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Trigger Point Release 24 26

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47 views3 pages

Trigger Point Release 24 26

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Novi Desriyani
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© © All Rights Reserved
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22 The Concise Book of Trigger Points

Fascia and Myofascia


Fascia wraps up the viscera, muscles and even our skeletal system. The body is a system of
interconnecting tubes made of connective tissue fascia and possesses an interlocking of fascial planes
that connect one muscle group with another. Due to this interconnectedness, restriction in one area will
result in reduced range of motion in another local or distal area. So, the fascia covering the anatomical
leg merges at the inguinal ligament with the transversalis fascia wrapping up the peritoneal cavity. The
transversalis fascia merges with the fascia of the diaphragm and continues up to merge with the parietal
pleura surrounding the lungs. The parietal fascia merges with the cervical fascia and on up to the galea
aponeurotica, and so on. It is worth spending some time exploring this tissue, since it is directly
implicated in the manifestation of trigger points.

Myofascia
The superficial fascia that invests muscle is also known as connective tissue. It is a clear, fibrous tissue.
The components of the connective tissue are long, thin, flexible filaments of collagen, surrounded by
ground substance. The ground substance is made up of glycosaminoglycans (30%) and water (70%),
together forming a gel. It is modified according to where it is located in the body (superficial or deep) but
it is somewhat like plastic wrap in nature. For example, if you eat chicken, you may well be aware of the
superficial fascia; this lies under the skin and is a tough, transparent, tissue layer. This myofascia invests
muscles like an envelope; it is plastic-like, and when it is injured or damaged, it becomes shorter,
condensed and tighter. Trigger points mainly manifest in the myofascial tissue; the contracture of this
fascia gives rise to nodules underneath the skin. Depending on where it is located, it is classified in many
different ways:

Endomysium
A delicate connective tissue called endomysium lies outside the sarcolemma of each muscle fibre,
separating each fibre from its neighbours, but also connecting them together.

Fasciculi
Muscle fibres are arranged in parallel bundles called fasciculi.

Perimysium
A denser collagenic sheath called the perimysium binds each fasciculus.

Epimysium
The entire muscle, which is therefore an assembly of fasciculi, is wrapped in a fibrous sheath called the
epimysium.
Deep Fascia
A coarser sheet of fibrous connective tissue lies outside the epimysium, binding individual muscles into
functional groups. This deep fascia extends to wrap around other adjacent structures.
Skeletal Muscle, Muscle Mechanics and Fascia 23

Figure 1.16: The connective tissue sheaths of skeletal muscle.

Embryological Development of Fascia


An overview of the embryological origin of connective tissues may provide some insights into the
formation and location of trigger points. Trigger points tend to manifest within the epimysium according
to myofascial strain patterns. These patterns start to develop very early on in the developing embryo,
and may also be related to foetal alignment in the womb. These strain patterns develop as we mature
from childhood to adulthood and are influenced by, for example, posture, weight gain and mechanical
injury. As stated above, fascia supports organs, wraps around muscles and condenses to form ligaments,
aponeuroses and even bones.

By the end of the seventh week of development, the embryo has most of its organs, bones, muscles and
neurovascular structures in place. A group of 'filler cells' begins to proliferate around these structures.
This filler is derived from mesodermal tissue, a primitive fascia that is constructed from cells, fibres and
intercellular matrix. This matrix has the consistency of glass wool in a soft, jelly-like substrate. In most
body areas, this primitive fascia remains supple until birth. In some areas, however, it condenses and
becomes 'directional', in response to internal and external pressures and tensions. Ligaments and
tendons begin to form in these areas. Stress and strain lines develop in these tissues, and bone salts are
laid down, causing primitive ossification. As the bones grow, they drag some of the connective tissue
fibres into 'differentiated' ligaments. An example of this is the pre-vertebral cartilage, which grows and
pushes into the mesodermal connective tissue beds. As it does so, it creates lines of stress that help to
maintain integrity and provide a scaffold for further directional growth. As the bones start to grow, the
complexity of strains and directional pulls results in the differentiated spinal ligaments (flavum,
posterior longitudinal, etc.).

Furthermore, it has been reliably demonstrated that primitive organ growth relies on this mesodermal
intracellular matrix. The 'potential' pancreas, for example, will only differentiate into a mature organ in
the specific presence of this 'primitive' potential fascia. It has been suggested that the primitive or
potential fascia creates a 'specific energy field' in which the cells of the 'potential' organ mature and
differentiate. (Schultz, 1996). This may make more sense when we consider that the bones, muscles,
ligaments and myofascial elements of connective tissue all share a characteristic pattern of growth.
24 The Concise Book of Trigger Points

Figure 1.17: Fascial bag: the relationship between myofasciae and bone.

The relationship between a developing muscle and its enveloping connective tissue myofascia is
complex. The stress lines may provide a key to understanding this relationship. It has been suggested
that during the second month of embryological development, connective tissue is laid down before
muscle tissue, and that clumps of 'potential muscle tissue, caught within this directional pull,
differentiates into mature muscle oriented along the line of pull'. (Schultz, 1996). These clumps of muscle
tissue elongate through directional pressure. At this point they develop, differentiate, mature and grow
in size through mitotic cell reproduction to form the muscles as we know them.

In other words, it is the growth of fascia along lines of stress and strain that is the powerhouse of muscle
orientation and development. This also explains why muscle action is not singular, but interconnected.
For example, a contraction of the biceps brachii muscle will exert a force on the fascia of the whole arm,
shoulder and neck. Fascia has neither beginning nor end, and is described by anatomists according to
location. On closer inspection the myofascial bags surrounding the muscles are actually part of a
continuum. This may also go some way to explaining the referred pain patterns stimulated by pressing
on a trigger point.

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