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Personal Injury Blog

Muscle Spasm Vs. Myofascial Trigger Point

Douglas E. Schmidt, the Senior Trial Lawyer at the Schmidt Law Firm, recently spoke to 70 chiropractors at a Continuing Chiropractic Education seminar. The subject was “Boundaries” with emphasis on record keeping.

Schmidt presented a review of the medical literature regarding the subject of MYOFASCIITIS and CHRONIC MYOFASCIAL PAIN SYNDROME. Many of the chiropractors in attendance were particularly interested in Schmidt’s review of the medical and chiropractic literature regarding the subject of how MUSCLE SPASM “morphs” into MYOFASCIAL TRIGGER POINTS.

Schmidt observed that many medical doctors and some chiropractic doctors do not give proper recognition to the entity of CHRONIC MYOFASCIAL PAIN SYNDROME with the principal diagnostic feature being TRIGGER POINTS or TAUT BANDS. This condition was first brought to public attention in 1983 by Doctors Janet Travell and David Simons in their book, “Myofascial Pain and Dysfunction-The Trigger Point Manual”.

In 1989, Doctors Travell and Simons were the featured speakers at the 1ST INTERNATIONAL SYMPOSIUM ON MYOFASCIAL PAIN AND FIBROMYALGIA, sponsored by the Department of Physical and Rehabilitation of the Medical School.

Foreman and Croft, in their outstanding text, Whiplash Injuries-The Cervical Acceleration/Deceleration Syndrome (3rd ed 2002) describe the evolutionary process of the development of a myofascial pain syndrome (disorder):

In the early stages, this condition is referred to as a strain. As the condition develops, secondary effects are made manifest (such as muscular contractions and reductions in range of motion, development of trigger points, weakness, etc.) The tendency, then, for many practitioners is to refer to the condition as a chronic strain, which actually is incongruous because strains heal in a few weeks. In a study of patients referred to a pain treatment center, it was found that for patients with vague diagnoses such as chronic pain, psychogenic pain, and cervical strain, the five most commonly missed diagnoses were MPD (Myofascial Pain Disorder), facet disease, peripheral nerve entrapment, radiculopathy, and TOS (Thoracic Outlet Syndrome).

Foreman and Croft state that the "Two major components of MPD (Myofascial Pain Disorder)...are the trigger point (TrP) and the reference zone, which is a zone of pain felt when palpating the TrP." P. 384 .

Schmidt also reviewed the more recent description of the entity of MYOFASCIAL PAIN SYNDROME in the 4 volume set published by the American Medical Association for use in its Continuing Medical Education Program for Primary Care Physicians entitled Pain management-Overview of Physiology, Assessment and Treatment. That text contains the following description MPS:

Myofascial pain syndrome is a condition of mild to severe muscle pain associated with trigger points, the pain is typically localized, often to a single muscle. The syndrome commonly follows "muscle overload" such as may occur or with acute injury... patients complain of a deep, aching pain that is worsened by activity. Postural muscles are often affected. The pain may wax and wane but is usually present always present and can at times be severe.

Trigger points are a diagnostic feature of this syndrome. On physical exam there will be muscle tenderness and limited range of motion and these may be associated with palpable trigger points or "taut bands." Palpating the trigger point produces a local twitch (a visible shortening of the muscle) and referred pain and myofascial pain and most often involves the posterior neck low back shoulders, and neck. Chronic pain in the muscles of the posterior neck and referred to muscles in the head and cause persistent headaches; trigger points and lower back muscles can cause referred pain to the leg that mimics sciatica.

Schmidt observed that many medical doctors and chiropractors do not carefully assess patients for myofascial pain syndrome and certainly do not document in their charts to exact location (specific muscles) of the myofascial trigger points.

Schmidt is a trial lawyer with over 40 Years experience in representing the victims of personal injury and wrongful death in motor vehicle accidents, industrial and construction site accidents, and other types of traumatic injury. He strongly supports chiropractic for his patients and aggressively pursues recovery of chiropractic bills in many No Fault arbitrations. In the last calendar year, he attended 51 No Fault arbitrations, the large majority of them having a chiropractic billing in issue.

Douglas E. Schmidt
Personal Injury Attorney

13911 Ridgedale Drive,
Suite 110
Minneapolis, MN 55305

Phone (952) 473-4530
Toll Free 1-800-656-8450
Fax (952) 544-1308

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