Fibromyalgia
Chronic myofascial pain trigger points
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Basic science of CMP trigger points

"The conventional explanation for trigger points is that a small patch of muscle fibers has become clenched so tightly that it chokes off its own circulation. This causes a build up of waste products that aggravates sensory nerve endings and causes more clenching — a vicious cycle.

A “sarcomere” is the smallest functional unit of muscle physiology. Muscles contract because sarcomeres contract. A sarcomere consists of several threads of protein that overlap like the tines of a fork, grab onto each other like Velcro, and pull towards each other. Sometimes a section of sarcomeres contract excessively.

Why? There are several possible triggers:

"Injuries in general cause protective spasm around adjacent joints to limit movement. This often becomes chronic, and the muscle develop trigger points due to the constant over stimulation. The over exertions of weekend warrior-ism may lead to trigger point formation due to the excessive and unfamiliar stimulation of one of those muscles “you didn't know you even had.”

"A cold draft often leads to the formation of trigger points. The body reflexively increases muscle tone when the over lying skin is chilled. Emotional stress and fatigue increases the resting tone of muscle, and lowers our pain threshold, both of which probably predispose us to trigger point formation."

"Once they have started, trigger point tends to choke off their own blood supply, causing a build up of waste products that aggravates sensory nerve endings and causes more clenching — a vicious cycle. This is why trigger points tend to be persistent. It also makes it easy to see why massage can help to relieve them with well-aimed squishing that both moves stagnant tissue fluids and mechanically lengthens the sarcomeres."

"Meanwhile, sarcomeres up and down the line get stretched out, which results in a muscle that is partly contracted and partly over-stretched. This is why stretching does not necessarily help: most of the muscle is already stretched too much."

"Finally, since sarcomeres depend on overlap of their protein fibers for muscle contraction, muscles with trigger points are also weak. Their sarcomeres’ proteins can't get a grip on each other. And so lifting weights with muscles that have trigger points in them does not work terribly well: not only will you not be able to lift much, but your tissues will probably not adapt well to the stress." Paul Ingraham, Registered Massage Therapist (Vancouver)


Denervation Supersensitivity and CMP points: Chronic Neuropathic pain

Just a little note on the Denervation Supersensitivity that happens with CMP points. Don't both looking up Denervation Supersensitivity unless you have a medical degree, as most discussions about it, are for doctors ... what it means in a laymen's terms however, is the nerves are trapped, blocked, pinched and overtly sensitive, often due to the fact they are nearly starving to death for lack of blood supply. A quick glance at the above notes on trigger points, makes the reason for that pretty apparent. They are under stress and scream that message to the brain, as they are chronically irritated.

Now what this means for those of us with FM ? A simple analogy you have all experienced at least once. Which is, whacking your elbow, while hurrying out of a doorway for example. Hitting "funny bone". It's such a common experience, we even have a name for it and it's not at all funny to experience, it's quite painful. But what does it mean to the body when this happens ?

It means your entire forearm and hand go numb and tingle, as you dance about holding your elbow, normally bent over due to the pain, saying a few choice words, as you rub your elbow. If you happened to be holding anything at the time, it just hit the floor as the hand holding the object, just quit working.

Why does this happen ? Because you just smacked a very large cluster of nerves that happen to lie very close to the surface at the elbow joint. And those nerves are now screaming a message of pain to the brain. They cannot even remotely make the arm below that nerve center work, as the entire messaging system just got totally scrambled and over stimulated, due to striking the nerves. Now this odd little pain dance typically goes away after a few moments, with some lingering pain due to bruising perhaps.

Now, image that same thing, taken down a few steps, the same pain, same tingle, the same loss of function and weakness and spread it out over nearly every joint muscle combo, in the body and you get some idea of what it means to have chronic neuropathic pain, for a person with CMP.


Chronic myofascial pain

(CMP) is sometimes referred to as "myofascial pain syndrome" (MPS), especially in the older literature.

"A syndrome includes a specific set of signs and symptoms that occur together. A disease, on the other hand, has a known and defined cause and mechanism(s) for producing symptoms. Myofascial pain due to trigger points is now considered a true disease, rather than a syndrome (i.e., CMP, rather than MPS).

Fibromyalgia is a syndrome, as are rheumatoid arthritis and lupus. CMP is a musculoskeletal chronic pain syndrome which is non progressive (although it may seem to be), non degenerative, and non inflammatory. It is caused by the activation of one or more trigger points.

Trigger Points: 

Trigger points (TrPs) are not the same as the "tender points" that occur in fibromyalgia or acupressure points; they are extremely sore or hyperirritable areas that can develop anywhere in the body and are more common than generally thought. They may feel like knots, nodules, hard lumps, or taut, ropy bands of fibers in the muscles. In very severe cases, muscle may feel like hardened concrete.

TrPs may be active or latent. Active trigger points cause pain, and latent ones can be "recruited" into causing pain. While CMP is not progressive, it can appear to be since each trigger point can develop satellite and secondary trigger points, which can themselves form satellites and secondaries, and so on.This cascade is especially likely if perpetuating or aggravating factors are not identified and corrected.

Aggravating Factors: 

Perpetuating or aggravating factors are numerous, and often unique. Common ones include: 

poor posture and body mechanics,
repetitious exercises or work
anything that restricts movement or decreases oxygen supply to the muscles
Impaired sleep
chewing gum
dental work
exposure to organic chemicals or heavy metals
inhalant and food allergies
nutritional deficiencies
metabolic and endocrine dysfunction
malabsorptive conditions in the gut
chronic infections
fibromyalgia
alcohol ingestion
and stress (physical and/or mental) are perpetuating factors in some patients.

When a trigger point is stimulated, it refers pain to other areas of the body in specific, predictable, characteristic patterns. Stimulation of some trigger points may also cause seemingly unrelated signs and symptoms; these include:

Migraines
other headaches
jaw pain
neck pain
lower back pain
earaches
heartburn
pseudo-heart pain
extreme dizziness
nausea
loss of balance
staggering
clumsiness
tinnitus
distorted perception of weight when lifting with hands
carpal tunnel syndrome-like symptoms
irritable bowel syndrome
bruxism
dysmenorrhea
impotence
painful intercourse
paresthesias
sciatica
leg cramps
buckling knees and ankles
blurring of vision
double vision
trouble swallowing
hypoglycemic-like symptoms
sweating
blanching
lacrimation
salivation
coryza
sinus pain
congestion
pilomotor activity
and decreased immunity

Joint pain that can be mistaken for arthritis, tendonitis, bursitis, or ligament injury may also occur.Trigger point activation may cause muscle contraction, which can pull bones out of alignment and lead to osteoarthritis. Trigger point activation may also be a contributing factor to the development of scoliosis." Chronic myofascial pain