The author hypothesises that partial contraction (using no more than 20 to 30% of patient strength, as is the norm in MET procedures) may sometimes fail to achieve activation of the fibres housing the trigger point being treated since light contractions of this sort fail to recruit more than a small percentage of the muscle's potential.
Subsequent stretching of the muscle may therefore not directly involve any of the critical tissues surrounding and enveloping the myofascial trigger point.
Failure to actively stretch the muscle fibres in which the trigger is housed may account for the not infrequent rapid recurrence of trigger point activity in the same site.
Repetition of the same stress factors which produced it in the first place could also be a factor in such recurrence of course.
A method which achieved precise targeting of these tissues (in terms of tonus release and subsequent stretching) would be advantageous.
Selye has described the progression of changes in tissue which is being locally stressed. There is an initial alarm (acute inflammatory) stage followed by a stage of adaptation or resistance when stress factors are continuous or repetitive.
In the stage of adaptation muscular tissue becomes progressively fibrotic, and if this change is taking place in muscle which has a postural rather than a phasic function the entire muscle structure will shorten.
Clearly such fibrotic tissue, lying in altered (shortened) muscle, cannot simply ‘release’ itself in order to allow the muscle to achieve its normal resting length (as we have seen, this is a prerequisite of normalisation of trigger point activity). This is not simply a case of altered tone, but of altered tone and structural change to the muscle fibres.
Normalisation requires ‘something’ to be done which effectively releases and stretches the tight fibrotic tissue housing the trigger point(s).
Along with various forms of stretch (passive, active, MET, PNF etc) it has been noted above that inhibitory pressure is commonly employed in treatment of trigger points.
Such pressure technique methods (analogous to acupressure or shiatsu methodology) are often successful in achieving at least short-term reduction in trigger point activity and are variously dubbed ‘neuromuscular techniques’.
Application of inhibitory pressure may involve elbow, thumb, finger or mechanical pressure (a wooden rubber tipped T-bar is commonly employed in the US) or cross-fibre friction.
All of these methods induce a degree of local trauma to the tissues when applied during treatment - although when the pressure is applied for a short period only or intermittently rather than constantly this tendency is minimised.
Is there another way of targeting precisely the tissues in which the trigger is housed so that when stretching is introduced, using Muscle energy or passive stretching, the offending fibrotic musculature is indeed treated?
Clinical experience indicates that by combining the methods of direct inhibition (pressure mildly applied, continuously or in a make and break pattern) along with the concept of strain/ counterstrain and MET just such a specific targeting can indeed be achieved.
Strain/Counterstrain (SCS) briefly explained.
Jones has shown that particular painful ‘points’ relating to joint or muscular strain, chronic or acute, can be used as ‘monitors’ - pressure being applied to them as the body or body part is carefully positioned in such a way as to remove or reduce the pain felt in the palpated point.