Dr.
Travell, "Acute myofascial pain due to TPs caused
by clearly identifiable strain of one muscle is, as a rule, easily relieved.
If the patients pain has increased as the range of motion decreased, the therapeutic
results are still likely to be good. If the pain has decreased as the range
of motion also decreased, which may indicate increasing fibrosis, achieving
relief of pain and return of function becomes more challenging. Patients who
have had a stable pattern of referred TP pain for months or longer, without
extension to other muscles, are likely to respond well to treatment. When the
pain has spread and is gaining momentum with successively more muscles becoming
involved, multiple perpetuating factors must be eliminated before specific myofascial
therapy will give sustained relief."
Paraphrase = The simpler, fewer and shorter duration
trigger points have a faster and easier recovery. Multiple sites, long duration,
increasing number and higher and longer severity trigger points take much longer
to resolve or reduce and may not end completely.
Goals of treatment are:
1. Decreased pain
2. Increased mobility and ROM
3. Increased function
4. Better patient control of environment/self/precipitating factors
Depending on the severity, patient's commitment and a broad treatment approach
most patients can recover significantly or fully within a reasonable time.
Estimates of treatment duration are:
| Acute | Short term (<6mo.) Constant Chronic | Long term (>6mo.) Recurring Chronic | Long term (> 1 yr) | |
| Single or Localized | Mild- moderate | 3 » 1/wk 1 - 3 wks | 3 » 1 /wk 3 - 8 wks | 3 » 1 /wk 3 - 8 wks |
| Severe | 3 » 1 /wk 3 - 8 wks | 3 » 1 /wk 3 - 8 wks | 3 » 1 /wk 3 - 8 wks | |
| Multiple <9 | MPS Mild - moderate | 3 » 1 /wk 3 - 8 wks | 3 » 1 /wk 6 - 12 wks | 3 » 1 /wk 10 - 20 wks |
| Severe | Daily » 3/wk 6-12 wks | Daily » 3/wk 6-12 wks | Daily » 3/wk 10-20 wks | |
| Multiple 9+ FMS | Mild - moderate | N/A | Daily » 3/wk 4-12 mos | Daily » 3/wk 4-12 mos |
| Severe | N/A | Daily » 3/wk 6-12 mos | Daily » 3/wk 6-12 mos |
» = "down to" - i.e. 3 » 1/wk 1 - 3 wks = 3 down to
1 time per week for 1 to 3 weeks
MPS = Myofascial Pain Syndrome = TPs in 8 or fewer of the 16 regions of the
body
FMS = Fibromyalgia Syndrome = TPs in 9 or more of the 16 regions of the body
Sample Patients
#1. Recent documented injury with grade 4 trigger points in only one body
region (neck/shoulders)
= Single or Localized / Severe / Acute - 3 per week x 1 to 3 weeks, 2 per
week x 1 to 3 weeks until TP is gone and then a final exam 1 or 2 weeks later
for a total of 3 to 8 weeks.
#2. Long term recurring chronic fibromyalgia. Daily for 4 to 12 weeks, 3 to 4 times per week for 2 to 6 months, 1 to 2 times per week for 6 to 12 weeks, etc. = total 6 to 12 months
Reasons for Failure
Lack of patient commitment
Misunderstanding / lack of doctor-patient education
Continuation of precipitating and/or perpetuating factors
Excessive patient zeal
Lack of familial support
Lack of doctor technique
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