pag. 1 faculty of physical education & rehabilitation department of human physiology &...
TRANSCRIPT
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Faculty of Physical Education & Rehabilitation
Department of Human Physiology & Sports Medicine
VUB Congress 2007
Andre Farasyn Ph.D. PT DO
Referred muscle pain is primarily peripheral in origin:“The barrier-dam theory”
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1. An infitration…
2. …on a muscular “Trigger Point”…
3. …activates a referred pain...
INTRODUCTION
.....Kellgren, 1937
Referred muscle pain
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Overview of different possible mechanisms of referred muscle pain:
INTRODUCTION
Referred muscle pain
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F
E
D
B
A
C
1. Mechanical pressure…
2. …on a muscular “Trigger Point”…
3. activates (A & B) via spinal reflex…
4. …(C) …a bodily area of referred pain...
6. other stimuli (E & F) co-activates…
5. …and in turn activates (D) the CNS
Hypothesis of Travell & Simons (1998)
INTRODUCTION
Referred muscle pain
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New hypothesis for the phenomenon of referred muscle pain
Andre Farasyn
Referred muscle pain is primarily peripheral in origin:
“The barrier-dam theory”
Medical hypotheses 2007;68:144-50.
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B
A
1. Mechanical pressure…
2. …on a “Trigger Point” …
5. secondly activates the afferent “postlocal” nerve (B) …downstream…and in turn via spinal transduction…
4. ..the creation of a referred pain zone..(sec)…
3. ..disturbes firstly the afferent “prelocal” nerve (A) …upstream: with the consequence of…
6. …actives the CNS
Just like a barrier-dam…
Referred muscle pain is primarily peripheral in origin:“The barrier-dam theory”
New hypothesis: Farasyn A.: “The barrier-dam theory”
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E
B
A
C
Co-activates parallel sensitive nerves (E => C) creating adjacent zones of referred pain…
Referred muscle pain is primarily peripheral in origin:“The barrier-dam theory”
New hypothesis: Farasyn A.: “The barrier-dam theory”
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Discussion & Conclusion
Confirmation needed in experimental referred muscle pain provocation tests
Referred muscle pain is primarily peripheral in origin:“The barrier-dam theory”
New hypothesis: Farasyn A.: “The barrier-dam theory”
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Fig. from Gray’s Anatomy (1919)
Examples of referred muscle pain syndromes:
2. Tension headache
1. Repeated strain injury
3. Bilateral (non-specific) low back pain
4. Pseudo-ischialgia
Referred muscle pain is primarily peripheral in origin:“The barrier-dam theory”
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1. Repeated strain injuryM. Infraspinatus Trigger Point
=…according to segmental innervation when stimulated…
Examples of referred muscle pain syndromes:Hypothesis of Travell & Simons (1998)
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1. Repeated strain injury M. Infraspinatus Trigger Point
=…not the brain is the misleader, but the human interpretation…
Examples of referred muscle pain syndromes:Hypothesis of Travell & Simons (1998)
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Examples of referred muscle pain syndromes:
= …what happens upstream of the peripheral sensitive nerve entrapment …
New hypothesis: Farasyn A.: “The barrier-dam theory”1. Repeated strain injuryM. Infraspinatus Trigger Point
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Fig. from Benninghoff & Goerttler, 1967
2. Tension headacheExamples of referred muscle pain syndromes:
1. The N. Occipitalis major
= …peripheral sensitive nerve
entrapment syndromes of…
2. The N. occipitalis minor (C2-3)
3. The N. Auricularis magnus
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Fig. from Benninghoff & Goerttler, 1967
2. Tension headacheExamples of referred muscle pain syndromes:
= …peripheral sensitive nerve
entrapment syndromes of…
4. The N. Supraclavicularis &
N. Transversus colli
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Fig. from Gray’s Anatomy (1919)
3. Bilateral low back painExamples of referred muscle pain syndromes:
= …peripheral sensitive nerve
entrapment syndromes of…
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4. Pseudo-ischialgiaExamples of referred muscle pain syndromes:
=…peripheral sensitive nerve entrapment syndromes…
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The primary pathogenesis of referred pain is presumed…
Conclusion:
Referred muscle pain is primarily peripheral in origin:“The barrier-dam theory”
to be a peripheral sensitization with additionally a central modulation and ….not vice versa….
probably nothing else than a simple local peripheral
sensitive nerve entrapment syndrome….
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Recommandations
Referred muscle pain is primarily peripheral in origin:“The barrier-dam theory”
In the future we need to generate a greater interest in:
muscle tenderness research and …..
exploring electrographical & myometrical measurements of peripheral sensitive nerve entrapment syndromes.
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Thank you for your attention…!
Referred muscle pain is primarily peripheral in origin:“The barrier-dam theory”