Steven Capobianco - The Trigger Point Discussion: Part I
Summary
In this conversation, Dr. Beau and Steven Capobianco discuss the complex topic of trigger points and their role in manual therapy. They explore various theories and mechanisms behind trigger points, including the soft tissue milieu, neurogenic inflammation, and peripheral and central sensitization. They emphasize the importance of considering the broader context of the patient and adopting a synergistic approach to treatment. The conversation also touches on the interrater reliability of palpation and the role of experience in improving accuracy. In this part of the conversation, the subjectivity and objectivity of palpation are discussed, highlighting the challenges of accurately locating trigger points. Advancements in technology, such as MSK ultrasound, elastography, and T1Q mapping, are explored as potential tools for identifying trigger points and dysfunctional tissue. The role of hyaluronan in the extracellular matrix and its impact on tissue mobility and sensitization is examined. The concept of peripheral sensitization and neurogenic inflammation is introduced, emphasizing the importance of addressing cutaneous nerve entrapments in treatment approaches. In this conversation, Steven Capobianco and Dr. Beau discuss the role of touch and movement in addressing pain and dysfunction. They explore the influence of peripheral and central structures, such as trigger points and the limbic system, on the experience of pain. They also delve into the importance of the therapeutic alliance and the need for open-minded discussions in the field of musculoskeletal therapy. Overall, the conversation highlights the complexity of pain and the need for individualized approaches that consider both physical and psychological factors.
Takeaways
Trigger points are a real phenomenon experienced by patients, and their presence should be taken seriously by manual therapists.
The soft tissue milieu, including the extracellular matrix and fascial network, plays a significant role in trigger point development and treatment.
Neurogenic inflammation and neuritis are potential causes of trigger points, highlighting the involvement of nerves and cutaneous tissues.
Peripheral and central sensitization contribute to the pain experience associated with trigger points, and understanding these mechanisms can inform treatment approaches.
A synergistic approach that considers multiple theories and mechanisms may be more effective in addressing trigger points than focusing on a single theory.
The accuracy and interrater reliability of palpation improve with experience, allowing for more consistent identification of trigger points. Palpation is subjective and may not accurately locate trigger points, highlighting the need for advancements in technology.
MSK ultrasound, elastography, and T1Q mapping are emerging technologies that can aid in identifying trigger points and dysfunctional tissue.
Hyaluronan plays a crucial role in tissue mobility and sensitization, and its quantity and quality can impact tissue slide and glide.
Peripheral sensitization and neurogenic inflammation contribute to pain and can be addressed through treatment approaches that target cutaneous nerve entrapments. Addressing pain and dysfunction requires considering both peripheral and central structures.
The influence of touch on the nervous system can impact the experience of pain.
Therapeutic alliance and effective communication are crucial in guiding treatment decisions.
Open-minded discussions and collaboration are necessary to advance the field of musculoskeletal therapy.
Chapters
00:00 Introduction and Setting the Stage
00:24 The Phenomenon of Trigger Points
07:23 The Soft Tissue Milieu and Extracellular Matrix
10:37 Neurogenic Inflammation and Neuritis
26:26 Synergy Across Approaches
27:18 Interrater Reliability of Palpation
28:40 Subjectivity and Objectivity of Palpation
31:59 Advancements in Technology: MSK Ultrasound
32:58 Advancements in Technology: Elastography
34:55 Advancements in Technology: The Pact Device
37:31 Advancements in Technology: T1Q Mapping
39:24 Hyaluronin and the Extracellular Matrix
41:49 Chemical Milieu and Central/Peripheral Sensitization
50:11 Treatment Approaches for Sensitization
57:03 Peripheral Sensitization and Neurogenic Inflammation
58:26 Cutaneous Nerve Entrapments
01:01:15 Addressing the Peripheral Structures
01:04:04 Central Sensitization and Trigger Points
01:05:08 Spinal Cord Central Sensitization and Limbic System Response
01:06:27 The Influence of Touch on the Nervous System
01:07:53 Influencing the Nociceptive Barrage
01:08:23 Considering Other Physiological Factors
01:09:23 The Spreading of Pain and Receptive Fields
01:10:23 Using Touch to Change the Narrative
01:11:19 The Role of Touch in Influencing the Limbic System
01:13:16 The Role of Trigger Points in Pain Referral Patterns
01:15:33 The Effectiveness of DNS and the Importance of Therapeutic Alliance
01:17:01 Making Decisions Based on Individual Factors
01:21:09 The Need for Open-Minded Discussions and Clarity
01:25:02 Creating Productive Solutions for Patients
01:27:38 The Importance of Communication and Art in Therapy
01:30:23 The Future of MSK Powwow and Continuing the Conversation
Citations
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