angina pectoris pathophysiology
Trigger Point Therapy
Trigger Point Therapy
Boris Prilutsky
Introduction
Massage medical procedure involves the mobilization of the skin and fascia of the muscle, trigger point therapy, relaxation techniques and post-isometric. Each of these modalities is also important to achieve rapid and lasting results. For decades, the widespread use of medical massage has proven safe and effective treatment support and movement system disorders, disorders of internal organs, stress management, and more.
Recent years, there have been many arguments within the professional community about practitioners of the use of manual therapy and trigger point therapy. In recent professional publications many authors have been asking the following questions: Is it enough to cause the formation of fibrous tissue in muscles? Histological studies have never trigger point is? Is there a theory of peripheral nerve pain of the endplate of a new theory and theory only? Do you use compression techniques for trigger point ischemic treatment safe and effective?
The short answers to questions above are:
1. the formation of muscle tissue is fibro myogelosis an incurable muscle disease.
2. In many cases myogelosis is the result of an inadequate treatment of trigger points.
3. A trigger point is a pinpoint location Pain can be found in muscles, connective tissue and periosteum. The morphology of this point of pain is such that the demand for blood supply is much greater than the supply of royal blood.
4. The theory of pain of peripheral nerves in the neuromuscular junction is not a new theory.
5. Any theory must be supported by clinical production.
6. ischemic compression as a method of trigger point therapy has been tested at least four years of widespread use, a safe and effective.
7. ischemic compression techniques applicable the gradual increase of pressure, which excludes the possibility of harm to the patient and therapist.
In search of true understanding of the pathophysiology, the sophistication and complexity of the body requires us to adopt an inclusive approach to all questions. So I would like to present the reader with a brief review of the scientific question of trigger points and trigger point therapy concept.
If you want to see hands on demo, please click on the link below:
http://medicalmassage-edu.com/dvd-details.php?dvd_id=27&dvd=12
Nature trigger points
No statement in any modern scientific literature calls a trigger point of a band "tight fibro-connective tissue. "However, it has already been used late 19th/early twentieth century until histological studies conducted German scientists (Glogowski, and Wallraff, 1951; Miehlke et al., 1950) has shown there is no proliferation of connective tissue (myogelosis) in the region a trigger point in muscle. "In our opinion, fibrositis (in regard to trigger points) became a desperate diagnosis ambiguous … Best avoided "(Travell, Simons, 1983). However, the tissue will grow between the muscle fibers when a core is myogelosis formed (Glogowski, and Wallraff, 1951). Myogelosis is a clinical course of the years of recovery point trigger active in the same area. In Meanwhile, the trigger point therapy is useless if the heart is already formed myogelosis.
In 1843, for the first time, the doctor Dr. German F. Froriep described as the formation of painful trigger points in skeletal muscle. In 1921, another German researcher, Dr. H. Schade, a review Histological and formed the concept of myogelosis. In 1923, the British physician Dr. J. Mackenzie offers the first explanation of the pathophysiological mechanism activation and training issues raised by the concept of reflex zones in the skeletal muscles in the central and peripheral nervous system play a role. Concept reflex zones has been developed by the American scientist Prof. I. Korr in 1941 in a series of brilliantly designed experimental studies. Thus threshold concept was developed long before the work of Travell and Simons, who based their publication (see references in "Trigger Point Manual" by Travell and Simons) in the work of scientists mentioned.
There are many published results of the evaluation histological zones trigger. Even in the short list of references at the end of this article, you can find plenty of evidence with 5 numbers reference, 6, 7, 13 and 15.
It is wrong to say that Dr. Travell and Simons, the doctor recommended using ischemic compression to trigger point therapy. They defended the injection, stretch and spray techniques muscle energy techniques and trigger point therapy. Although, Travell and Simons mentioned ischemic compression as an option based on European medical sources, not recommended as a method of treatment.
The role of vasodilators in the local ischemia
Awad (1973) examined the biopsy trigger points using an electron microscope and found a significant increase in the number of platelets, causing release serotonin and mast cells, which turn releases histamine. Both serotonin and histamine are potent vasodilators and their increase is a sign clear that the body tries to fight against local ischemia in the region the trigger point. In his now classic, Fassbender (1975) method histological examination of the circulation in the area of the trigger point and proved once and for all "… The trigger point represents a region of local ischemia. "The same results were obtained by Popelansky et al. (1986) Assessment of radio-isotopes used in the field of blood flow trigger point.
The theory of the endplate
The theory of the endplate is not a new theory. Travell and Simmons has consistently emphasized the nervous system as a critical factor in the development of trigger point and emphasize the importance end-plate zones. Even the names of particular types of trigger points called "trigger points for motor, located in the center of the muscle to neuromuscular junction. "The structure functionally significant with respect to the innervation of muscle fibers is the junction neuromuscular (motor endplate region )…" and "Some trigger points are closely associated with neuromuscular junctions, other not. "(Travell and Simmons, 1983). The idea of the nervous system and the role of endplate areas is not a new concept. In 1947, Professor Korr addressed the same issues in their research.
According to histological studies (Heine, 1997; Gogolev, 2001) chronic pain and stress of low grade in skeletal muscles and fascia are responsible for the low-grade inflammation in the terminal parts of sensory and motor neurons end in the soft tissues. This inflammation chronic active local fibroblasts, collagen deposition with some nerve endings that form the back called collagen. " This further irritating factor triggers an afferent sensory flow to the central nervous system, which is interpreted by the brain as pain. This mechanism described in part by the generation of pain in trigger points motor. We consider that the terminal parts of sensory neurons and motors are located in soft tissues, including skeletal muscle. In other words, it would be logical to assume that something must irritate end portions sensory and motor neurons. That something is a tension in skeletal muscles, including trigger points that are not associated with trigger points engines (as found in other parts of the skeletal muscle). Note that all inflammatory processes, whether in the end plates motor or muscle tissue means that there is a decrease in the amount of blood supply to inflamed tissues. It follows that the compression ischemic phase may be regarded as an effort anti-inflammatory.
There is no doubt that myofascial pain may be the result of abnormalities peripheral nerves. An example of this would be a piriformis sciatic nerve irritation excessive tension resulting in the formation of trigger points in muscles innervated by the sciatic nerve. This list can go on all peripheral nerve compression in key areas causing the formation of trigger points in muscles innervated by this nerve.
If one examines a patient with peripheral arterial disorders (for example, Buerger's disease) are numerous active and Latent trigger points in muscles of legs and feet. Would certainly be nice to insufficient blood supply because blood vascular abnormality responsible the formation of trigger points in skeletal muscles rather than abnormalities in the motor end plates. The same is true of points trigger points in skeletal muscles, which develop as a result of visceral disorders (eg, patients suffering from cardiac trigger points active in the trapezius, levator scapula and rhomboid muscles). In these cases, abnormal endplates has nothing to do with the formation of trigger points in skeletal muscle. They are the result of the phenomenon of convergence of pain stimuli in the same segments of the spinal cord that are responsible innervation of the organ affected both internal and skeletal muscles. In 1955, Dr. Dalicho Glezer and formulated the theory that is clinically proven yet. Have been proposed and developed maps of reflex zone abnormalities of the skin, fascia and muscles, including the development trigger points.
The energy crisis Theory
There is another theory which links the formation of trigger points shortages ATP in the affected muscles due to inadequate blood flow. ATP is the energy source for cellular function, including muscle. The Proponents of this theory, called the theory of the energy crisis, said the formation of trigger points in athletes in a very healthy have no signs of deterioration of peripheral nerves and still being developed active trigger points. gradual increase muscle tone at rest in normal muscles triggers local vasoconstriction, interstitial edema, and depletion of ATP and subsequent formation Trigger Spots. Professor D. Simons revised this theory, and widely used work done by his colleagues, Dr. DR Hubbard and Dr. GM Berkoff, in own research.
Trigger Point therapy protocol
Ultimately the trigger point therapy has the following objectives:
1. Remove protective muscle tension in the muscles which harbor trigger points active.
2. Delete the condition of peripheral hyper, receivers of pain in particular.
3. Lock the system-analysis of pain patients.
4. reflex vasodilation occurs.
5. Eliminate ischemia Local.
To achieve these objectives effectively, the practitioner must do a treatment threshold using several components of equal importance:
1. Detecting the location of active trigger point.
2. To detect the radiation path tissue pain and examine in this way in the event trigger points are formed by satellite.
3. Put your finger on the trigger point. Apply Slowly vertical compression tissues until the patient feels the first sign of pain. Once they produce a constant pressure increase but keep it at this level. After 10 seconds of applying pressure, the pain that the patient initially felt will disappear. The patient should immediately report to you as soon as he or she feels the pain stops. Over the next 20 seconds, the doctor will be able to get to the bottom "of the point of travel without activating unwanted pain and generation of stress analysis system of muscle protection in the affected muscle or muscle in the region.
4. To carry out after the first three goals to the techniques of stroking and kneading of the muscles involved in the regime of the inhibitor for 5-7 minutes (gradual increase of pressure ideally in the same direction of stroke).
5. Leave the trigger point as quickly as possible to produce quickly and efficiently vasodilation and the elimination of local ischemia.
The therapy protocol correct trigger is not cheating. This protocol is also effective for motor points, trigger, and points that trigger others. applied pressure is never strong enough to go over the pain threshold of the patient, causing pain and damage to nerve endings of the motor. peripheral vasodilation restores local pH to normal, increases oxygenation of tissues in the area of the trigger point, and gradually eliminates the trigger point.
References
1. Awad EA: Interstitial myofibrositis: the hypothesis of the mechanism, Arch. Phys. Rehab Med, 54 (10) :449-453, 1973
2. Fassbender HG Pathology of rheumatic diseases. Springer Verlag, New York, 1975
3. Froriep, F. Pathology Ein Beitrag zur Therapie und Rheumatismus of. Weimar, 1843.
4. Glezer, O., Dalicho Segmentmassage VA. Leipzig, 1955
5. Glogowski, G. Wallraff, J. Ein Beitrag zur Klinik und der histological Muskkelharten (Myogelosen) ", Z. Orthop., 80:237-268, 1951
6. Gogolev, RUs "New approaches to diagnosis and the treatment of fibromyalgia associated with spondylosis. "There. Architect, 4:40-45, 2001.
7. Heine, H. Medicine Lehbruh der biologische. Hippocrates, Stuttgart 1997.
8. Hubbard DR, Berkoff, GM "Myofascial trigger points show spontaneous needle EMG activity", the spine, 18:1803-1807, 1993.
9. Korr, IM "base Osteopathy neuronal injury. Jaoa, 47 (4): 191-198, 1947.
10. Kreymer, vibration massage in diseases AY nervous system.
Tomsk University, Tomsk, 1987.
11. Mackenzie, J. angina pectoris. Henry, Frowde and Hodder & Stroughton, London, 1923.
12. Mezlack, R. Wall, P. "Mechanisms of pain: a new theory." Science, 150 (November): 971-979, 1965.
13. Miehlke, K., Schulze, G., Eger, W. "Klinische und Experimentelle Untersuchungen zum fibrositis-syndrom. Rheumaforsch Z., 19:310-330, 1960.
14. Popelansky, YY, Zaslavsky, ES, Veselovsky, vice president of medical and social importance, etiology, pathogenesis and diagnosis of non-articular diseases soft tissues of the LIMS and back. Vorpr. Arthritis., 3:38-43, 1986.
15. Schade, H. "Untersuchungen in der Erkaltungstrade: III. Rheumatismus über den in besondere den Muskelrheumatismus (Myogelose). "Munch. Wschr Med., 68, 95-99, 1921.
16. Travell JG, Simons DG Myofascial pain and dysfunction. Trigger points manual. Williams & Wilkins, Baltimore, 1983.
17. Wall PD, Crowly-Dillon, JR "The pain, itching and vibration." AMA Arch. Neurol., 2: 19-29, 1960.
About the Author
Boris Prilutsky, MA, has been teaching medical massage for over 30 years. He is the founding director of the Institute of Professional Practical Therapy (IPPT) in Los Angeles, Calif., and graduated from the Pedagogic Institute of Higher Education in Vinnitsa, Ukraine, with a degree in physical education, and Medical College in Ramat-Gan, Israel, with a major in chiropractic medicine. Boris has worked with athletes and athletic organizations throughout Europe, has been a personal therapist to many world dignitaries, and has trained thousands of therapists worldwide. He also treats patients with various neural, muscular and skeletal disorders at the Back and Limb Institute in Beverly Hills, California.
(310) 550-6109
What is the pathophysiology of angina?
The short answer would be helpful or simply a web link. Thank you
Decrease of blood and oxygen reaching the heart muscle. The pain occurs because the muscle will "omg, my need for oxygen are not met, Help!
angina pectoris pathophysiology
