Are Myofascial Trigger Points a Major Cause of MSDs? Part I

Musculoskeletal disorders (MSDs) continue to cost U.S. employers billions of dollars annually to diagnose and treat, but there doesn’t appear to be a noticeable reduction in the incidence of MSDs in the workplace. The Bureau of Labor Statistics (BLS) has reported in its 2012 analysis of workplace injuries and illnesses that MSDs account for more than a third of total injuries, virtually unchanged from the previous year.

BLS Quick Stats on MSDs

  • MSDs or ergonomic injuries accounted for 34% of all workplace injuries and illnesses requiring days away from work in 2012.
  • Injured workers with MSDs required an average of 12 days before returning to work compared to the 9-day average for all cases.
  • The most severe MSD cases occurred to the shoulder requiring a median of 24 days before returning to work.
  • Laborers and freight, stock, and material movers experience the most MSDs.

With the incidence of MSDs remaining stagnant, and with an increase in the average days off work, it appears that health and safety professionals need to take a closer look at their ergonomic strategies as well as their treatment methods.

Myofascial Trigger Points (TPs) May be an Overlooked Cause of MSDs

Travel Trigger PointMyofascial trigger points were first recorded in medical literature in the 1940s by Janet G. Travell. In the 70s and 80s, Travell began using the term “myofascial trigger points” and published a paper titled, “Myofascial pain & dysfunction: the trigger point manual.”

It wasn’t until the turn of the century, however, that trigger points made their way back into the medical spotlight.

Prior to the late 90s, myofascial trigger points were difficult to detect with existing technology. The development of musculoskeletal ultrasonography, and more recently acoustic sonoelastography, were critical to establishing trigger points as a cause of MSDs. By the year 2000, nearly 90% of pain specialists agreed that trigger points resulting in Myofascial Pain Syndrome (MPS) was a legitimate diagnosis.

What are Myofascial Trigger Points?

Example: micro graph of extracellular fascial network inherent in muscle tissue. This collagen based fascial network envelops muscle fibers, bundles, and the muscle belly itself.Myofascial TPs are generally known as “muscle knots.” The knots typically form deep inside the muscle tissue making them difficult to diagnose and treat. The knotted muscle becomes so dense that it cuts off its blood supply causing even more pain and irritation. A person with multiple trigger points is diagnosed as having myofascial pain syndrome (MPS).

The actual cause for trigger points is multi-faceted and widely-debated. The usual suspects are agreed upon by many experts including muscle over­use, injury, disease, chronic postural strain, age-related musculoskeletal decline (decondition­ing), and Trigger Point Illustrationsarcopenia (the degenerative loss of skeletal muscle mass). Stress, tension, anxiety are among the potential psychological causes of trigger points. TPs can often cause or exacerbate chronic conditions such as back pain, headaches, hip pain, and trauma.

If American industry is to ever reduce its exposure to the billions spent annually on MSDs, it’s going to have to examine the root causes. New technology and renewed research efforts have identified myofascial trigger points as a potential major cause of Musculoskeletal Disorder.

Micrograph illustrations to the left captures the extracellular fascial network inherent in muscle tissue. This collagen based fascial network envelops muscle fibers, bundles, nerves and the muscle belly itself. 

Part II New Diagnostic and Treatment Technologies for Myofascial Trigger Points

Look for Part II of this article in the June InjuryFree News letter coming out next month!