Myofascial trigger points: spontaneous electrical activity and its consequences for pain induction and propagation

Hong-You Ge, César Fernández-de-Las-Peñas, Shou-Wei Yue, Hong-You Ge, César Fernández-de-Las-Peñas, Shou-Wei Yue

Abstract

Active myofascial trigger points are one of the major peripheral pain generators for regional and generalized musculoskeletal pain conditions. Myofascial trigger points are also the targets for acupuncture and/or dry needling therapies. Recent evidence in the understanding of the pathophysiology of myofascial trigger points supports The Integrated Hypothesis for the trigger point formation; however unanswered questions remain. Current evidence shows that spontaneous electrical activity at myofascial trigger point originates from the extrafusal motor endplate. The spontaneous electrical activity represents focal muscle fiber contraction and/or muscle cramp potentials depending on trigger point sensitivity. Local pain and tenderness at myofascial trigger points are largely due to nociceptor sensitization with a lesser contribution from non-nociceptor sensitization. Nociceptor and non-nociceptor sensitization at myofascial trigger points may be part of the process of muscle ischemia associated with sustained focal muscle contraction and/or muscle cramps. Referred pain is dependent on the sensitivity of myofascial trigger points. Active myofascial trigger points may play an important role in the transition from localized pain to generalized pain conditions via the enhanced central sensitization, decreased descending inhibition and dysfunctional motor control strategy.

Figures

Figure 1
Figure 1
An example of motor behavior of spontaneous electrical activity (SEA) of a myofascial trigger point (MTP) during trapezius muscle contraction. The electromyographic (EMG) activity of the SEA of an MTP is similar to the surface EMG over an MTP on one side of the upper trapezius and to both the surface and intramuscular EMG activity of a normal muscle point on the other side of the upper trapezius. Note: following needle insertion into a MTP, surface EMG recording shows low amplitude activities.

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