Treating Myofascial Trigger Points with MLS® Laser Therapy

Myofascial trigger points (MTrPs) can contribute to pain, abnormal posture and gait, and sleep disruption in our patients and so appropriate therapy to reduce activation of MTrPs can improve quality of life enormously.

An MTrP is defined as a hyperirritable spot or “knot” located in a taut band of a muscle, capable of producing referred pain. In small animal patients, the taut band can be identified in a muscle belly by palpating perpendicular to the affected muscle fibres. Once the taut band is identified, palpation along the taut band will locate the nodule, or “knot” (a discrete area that feels like an intensely contracted structural unit within the muscle).

MTrPs typically form after muscle injury or repetitive overuse of muscles, and can therefore commonly be found in arthritic patients and those recovering from orthopaedic surgery. It has been proposed that sustained low-level contractions cause a decrease in perfusion, hypoxia, and ischemia leading to activation of cellular responses and increased neuropeptide release. Certain neuropeptides, including calcitonin gene-related peptide and substance P, facilitate an increased release of regulatory compounds, resulting in excessive acetylcholine. It is hypothesized that the excessive acetylcholine release, and subsequent sarcomere shortening and inappropriate changes in receptor activity, lead to development of a taut band within the myofascial and subsequent MTrPs.

Perpetuating factors MTrPs include:

• Mechanical stressors
• Muscle overload
• Osteoarthritis
• Repetitive motions
• Orthopedic disease
• Soft tissue injury
• Neuropathy
• Chronic infections/infestations
• Nutritional deficiency or inadequacy (e.g., anemia, inappropriate supplementation)
• Physical and emotional stress (tense/tight muscles/posture)

MTrPs can be located within the belly, origin, or insertion of a muscle and are known to cause decreased changes in range of motion, muscle weakness, and postural imbalance.

 

How to identify Myofascial Trigger Points in your patients

Due to the lack of objective measurements and diagnostic tools, identifying MTrPs by palpation remains the standard way of confirming their presence.

During palpation, the patient should be as relaxed as possible to enable identification of the taut bands. This is best achieved in lateral recumbency. Patients may flinch, yelp, cry out, or try to bite, depending on the location and intensity of pain.

Flat Palpation is best used to identify MTrPs in flat muscles or muscle groups, such as the paraspinal muscles. The examiner applies pressure with the pointer and index finger across the muscle fibres while simultaneously compressing the muscle against the underlying structure, such as a bone or bones, to identify the taut band.  

 

                                            

Pincer Palpation can be used on specific muscles such as the quadriceps and triceps. The examiner grasps the muscle belly between their thumb and finger and rolls the muscle between their fingertips down along the muscle belly until a taut band or bands are detected and a firm nodule within the band is palpated.

 

                                            

A common location for trigger points in dogs are:

• Proximal rectus femoris at the attachment to the iliac wing
• Mid triceps group
• Iliopsoas

                                             

 

Therapy for Myofascial Trigger Points

There are invasive and non-invasive therapies for the treatment of MTrPs. Invasive therapy with the use of acupuncture needles or injections is considered the most effective way of decreasing and preventing recurrence in activation of MTrPs. However, for those not permitted or trained to perform needling techniques, laser therapy can be an extremely effective alternative.

Laser therapy causes neural inhibition of the peripheral nerves supplying the muscle, immediately reducing pain and muscle spasm. It also improves microcirculation to the surrounding tissue, improving oxygen supply to hypoxic tissues and removing waste cellular metabolites – the muscle relaxes and normal movement can be restored.

A comparison study of dry needling and laser therapy in the masseter muscle found similar outcomes, with a statistical significance of reduction of MTrPs with laser therapy at a dose of 4 J/cm2 or dry needling with 2% lidocaine injection over the MTrPs. Patients were evaluated after a total of 4 sessions at intervals ranging between 48 and 72 hours; however, the number of treatments needed to deactivate MTrPs varies from patient to patient depending on whether the issue is chronic or acute.

 

How to treat with MLS® Laser

MLS® Laser devices are unique in delivering a Class 4 Laser power output (25-270 Watt peak power), whilst not overheating tissue. This enables exceptionally effective treatment of trigger points; the handset can be held still and in firm contact with the tissue delivering exact dosages. All units include a trigger point protocol for ease of use.

                                                          

 

 

Hear from users of MLS®

“I absolutely love the laser. It's quick and efficient and the results speak for themselves. The battery life copes beautifully with long days on the road and its light enough to be manageable for a mobile clinic. From wound healing to OA pain relief it's tried and tested to produce results. One of my favourite things is the lack of heat! Especially treating trigger points and small areas and in the canine world they seem to tolerate it better and it feels super safe!”

~ Miranda Cosstick, MScVetPhys MIRVAP(VP) RAMP, L3 Hydrotherapist, ICH Board, MCVP

 

"I cannot tell you how amazing this laser is and what fantastic effects it’s having!"

~ Jessica Dann MSc, McTimoney Animal Chiropractor

 

"As a veterinary physiotherapist I have been using a class 3B laser for over 5 years now and I have had brilliant results. I purchased MLS® Class 4 Laser based on a recommendation and despite only using it for two weeks, I have already had eleven clients message me after the treatment to say how well their pets are doing. Even regular clients who I have received Class 3B laser therapy for years saw more of an improvement after just one session. The portability makes it easy to transport between stable yards and it is easy to use with the pre-set programmes and comfortable to carry and use. The team are very helpful and always at the end of the phone with any questions too. I can highly recommend this product and it is well worth the price tag."

~ Jessica Jones, Adcertvphys, RAMP, IRVAP, BSC(hons), Fdsc 

 

For more information about our MLS® Laser products visit

 

References

Zhuang X, Tan S, Huang Q. Understanding of myofascial trigger points. Chin Med J 2014;127(24):4271-4277.

Hong CZ. Persistence of local twitch response with loss of conduction to and from the spinal cord. Arch Phys Med Rehabil 1994;75(1):12-16.

Wall R. Introduction to myofascial trigger points in dogs. Top Companion Anim Med 2014;29(2):43-48.

Frank EM. Clinical applications of myofascial trigger point therapy. World Small Anim Vet Assoc World Cong Proc 2007. vin.com/apputil/content/defaultadv1. Accessed December 15, 2018.

Conarton L, Downing R, Goldberg ME. The veterinary technician in alternative therapies. In: Goldberg ME, ed. Pain Management for Veterinary Technicians and Nurses. Ames, IA: Blackwell and Wiley; 2015:317-322.

Uemoto L, Garcia M, Govea V, et al. Laser therapy and needling in myofascial trigger point deactivation. J Oral Sci 2013;55(2):175-181.

Uemoto L, Azevedo R, Alfaya T. Myofascial trigger point therapy: laser therapy and dry needling. Curr Pain Headache Rep 2013;17:357.