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Trigger Point Procedure

Trigger Point Procedure is made up of three parts - Scan, Exam, and Therapy. The only difference in the three is the time of maintained pressure.

THE FIRST KEY TO FINDING TRIGGER POINTS

is to realize that you, the examiner, can not feel them yourself. Research at the Southern California University of Health Sciences (formerly Los Angeles College of Chiropractic) showed that without patient feed back there was no inter-examiner reliability between experienced doctors in finding trigger points on patients. Personal experience has demonstrated this as well. Many times I have had different doctors work on me stating they have found a trigger point and that it was finally going away (I felt none there) or have pressed on one and not realized they had found one.

It is very easy to find a trigger point. All you have to do is apply firm pressure where you suspect trigger point to be and ask the patient to tell you when they feel an abnormal or sharp pain. They feel the results of pressure. They will direct you to where trigger points are. To determine that the pain is truly coming from a trigger point ask the patient to tell you when the maintained pressure causes a change in sensation - a decrease, narrowing of the pain pattern, or change from sharp to dull. If this happens within 15 to 45 seconds you have a trigger point. If it goes 60 seconds without any change you are not on a trigger point. It may be a bony prominence, cyst, fibromyalgia, other pathology, or you may be on the edge of the trigger point instead of on the top center of it.

SCANNING FOR TRIGGER POINTS

is the process of finding Tender Points (potential trigger points) on a fast basis. It is essentially applying firm pressure in muscle regions where suspected trigger points are for no more than 1 second per site. The process is to find where there are abnormal pain responses at either a "Jump Sign" reflex speed response or where the patient tells you there is pain where you just were in the scan. By using a cadence of 1 second per spot you do not apply pressure long enough to create pain unless there is a potential trigger point there. You are not trying to find all the trigger points, only the major ones in a given muscle region. If you are going at a good speed and pressure you will find that a "Jump Sign" will occur as you press on a trigger point but the subjective complaint of pain will be delayed until you have reached the next one or two spots on the scan. This is good. You can scan the entire body core, front and back, in as little as 2 minutes.

EXAMINATION FOR TRIGGER POINTS

for trigger points is the maintained application of pressure on a tender point. If the patient tells you it changes (describe the possible changes to the patient) within the 15 to 45 seconds than you have an actual trigger point. You only have to test the main or central trigger point in each muscle region. If it doesn't change within 60 seconds you are either not on top of the trigger point (use tissue slack to roll on to it and start the timer again for up to 50 seconds) or it is not a trigger point.

THERAPY FOR TRIGGER POINTS

is the finding and dissipating of all the trigger points in a muscle region. Generally, by doing the therapy, you will cause an improved change immediately in the patient of between 30% to 60%. This noticeable improvement will last for a period of time but the original pain will usually return. The length of time to patient feels better before the first signs of return of pain give an indication of the chronicity and seriousness of the trigger points and how long it will take for the condition to be resolved, cured or reach plateau.
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