What are Myofascial Trigger Points?
If your dog has muscular pain which is poorly responsive to non-steroidal anti-inflammatories (such as Rimadyl or Metacam) and rest there is a possibility it may be suffering with Myofascial Trigger Points. An older dog may not be slowing down from age but due to the pain from Trigger Points.
These are hyperirritable points found in muscles, fascia and tendons which can feel hard and nodular on palpation and are extremely painful, even on light compression. They are extremely common in humans and animals. If you are familiar with the knotty, painful areas found during a massage for yourself then you have had the experience of a Trigger Point. The pain and muscle dysfunction caused by their presence often leads to severe debility as they shorten the areas of muscles where they sit and in so doing place biomechanical strain on joints. In fact they can disguise themselves as joint pain due to referred pain e.g. a painful elbow may be due to a Trigger Point in the triceps muscle. Quite often there will be Trigger Points that cause no acute pain on normal activity but are painful on palpation. Over time these “Latent” Trigger Points lead to restriction of movement and weakness of the affected muscle.
Symptoms of Mysofascial Trigger Points
- Reluctance to jump up
- Reluctance to be touched in certain areas.
- Restriction in normal activities such as running, ball chasing etc.
- Compulsive licking of an area
- Sleep disturbances
- Withdrawal from normal activity
- Reduction in appetite
- Slow and lethargic
- Complete rest, strenuous exercise and cold weather may worsen the signs of Trigger Points.
What causes Trigger Points?
- Trauma (Motor Vehicle Accidents, dog fights, surgery)
- Chronic muscle fatigue or repetitive strain injury (e.g. agility dogs, frisbee dogs, racing greyhounds)
- Falls from a great height causing acute muscle overload
- Orthopaedic disease eg osteoarthritis
- Prolonged periods of immobility
- Psychological stress
- Chilling of muscles.
- Sometimes a poor response to orthopaedic surgery may be due to Trigger Points that formed in traumatised muscle.
Unfortunately trigger points will not be picked up on laboratory tests, x-rays, ultrasounds and MRI/CT scans and will be missed during a physical examination if not looked for. They typically poorly respond to conventional pain relief such as non-steroidal anti-inflammatory agents. To treat they need some form of physical therapy.
How are they treated?
The Trigger Point needs to be deactivated. We do this by using either direct pressure, acupuncture, use of a TENS machine or laser therapy. They can be a little uncomfortable to treat at first but become smaller and soften at further treatments reducing discomfort. Following this it is important to stretch the muscle which has been contracted to allow it to regain normal use. Muscle stretches at home will be important to “retrain” this muscle. Most muscle Trigger Points need at least two to three treatments to become deactivated. Unfortunately, once present, they are never eliminated completely and it will be necessary to try and avoid their flaring up. A variety of methods to avoid their reactivation will be discussed with you at the time of treatment.
Intermittent Trigger Point therapy is generally needed to maintain improvement which may be every 2 to 3 months.