Thursday, November 7, 2013

Unraveling The Mystery Of Fascia And Myofascial Trigger Points (Part I)

 by Susan E. Davis, PT

Ah, what a tangled web they weave, those fascia bundles!  

Fascia is a network of connective tissue that surrounds body organs, muscles, groups of muscles, nerves, etc. It is a dense maze of collagen fibers that provide structure and support for these internal body parts.

Now, I hope I don’t make the reader squeamish when I say that my first semester of physical therapy training involved dissecting a human cadaver and having to literally tear through the fascia layers to get to muscles and nerves. That experience was invaluable in understanding the feel and density of fascia and developing a sense of what a patient would experience if that same tissue was tight or restricted. Ouch!

The fibers of the fascia are continuous from around the muscle through the outer layer of bone

Because fascia is so physically prevalent surrounding muscles, the term “myo (meaning ‘muscle’) fascial” is used to describe the type of pain syndrome that develops when it is traumatized.

Myofascial pain occurs from any type of overload, repetitive motion, fatigue, direct injury such as compression or over- stretching, and due to exposure to cold/having a chill.

The exact mechanism of pain is still speculative, but most medical folk believe it is mechanical in nature.

In other words, it is not inflammatory or chemical and does not typically respond to anti-inflammatory medication.  

It responds to treatment that is mechanical and physical in nature.

Myofascial pain is typically a chronic disorder associated with tender and sensitive spots or zones in the muscle that develop, called trigger points.

These trigger points (MTrPs) can be either active or latent (in remission) and can cause pain either locally (at that direct spot) or in referred (in another location).

The first type of trigger point that causes pain locally when compressed or pushed with your finger, is also called a “nodule”.  

The second type causes pain in a different, and seemingly unrelated, area of the body when it is compressed.  

Weird, right?

It is very challenging for the therapist to determine if a painful part of the patient’s body is actually being caused by a trigger point in a different spot!

Now, it becomes all the more challenging when the patient is an animal who cannot speak and subjectively identify where the pain is located when you press on their trigger point!

In veterinary medicine, myofascial pain syndromes with trigger points are diagnosed only after other things are ruled out: bone issues, joint, neurological status, etc.   

It generally takes longer to figure out when animals have myofascial pain as compared to humans.

Sometimes the diagnosis of myofascial pain with trigger points can only be surmised when tenderness and hardness of the tissue softens and disappears after animal treatment.

There are diagnostic tests available that measure pressure thresholds in soft tissues, as well as thermography which measures tissue heat. Use of x-rays and ultrasound are of no help in directly diagnosing MTrPs.


Susan E. Davis (Sue) is a licensed Physical Therapist with over 30 years of practice in the human field, who transitioned into the animal world after taking courses at the UT Canine Rehabilitation program.  She is located in Red Bank, New Jersey.

She has been providing PT services to dogs and other animals through her entity Joycare Onsite, LLC in pet’s homes and in vet clinics since 2008.

She also provides pro bono services at the Monmouth County SPCA in Eatontown, NJ.  Sue is the proud “dog mommy” to Penelope, a miniature Dachshund with “attitude”.  For more information see her website , or follow on Twitter @animalPTsue.

Sue is also the author of a fantastic book on physical therapy, Physical Therapy And Rehabilitation For Animals: A Guide For The Consumer.  

Physical therapy can do so many great things for your dog. Understanding all the possibilities physical therapy can offer will change your dog's life. This book definitely belongs on the shelf of every dog lover.

Articles by Susan E. Davis:
Functional Strengthening Exercises: the What, Why and How
One Thing Leads To Another: Why The Second ACL Often Goes Too
Compensation: An Attempt To Restore Harmony
Paring Down to the Canine Core
Canine Massage: Every Dog ‘Kneads’ It”
Photon Power: Can Laser Therapy Help Your Dog?  
Physical Therapy in the Veterinary World  
Reiki: Is it real? 
Dog Lessons: Cooper  
The Essentials Of Canine Injury Prevention: 7 Tips For Keeping Your Dog Safer 
It's Not Just Walking, It's Therapy! 
Treatment And Prevention Of Canine Intervertebral Disc Disease (Part I)
Treatment And Prevention Of Canine Intervertebral Disc Disease (Part II Physical Therapy)
Range Of Motion: It’s A Matter Of Degree…
The Weight Of Water And How It Helps Dogs 
By Land or By Sea? A Comparison of Canine Treadmills 
Unraveling The Mystery Of Fascia And Myofascial Trigger Points (Part I)
Unraveling The Mystery Of Fascia And Myofascial Trigger Points (Part II) 
Scar Tissue: Is it Too Much of a Good Thing? 
Physical Therapy Tip Of The Month: Ramps! 
Physical Therapy Tip Of The Month: Indoor Duo Dog Exercises!
Physical Therapy Tip Of The Month: Best Practices After Your Dog’s Surgery

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