Trigger points are hyperirritable spots within taut bands of muscle that are painful on compression and can cause referred pain patterns. They are commonly caused by overload, injury, lack of exercise, or poor posture in sedentary individuals between 27-55 years old. Trigger points have two types - active points that cause pain at rest and latent points that cause pain with direct pressure or muscle contraction. Electrotherapy can stimulate the body's endogenous opiate system to relieve pain by using low frequency stimulation below 10 Hz with long pulse durations to activate areas of the brain and spinal cord that inhibit nociception.

1. TRIGGER POINTS
ELECTROTHERAPY
ADITYA JOHAN .R,M.FIS

2. DEFINITION
• A Trigger Point (TrPt) is a hyperirritable spot associated
within a taut band of a skeletal muscle
• Painful on compression or muscle contraction
• Usually responds with a referred pain pattern distant from
the spot
• Very often there are nodules palpable within the muscle
often at the size of 2-10 mm

3. ETIOLOGY & EPIDEMIOLOGY
• Mainly due to overload
• An injury sustained by a fall
• Lack of exercise or a bad posture can lead to trigger points
• Most common in sedentary persons between 27,5-55 years
• 45% of the patients are men
• Trigger points may be at different places in both skeletal
muscles in the hip, neck, shoulder
• usually in places where nerves connected the muscle fibers

4. TAUT BAND & NODULES

5. PATHOPHYSIOLOGICAL PROCESSES
• Sensitization of peripheral muscle nociceptors
• Sensitization of second-order neurons in the dorsal
horn
• Dysregulation of the descending endogenous pain
control system

6. CHARACTERISTICS/CLINICAL PRESENTATION
• Active TrPts
Active TrPts produce pain symptoms at rest
often with referred pain which may be described as radiating
or spreading, usually not associated with a nerve or
dermatome
• Latent TrPts
Latent TrPts do not provoke spontaneous pain
The TrPt may refer pain with direct mechanical stimulation or
muscle contraction

7. ELECTROTHERAPY FOR ENDOGENOUS OPIATE
LIBERATION
• Endogenous refers to something from within or that is
developed from internal systems
• Opiates are drugs containing opium or its derivatives
and are used in medicine for inducing sleep and relieving
pain
• Endogenous Opiate : the ability of the body to produce
and release strong pain-relieving substances

8. • Endorphins include enkephalins, dynorphin, and β-
endorphin
• The transmission of nociceptive information can be inhibited by
pain matrix activity
• Brainstem areas that provide intrinsic antinociception form a
neuronal descending system
 Rostral ventromedial medulla
 Periaqueductal gray (PAG) in the midbrain
 Locus coeruleus in the pons

10. ELECTROTHERAPY FOR ENDOGENOUS OPIATE LIBERATION
• Theoretically, stimulation of the endogenous opiate system can
also lead to pain relief
• Lower frequency stimulation (less than 10 Hz) with longer
pulsedurations producing longer lasting relief
• Electrical stimulators capable of rates of 1 to 5 pps, a pulse
duration greater than 200 microseconds
• An intensity to create a muscle twitch may generate pain relief
through this mechanism
• Electrode placement sites may include motor points that may
also be acupuncture points or trigger points.