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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”