, incomplete, or controversial. To address these deficiencies, investigators have recently applied clinical, imaging (of skeletal muscle and brain), and biochemical analyses to systematically and objectively study the MTrP and its role in MPS. Data suggest that the soft tissue milieu around the MTrP, neurogenic inflammation, sensitization, and limbic system dysfunction may all play a role in the initiation, amplification, and perpetuation of MPS. The authors chronicle the advances that have led to the current understanding of MTrP pathophysiology and its relationship to MPS, and review the contributions of clinicians and researchers who have influenced and expanded our contemporary level of clinical knowledge and practice.
Rehabilitation Medicine Department, Clinical Center, National Institutes of Health, 9000 Rockville Pike, Bethesda, MD 20892.
Jay P
JP
Shah
Rehabilitation Medicine Department, Clinical Center, National Institutes of Health, Bethesda, MD.
Nikki
N
Thaker
Rehabilitation Medicine Department, Clinical Center, National Institutes of Health, Bethesda, MD.
Juliana
J
Heimur
Rehabilitation Medicine Department, Clinical Center, National Institutes of Health, Bethesda, MD.
Jacqueline V
JV
Aredo
Departments of Electrical and Computer Engineering and Bioengineering, Volgenau School of Engineering, George Mason University, Fairfax, VA.
Siddhartha
S
Sikdar
Center for the Study of Chronic Illness and Disability, College of Health and Human Services, George Mason University, Fairfax, VA.
Lynn
L
Gerber
D049669:History, 16th Century; D049670:History, 17th Century; D049671:History, 18th Century; D049672:History, 19th Century; D049673:History, 20th Century; D006801:Humans; D018482:Muscle, Skeletal / Q000503:physiopathology*; D009209:Myofascial Pain Syndromes / Q000266:history* / Q000503:physiopathology; D010147:Pain Measurement / Q000266:history; D061028:Trigger Points / Q000503:physiopathology*