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A Review of Myofascial Pain and Fibromyalgia—
Factors That Promote Their Persistence

by
Robert D. Gerwin

Chronic muscle pain (myalgia) is a common problem throughout the world. Seemingly simple, it is actually a difficult problem for the clinician interested in determining the aetiology of the pain, as well as in managing the pain. The two common muscle pain conditions are fibromyalgia and myofascial pain syndrome. Fibromyalgia is a chronic, widespread muscle tenderness syndrome, associated with central sensitisation. It is often accompanied by chronic sleep disturbance and fatigue, visceral pain syndromes like irritable bowel syndrome and interstitial cystitis … download this article (pdf) »

An Expansion of Simons’ Integrated Hypothesis of Trigger Point Formation

by
Robert D. Gerwin, Jan Dommerholt, and Jay P. Shah

Myofascial pain syndrome (MPS) is a myalgic condition characterized by local and referred pain that originates in a myofascial trigger point (TrP). The term myofascial TrP was coined to describe a zone of intense pain in a hardened muscle band that refers (triggers) pain distantly when stimulated. The active TrP has two clinical attributes that must be explained for there to be a more complete understanding of the nature of myofascial pain. One attribute is a motor dysfunction of the muscle that is characterized by a constant, discrete hardness within the muscle. It usually is palpable as a taut band or nodularity within the belly of the muscle. The other attribute is a sensory abnormality that is characterized primarily by pain … download this article (pdf) »

Referred Pain From the Trochlear Region in Tension-Type Headache: A Myofascial Trigger Point From the Superior Oblique Muscle

by
Cesar Fernandez-de-las-Peñas, Cristina Alonso-Blanco, Maria Luz Cuadrado, Robert Gerwin, Juan A. Pareja

Tension-type headache (TTH) is a prototypical headache in which pericranial myofascial tissues can play an important role. Some authors have claimed that pain from pericranial head, neck, and/or shoulder muscles are referred to the head, and are experienced as headache. Simons et al described the referred pain patterns from different myofascial trigger points (MTrPs) in these muscles, which produce pain features that are usually found in patients suffering from TTH. AMTrP is a hyperirritable spot associated with a taut band of a skeletal muscle that is painful on compression, palpation, and/or stretch, and that can give rise to a typical referred pain pattern. Some of the characteristics of TTH, such as the pressure and/or tightness pain quality or the increased tenderness to palpation of pericranial myofascial tissues resemble MTrPs referred pain descriptions. Therefore, MTrPs might contribute to the pathogenesis of TTH. Recently, primary trochlear headache (PTRH), a new cephalgia, has been described by Yangüela et al … download this article (pdf) »

Trigger Points in the Suboccipital Muscles and Forward Head Posture in Tension-Type Headache

by
Cesar Fernandez-de-las-Peñas, Cristina Alonso-Blanco, Maria Luz Cuadrado, Robert Gerwin, Juan A. Pareja

Headache disorders are one of the most common problems seen in medical practice. Among many types of headache disorders, tension-type headache (TTH) is the most frequent in adults. Population-based studies suggest 1-year prevalence rates of 38.3% for episodic TTH and 2.2% for chronic TTH (CTTH). In spite of its scientific interest, the pathogenesis of TTH is not clearly understood. Some authors have claimed that pain from pericranial head, neck, and/or shoulder muscles is referred to the head, and is experienced as headache. In their comprehensive text, Simons et al described the referred pain patterns from different myofascial trigger points (TrPs) in head and neck muscles, which produced pain features that are usually found in patients suffering from TTH. ATrP is a hyperirritable spot associated with a taut band of a skeletal muscle. It is painful on compression and on stretch, and usually gives rise to a typical referred pain pattern … download this article (1.1 MB pdf) »

Robert Gerwin of PRM has written contributing articles to this journal.

Differential Diagnosis of Myofascial Pain Syndrome and Fibromyalgia, by Robert D. Gerwin

The Management of Myofascial Pain Syndromes by Robert D. Gerwin

Myofascial and Visceral Pain Syndromes: Visceral-Somatic Pain Representations, by Robert D. Gerwin

A Standing Complaint: Inability to Sit: An Unusual Presentation of Medial Hamstring Myofascial Pain Syndrome, by Robert D. Gerwin

Interrater Reliability in Myofascial Trigger Point Examination

by
Robert D. Gerwin, Steven Shannon, et al

The myofascial trigger point (MTrP) is the hallmark physical finding of the myofascial pain syndrome (MPS). The MTrP itself is characterized by distinctive physical features that include a tender point in a taut band of muscle, a local twitch response (LTR) to mechanical stimulation, a pain referral pattern characteristic of trigger points of specific areas in each muscle, and the reproduction of the patient’s usual pain. No prior study has demonstrated that these physical features are reproducible among different examiners, thereby establishing the reliability of the physical examination in the diagnosis of the MPS … download this article (pdf) »

Pressing Need: Flatten Myofascial Pain Syndrome with Manual Therapy

by
Susan Birk

Considering the several million people in the U.S. who are affected by myofascial pain syndrome (MFPS), one might think there would be a fair number of treatment options. However, the fascia and its treatment continue to be something of a mystery to pain experts, healthcare professionals, and some physical therapists. Problems involving the intricate layers of connective tissue that covers, connects, and separates the muscles, organs, and other soft tissue body structures constitute a major source of acute and chronic pain … read this article »

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