Drukagometrie bij patinten met subacute lage

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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
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Referred muscle pain
INTRODUCTION
1. An infitration
2. on a muscular Trigger Point
3. activates a referred pain...
.....Kellgren, 1937
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Referred muscle pain
INTRODUCTION
Overview of different possible mechanisms of
referred muscle pain
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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
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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 200768144-50.

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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
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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
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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
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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)?
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Examples of referred muscle pain syndromes

• Repeated strain injury
• M. Infraspinatus Trigger Point

Hypothesis of Travell Simons (1998)?
according to segmental innervation when
stimulated
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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
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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
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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
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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
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Examples of referred muscle pain syndromes
3. Bilateral low back pain
peripheral sensitive nerve
entrapment syndromes of
Fig. from Grays Anatomy (1919)?
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Examples of referred muscle pain syndromes
4. Pseudo-ischialgia
peripheral sensitive nerve entrapment
syndromes
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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.

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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.

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