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Name a chronic pain syndrome involving sleep disorders and active tender points among all quadrants of the

body,Fibromyalgia What are the two reasons not to overtreat Fibromyalgia with massage?,1) Pain sensitivity is high 2) Accumulation of waste product in tissues may be difficult to flush out adequately What is the relationship between hormones and deep sleep in Fibromyalgia?,In deep sleep (stage 4) aduls secrete growth hormone which stimulates new cells and collagen for healing. Seratonin levels are also redued, so everything hurts more (pain sensation not modulated). Result is a stress/pain/fatigue viscous cycle. What is the calcium, phosphate and fatigue connection associated with Fibromyalgia?,Phosphates which accumulate rather than forming ATP attract calcium ions to maintain pH balance. This leads to energy production and calcium reabsorption issues. This results in inefficient muscle contractions and debilitating fatigue. What is the pain and cerebrospinal fluid connection associated with Fibromyalgia? What three things happen with blood and/or nerves as a result of this?,CSF of FMS patients reveal high levels of two neurotransmitters which initiate nerve activity, cause vasodilation, and increase pain sensation. What tender points are associated with Fibromyalgia?,Posterior: Occiput (GB) Trapezius (GB) Supraspinatus (BL) Gluteal (BL) Greater Trochanter (GB). Anterior: Low Cervical (ST) 2nd Rib (ST) Lat Epicondyle Humerus (LU) Medial Knee (SP). *(Acupressure Meridians) This vast array of possible factors is associated with what condition? Oxidative stress. Free radical activity. Inefficient hypothalamus-pituitary-adrenal axis. Aspartame use.,Fibromyalgia has these possible factors. What type of pain is experienced by FMS patients?,deep ache to burning and tingling When FMS is triggered by a specific trauma what may happen?,Extra tender points may develop in the area around the injury. Name three signs and symptoms associated with FMS besides tender points and widespread pain (in shifting locations that is difficult to pin down)?,Stiffness after rest Poor stamina Sensitivity amplification and low pain tolerance. Sensitivity amplification and low pain tolerance include what types of sensations? What three types in particular?,All kinds of sensations become more intense and are likely to cause pain. This includes light and sound but is true especially of cold, texture, and pressure. Is there an objective diagnostic test for Fibromyalgia?,No. It has a close correlation with IBS and chronic fatigue. People with this condition often also have migraine headaches, TMJ, and restless leg syndrome.,Fibromyalgia This condition presents similar symptoms to mild hypothyroidism, low grade Celiac disease, multiple chemical sensitivity syndrome, and candidiasis.,Fibromyalgia presents similar symptoms. Does massage help FMS?,Massage can help, but manual pressure exacerbates tender points. Tender points in FMS are often hypotonic, and not always in muscle tissue. What is hypotonic?,Hypotonic= having a reduced degree of tension (not tense)

Name five areas of self care that will help someone with FMS:,Proper nutrition, sleep, exercise daily, stretching, and reducing emotional stress. When massaging someone with FMS, remember to avoid the following:,AVOID: cold or ice tx aggressive pressure of tender points overtreating too much stimulation (includes sound, light, but especially cold, pressure, and texture) Name the condition identified when a person develops many trigger points:,Myofascial Pain Syndrome Common trigger points are felt as what?,irritable spots in muscles that are palpable as knots or taut bands within muscles (can be located in other tissue as well) Do women or men get MPS more often (Myofascial Pain Syndrome) and what age does it affect most?,Neither gender, and all ages, though it tapers off with advancing age. Trigger points relate to problems with the *W* between the *X* and the *Y* of the *Z* rather than to an initiating injury.,synapse motor neuron motor end plate myofiber In the trigger point phenomenon, there is a sustained involuntary contraction of what?,... of a group of sarcomeres. Sarcomeres are overlapping units of myofibrils that create the striations in a skeletal muscle) What are sarcomeres?,Sarcomeres are overlapping units of long fine skeletal muscle fiber. When a sarcomere bundle sustains an involuntary contraction near a neuromuscular conjunction, what is it called?,a central trigger point A "central trigger point" is the result of a sustained involuntary sarcomere bundle's contraction WHERE?,A central trigger point appears when a sarcomere bundle sustains an involuntary contraction near a neuromuscular conjuction. What is an attachment trigger point?,An attachment trigger point refers to a contraction that develops close to the tenoperiosteal junction and may also involve folded and dehydrated collagen fibers. What are the two simultaneous problems that arise when a microscopic contraction pulls on the rest of the myofiber and reates a taut band?,1) there is an increased need for fuel 2) there is a decreased supply of blood due to local ischemia. Describe an ATP energy crisis that is related to a MPS (Myofascial Pain Syndrome),A microscopic contraction pulls on the myofiber and creates a taut band. The area loses blood and demands fuel. Chemicals that increase sensitivity and pain are released. The muscle attempts to constrict further, more ACh is secreted. Poor local circulation limits ACh-neutralizing enzymes and inhibits the movement of calcium back into channels in the cell membrane. This results in a tiny, involuntary but prolonged and painful contraction of one part of a muscle cell. What may happen to local sensory neurons when a trigger point brings prolonged immersion in paincausing chemicals?,Neurons may become locally demyelinated and this may contribute to unique referred pain patterns seen with trigger points. (Lots of assumptions in these theories, though, such as the idea that a chemical is the cause of pain.) What are "satellite points"?,Satellite points are trigger points that form as secondary issue to primary trigger points. Name four areas where a satellite trigger point may appear:,1. where referred pain is perceived 2. where muscle fibers are overloaded because of compensation patterns to protect a primary trigger point 3. in antagonist muscles to the agonist muscle with a trigger point 4. in muscles which are referred pain areas for an organ, eg the heart.

What are two characteristics of a latent trigger point?,1. not painful 2. do not refer pain What are two characteristics of a latent trigger point with regard to pain?,1. not painful 2. do not refer pain What signs are associated with latent trigger points (2)?,Latent trigger points are associated with restricted range of motion and muscle weakness. True or False: A latent trigger point can turn into an active trigger point.,True. Very little stimulus can turn a latent TP active, whihis locally and distantly painful even when the muscle is "at rest". Trigger points that are not irritated may turn into what?,Latent trigger points Trigger points form at areas under stress due to (3 things) but can also be a complication of what?,Trigger points form at areas under stress due to postural habits, poor ergonomics, and repetitive motion, but can also be a complication of accomodating to the limited ROM and pain following a standard injury e.g. automobile accident, sports injury, etc. Qualities unique in musculoskeletal conditions to trigger points are (4):,1. taut bands or nodules 2. predictable trigger point map 3. referred pain pattern 4. regional pain (vs whole body) Is there a definitive diagnosis of MPS (Myofascial Pain Syndrome)?,No special criteria has been agreed upon to diagnose MPS. Since many people have trigger points, there is a vague line between many people and someone with MPS. Is MPS considered a chronic pain disorder?,Yes. Give two reasons why massage helps MPS.,1) effectiveness in improving myofiber function 2) helps clean up cellular debris from chronic muscle tightness. When muscle cells are not working, they can't exchange X for Y.,When muscle cells aren't working they cannot exchange nutrients for waste products. Is it possible to overtreat someone with trigger points?,Yes, metabolic wastes trapped in the area need to be flushed from the system gradually, not all in one session or too much strain on the organs. What is a more common name for a "muscle flicker" that occurs when palpating a trigger point?,twitch response