Терапия на миофасциални тригерни точки
IMTT (Interessengemeinschaft für myofasziale Triggerpunkt-Therapie) has been founded in 1995 and focuses on the study of myofascial pain and the development of manual and “dry needling” techniques for the treatment of myofascial trigger – points. The concept of treating myofascial pain represents a therapeutic intervention, related to application to the muscle complex. The IMTT forms an integrative treatment approach combining manual and dry needling techniques in the MTrP region, manual techniques for influencing fascial mobility, stretching and relaxation exercises as well as functional strengthening and ergonomical advices. The IMTT approach also suggests subjective and physical examination systematic procedures in order to recognize myofascial patterns of dysfunction where evident.
Trigger points are points of palpation sensitivity, over the skeletal muscle. Their presence has been related, among other, to factors, such as overload or traumatic over-stretching of the muscles. Myofascial trigger points have been also related to muscular and neurophysiological phenomena. In terms of physical examination, myofascial trigger points can be identified through skilled palpation, which includes the identification of taut bands. Taught bands are considered as zones of non-reversible contraction of muscle sarcomeres. Pressing these taut bands, will reproduce pain, which is frequently referring to other parts of the human body. For instance, trigger point palpation in the neck muscles can radiate pain to the area of the head. Similarly, pressure of myofascial trigger points located in the gluteal muscles can generate pain across the back, or the side, of the thigh and the lower leg, as far as the ankle. Referred pain patterns, as the ones described, make sometimes difficult to localize the source of symptoms.
Myofascial trigger point treatment can be utilized in acute as well as in chronic pain situations.
Manual treatment of the myofascial trigger – points is employed through 6 different approaches used individually or combined, based on the work of Janet Travell (USA), David Simons (USA), IDA Rolf (USA) and Beat Dejung (Switzerland). “Dry Needling” consists of an evolutionary modality, based on the classic manual treatment principles. The IMTT utilizes and develops both the superficial technique (Superficial Dry Needling, SDN), based on the work of Peter Baldry, MD, (Great Britain) and the deep technique (Deep Dry Needling, DDN), as presented (in the form of Intramuscular Stimulation) by Chan Gunn, MD, (U.S.). The Dry needling technique can be a valuable additional modality to the classical myofascial trigger - point treatment.
The IMTT concept starts with the module 1 (5 days) seminar. Module 1 addresses the assessment and manual treatment of MTrP in the trunk- neck- and shoulder muscles. After finishing module 1 participants can select either one or both of the available two options. Firstly, to continue with dry needle techniques (DN1 = 3 days) for muscles teached in module 1. Secondly, to attend the module 2 (5 days) seminar, which addresses the assessment and manual treatment of MTrP in the extremities, cranium and face. Module 2 is also concerned with peripheral nerve entrapments related to myofascial tissues. After finishing module 2, participants can proceed with dry needling techniques (DN2 = 3 days) for muscles teached in module 2. Prerequisites to attend DN2 is the completion of module 1, DN1 and module 2. The full IMTT educational program also includes additional workshops, clinical days and final competency exams, as described below:
Educational program for physiotherapists and doctors
Module 1 Course
Contents: Examination and treatment of trunk- neck- and shoulder muscles
Keywords: Neck pain, headache, shoulder pain, low back pain, thoracic pain
Aims: The participants are introduced to theoretical aspects regarding the etiology, pain mechanisms, development and management of myofascial trigger points. The practical part of the seminar focuses on the assessment and manual treatment processes aiming to the dysfunction of the neuro-muscular-skeletal system, caused by myofascial trigger points. In terms of treatment, the seminar presents manual techniques in the MTrP region, manual techniques for influencing fascial mobility, stretching and relaxation exercises, as well as functional strengthening and ergonomical advices.
Module 1 seminar is covering anatomically the neck, thorax, shoulder and pelvic region.
You can find more information on the IMTT web page: http://www.imtt.ch
Key Literature from IMTT members:
• Dejung B (2009) Triggerpunkt-Therapie. 3rd Edition (German). Huber Hans.
• Gautschi R (2016) Manuelle Triggerpunkt-Therapie: Myofasziale Schmerzen und Funktionsstörungen erkennen, verstehen und behandeln. 3rd Edition (German). Thieme.
• Gautschi R (2012) Trigger points as a fascia – related disorder in Schleip R, Findley TW, Chaitow L, Huijing PA (Eds) Fascia: The tensional network of the human body.p425-432. 1st edition. Churchill Livingstone Elsevier.
• Tanno – Rast H (2014) Praxisbuch Myofasziale Triggerpunkte: Diagnostik - Therapie – Wirkungen. 1st edition (German). Urban & Fischer Verlag/Elsevier GmbH.
• Tanno – Rast H (2016) Mięśniowo-powięziowe punkty spustowe. Diagnostyka – Terapia - Działanie. Edra Urban & Partner, Wrocław (Polish).