You have likely heard it from many including me in the previous five articles I have written for Oral Health, that ones posture in practice may be the cause of many of the ailments that occur.6Īny position that you put your body in produces a certain degree of tension and puts a certain degree of force through your body. This brings us to the second reason that it is important to understand trigger points and their resulting pain as dental professionals this reason relates to posture. Thus, the pressure that produces pain in the body isn’t due to actual muscle or connective tissue pathology, but rather sensitization of neural tissue, whether cutaneous nerve, nociceptive fibres or even the nerves of the nerve trunks themselves (nervi nervorum).5 Why does this happen? The sensitization of the neural tissue is a representation of decreased depolarization potential within the affected neural tissues, which means that activation takes place with a reduced amount of stimulation they are hyperaroused.4
Again, this is important to understand because approach to care changes based on this finding.īecause nociception is originated in neural tissue, this also explains the referral patterns that will be exhibited with typical trigger points.4
In reality what we are feeling as the palpable nodule and sensitive points, are neural tissues that have become sensitized. Therefore, trigger points are more accurately due to neural tissue and not muscle or connective tissue.3 This begins to make sense since the majority, if not all, of the known trigger points in the body coincide with where neural tissue innervates muscle and connective tissue. Nociception, or the noxious stimulation through the body signaling to the brain, is only generated in the nervous system. They aren’t capable of signalling pain in the body, so to imply that these tissues are the pain generators is just inaccurate and lazy thinking. The first is that although we call it a “myofascial” trigger point and the name implies the problem lies within the muscle and fascial/connective tissue, those tissues are non-noxious tissues. There are two reasons, both very important concepts to understand.
Why is this an important topic to discuss with dental professionals dealing with pain? With compression, the painful point can cause referred pain, referred tenderness, motor dysfunction/weakness and autonomic phenomenae”.2 Travell first described a trigger point as “a hyperirritable spot in the skeletal muscle that is associated with a hypersensitive palpable nodule in a taut band. Myofascial trigger points, as first described in 1843 by Froriep, and made famous by Travell and Simons in 1942, are a common contributor to the development and manifestation of pain in the dental professional.
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