Drukagometrie bij patinten met subacute lage - PowerPoint PPT Presentation

Title: Drukagometrie bij patinten met subacute lage


1
VUB Congress 2007

• Andre Farasyn Ph.D. PT DO
• Referred muscle pain is primarily peripheral in
  origin
• The barrier-dam theory

   Faculty of Physical Education
Rehabilitation Department of Human Physiology
Sports Medicine
2
Referred muscle pain
INTRODUCTION
1. An infitration
2. on a muscular Trigger Point
3. activates a referred pain...
.....Kellgren, 1937
3
Referred muscle pain
INTRODUCTION
Overview of different possible mechanisms of
referred muscle pain
4
Referred muscle pain
INTRODUCTION
Hypothesis of Travell Simons (1998)?
E
A
1. Mechanical pressure
2. on a muscular Trigger Point
B
F
C
3. activates (A B) via spinal reflex
D
4. (C) a bodily area of referred pain...
5. and in turn activates (D) the CNS
6. other stimuli (E F) co-activates
5
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 200768144-50.

6
Referred muscle pain is primarily peripheral in
originThe barrier-dam theory
New hypothesis Farasyn A. The barrier-dam
theory
1. Mechanical pressure
2. on a Trigger Point
B
3. ..disturbes firstly the afferent prelocal
nerve (A) upstream with the consequence
of
A
4. ..the creation of a referred pain zone..(sec)
Just like a barrier-dam
5. secondly activates the afferent postlocal
nerve (B) downstreamand in turn via spinal
transduction
6. actives the CNS
7
Referred muscle pain is primarily peripheral in
originThe barrier-dam theory
New hypothesis Farasyn A. The barrier-dam
theory
Co-activates parallel sensitive nerves (E gt C)
creating adjacent zones of referred pain
B
A
E
C
8
Referred muscle pain is primarily peripheral in
originThe barrier-dam theory
Discussion Conclusion
New hypothesis Farasyn A. The barrier-dam
theory
Confirmation needed in experimental referred
muscle pain provocation tests
9
Referred muscle pain is primarily peripheral in
originThe barrier-dam theory
Examples of referred muscle pain syndromes
1. Repeated strain injury
2. Tension headache
3. Bilateral (non-specific) low back pain
4. Pseudo-ischialgia
Fig. from Grays Anatomy (1919)?
10
Examples of referred muscle pain syndromes

• Repeated strain injury
• M. Infraspinatus Trigger Point

Hypothesis of Travell Simons (1998)?
according to segmental innervation when
stimulated
11
Examples of referred muscle pain syndromes

• Repeated strain injury
• M. Infraspinatus Trigger Point

Hypothesis of Travell Simons (1998)?
not the brain is the misleader, but the human
interpretation
12
Examples of referred muscle pain syndromes
New hypothesis Farasyn A. The barrier-dam
theory

• Repeated strain injury
• M. Infraspinatus Trigger Point

what happens upstream of the peripheral
sensitive nerve entrapment
13
Examples of referred muscle pain syndromes
2. Tension headache
peripheral sensitive nerve
entrapment syndromes of
1. The N. Occipitalis major
2. The N. occipitalis minor (C2-3)?
3. The N. Auricularis magnus
Fig. from Benninghoff Goerttler, 1967
14
Examples of referred muscle pain syndromes
2. Tension headache
peripheral sensitive nerve
entrapment syndromes of
4. The N. Supraclavicularis N. Transversus
colli
Fig. from Benninghoff Goerttler, 1967
15
Examples of referred muscle pain syndromes
3. Bilateral low back pain
peripheral sensitive nerve
entrapment syndromes of
Fig. from Grays Anatomy (1919)?
16
Examples of referred muscle pain syndromes
4. Pseudo-ischialgia
peripheral sensitive nerve entrapment
syndromes
17
Referred muscle pain is primarily peripheral in
originThe barrier-dam theory
Conclusion
The primary pathogenesis of referred pain is
presumed

• 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.

18
Referred muscle pain is primarily peripheral in
originThe barrier-dam theory
Recommandations

• 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.

19
Referred muscle pain is primarily peripheral in
originThe barrier-dam theory
Thank you for your attention!