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					1 Chiro Science Mid Term Exam Dr. Peter M.Schoeb Feb. 29, 1996 (Retyped 2.26.97) Multiple Choice Comparing the myofacial pain syndrome (MPS) with fibromyalgia syndrome (FMS), the MPS is of chronic nature- more than 3 months duration MPS is common and the prevalence is 50% male and female MPS produces generalized aching in the soft tissue MPS is uncommon and the prevalence is 80% female To assess trigger point (TP) the__________ is an objective sign found during palpation ? relaxed almost hypnotonic muscle around an active TP the local twitch response reproducing the chief complaint painful decreased ROM of the adjacent joint visible elevation over the TP along with hyperemia blunt trauma trauma with hemorrhage which caused the TP According to Dr. Travell, TP’s are manifest in four stages. Which stage describes a TP which is subacute and upon palpation, reproduces the chief complaint ? A) 1 two C) 3 D) 4 T / F Dr. Trevall’s treatment protocol for TP’s has the following sequence Vapo - coolant spray procedureStretchHeatThree cycles of full ROM T / F Dr. Nimmo’s Receptor Tonus Method suggests ischemic pressure on the TP of at least 15-20 seconds ? (should be 5-7 sec.s)

2 Multiple Choice The self feeding pain spasm pain cycle which perpetuates the existence of a TP may be successfully interrupted by which of the following procedures ? Application of moist heat for 10-15 minutes depending on the area and the severity of the TP “Quick stretch” of the involved muscle tissue to normalize tone Transverse friction massage of the Tp and the surrounding muscle tissue An adjustment at the appropriate vertebral level along with ischemic compression of the TP Gentle mobilization of the involved soft tissue T / F Postural Exam an ROM assessment are not necessary in the overall evaluation and differential diagnosis of TP’s and the myofacial pain syndrome Matching: Ddx.: TP’s vs. Tender points:

A. Tender points B. Trigger points

A - Tender points Primary fibromyalgia (Tender Point) Pain in prescribed locations in multiple areas (Tender Point) Localized tenderness without referral pattern (Tender Point) B - Trigger Points Found in belly and insertion of the traumatized muscles (Trigger Point) Source of consistent referred myofacial pain (Trigger Point) Myofacial Pain (Trigger Point) T / F Excess calcium in the contractile elements of the muscle fibers may cause sustained local muscle contractions Multiple Choice

3 “Finger palpation” of a taught muscle band / TP is the correct palpatory procedure for which of the following muscles ? A) B) C) D) Erector Spinae Supraspinatus SCM Rectus abdominus

Nimmo receptor tonus technique is best described as ? Adjustment of the spinal level associated with the TP Consistent vibratory pressure over the TP Nerve compression in the area of the TP to break the pain spasm pain cycle Application of static, constant pressure over the TP The presence of a sleep disorder, by definition greater than 80%, is characteristic of the following muscular condition ? A) B) C) D) E) Rheumatic myopathy Myofacial pain syndrome Myofascitis Hypermyotonia Primary fibromyalgia

The management of the myofacial pain syndrome would include the following ? A) Adjustment, systemic light aerobic exercise, rest, reduced stress B) Adjustment, stretching exercises, nutritional support and local treatment of choice C) Adjustment, heavy exercise, ice and interferential, local massage D) A&B E) A&C

T / F Skin and scar trigger points are mostly dormant, do not cause any discomfort and referred pain patterns are rarely present T / F Referred pain upon pressure on a Trigger point is a hallmark of the myofacial pain syndrome and indicates the presence of a Trigger Point. Fill in the Blank Name the five biomechanical and/or anatomical causes of myofacial pain: (each correct answer is worth one point)

4 1) 2 3) 4) 5) Nutrition Metabolic Endocrine Systemic Perpetuating Diseases Psychological factors

(This was transcribed as was …answers have not been verified 2.26.97) Good Luck ! More Stuff for Schoeby One Kanoby (Hand Written Notes In Library) Strain & counter Stain Manual Therapy Technique Places joint passively in the position of greatest comfort in order to relieve pain in order to relieve pain Eliminates inappropriate proprioceptor activity that perpetuates somatic or neuromuscular dysfunction. Decreases hyperactive myoitonic reflex arc (afferent gain originating from muscle spindle. Usually with in the same segment) Decreases approximation of relaxed joint surfaces and thus allows increase of ROM and joint mobility. Decreases muscle spasm of muscles surrounding affected joints

Myofacial Pain and Dysfunction Taught band in muscle Trigger point 4 stages (Travell) I. Acute, constant pain II. Sub acute, reproduces chief complaint III. Local pain upon plpation IV. No trigger points at all


Palpation: Local Twitch Response LTR = Objective sign reprodicing Chief complaint Assesment: 1. ROM 2. Postural Exam 3. Palpation of muscle Trigger Point (s) thru progessive Soft Tissue Levels Non-Myofascial Trigger Points ( trigger point types ) 1. Skin / Scar 2. Fascial and Ligamentous 3. Periosteal

A. Accupuncture & Trigger Points B. Motor Points vs. Trigger Points Musculoskeletal Diseases Rheumatoid Arthritis Dermamyositis Osteoarthritis Gouty Arthritis Polymyositis Psoriatic Arthritis

Neurologic Diseases Psycogenic Pain and Pain Behavior Neoplasms Neuralgias : (Neck Musculature)

Tortacolis Infection Trigeminal Neuralgia ( aka Tic DeLarue)


Causes of Myofacial Pain Metabolic Endocrine Nutritionnal Systemic Perpetuating Diseases Psycological Factors Also… Ergonomic (factors) Long 2nd Meta Tarsal (&) Short 1. Upper Arm 2. Hemi Pelvis 3. Leg Treatment Postural Corrections 1. Heel Lifts 2. Arch Supports 3. Ischial Lifts Vapocoolant Spray Proceedure 1. 45 cm/18 inches (30 degree Angle) 2. Stretch (Passive & Full ROM) 3. Heat (Moist) 4. 3 Cycles of Full ROM

Ergonomic Consideration 1. Car Seat 2. Chair Size 3. Ischial Lift 4. Support (Low Back) 5. Work Station a. Height b. Distance from Work Station = “the lever”

6. Chair

7 Back rest: Should Cover Inf. Angle of Scapula (stabilizes Shoulder Joint Muscles)