Typical Appointment
Myofascial trigger point therapy is a comprehensive form of pain relief. The following is the type of evaluation you would expect from a Certified Myofascial Trigger Point Therapist (CMTPT).
Prepare
Have any recent blood work/reports, x-rays, MRI, CT Scans ready* Also, prepare a list of current medications and be able to list any surgeries performed, especially if performed for pain.
Appointment
Patient History**: A very in depth patient history is taken to determine what causal factors are responsible for the condition of the patient. Areas of the patient’s life explored may be family, vocational, social, hobbies, illnesses and accidents. Chances are that the source of pain or dysfunction comes from one or several of these areas.
Postural Analysis: Since muscles with trigger points are shortened and tightened they will pull on the bones where they attach. These forces become apparent when bony landmarks of the body are compared to one another and then mapped on an intake form. By examining the types of pulls/torques on the body, the therapist can then determine where the shortened muscle groups are and begin treatment.
Pain Pattern Documentation: Next the patient, using one finger, will circle the area of pain on their body. The therapist will document the pain on a session sheet to use for comparison. The patient will also verbally tell the therapist about the pain, its intensity, what makes it worse or better.
Range of Motion Testing: Based on the patient's pain complaint, the pain map, and any verbal clues the therapist will then look for shortened muscles that are influencing the patient's condition by checking their range of motion. Once again, any muscle that has trigger points is going to have a decrease in range of motion and show up on the range of motion test.
Movement Analysis: The patient may be instructed to walk so the walking gait may be examined. The gait is the process in which a body ambulates, or walks. An uneven gait, such as a limp or abnormal movement in the pelvis may indicate further work in that area and will add another piece to the puzzle.
Perpetuating Factors: A perpetuating factor to muscle pain is like gasoline to a fire. It can be mechanical, nutritional, or systemic. Dr. Travell was so adamant about perpetuating factors that an entire chapter was dedicated in her two volume set, Myofascial Pain and Dysfunction: The Trigger Point Manual. She explained that unless perpetuating factors were either modified or eliminated altogether the patient would never achieve total pain relief.
Specific Soft Tissue Treatment: Treatment will then begin using one of several trigger point release methods. Trigger point pressure release is one that is used to manually manipulate the soft tissue which contains the trigger point and cause it to break up. Spray and stretch is another method that is used. In this method a vapocoolant, which is a spray that evaporates rapidly from the skin, is used to produce a cooling effect. While the therapist is spraying the muscle is being stretched at the same time to release the trigger point. After about five sweeps a heating pad is applied to warm the tissue. Other techniques to relieve trigger points include trigger point injections and myofascial release.
Myofascial Rehabilitation: At the end of treatment a specific muscle stretch retraining will be recommended. A muscle will want to revert back to its contracted, shortened state within one to two hours so frequent stretching will retrain the muscle to stay relaxed. This is the purpose of stretching. Also, some movement exercises and muscle strengthening may be recommended.
Patient Instruction and Involvement at all Stages of Treatment: This simply means that the patient and therapist will interact with each other in order to provide the feedback necessary to facilitate the therapy.
* NOTE: The blood work/scans are not for diagnostic purposes, but to determine if other pathological processes are at work perpetuating the pain condition. If this is a possibility a person will be referred to a practitioner for appropriate testing/diagnosis.
**NOTE: A physician referral with medical diagnosis is sometimes requested to eliminate other pathology that can mimic muscle conditions. Examples of these pathologies include, but are not limited to, cancer, heart conditions, thyroid conditions, vitamin deficiencies, and viral/bacterial infections.