特拉维尔的肌筋膜触发点手册范本

【学习肌筋膜触发点MTrPs】旋后肌和旋前圆肌触发点及其关联疼痛旋后肌（supinator) 和旋前圆肌(pronator teres)，顾名思义就是起着对前臂的旋前和旋后的功能，旋前即向内侧旋前臂背侧到前方或上方，在这个方向甚至可将前臂一直旋向内侧；旋后即将前臂背面向外旋到后面或下方；二肌是一对拮抗肌。

旋后肌位置较深，在肱桡肌的深面，紧贴于桡骨近侧端，从桡前旋到后方到尺骨。

旋后肌触发点在近肘下桡侧2-4cm的位置，其牵涉痛近似肱桡肌触发点的牵涉痛位置，也集中在肱骨外上髁和虎口的位置，与肱桡肌触发点不同的是，还有一块在肘前桡侧半边的集中牵涉痛区，但很少有在前臂的弥散性牵涉痛；参与了网球肘的疼痛。

患有旋后肌触发点的患者主诉肱骨外上髁和虎口的疼痛，并且在肘部完全伸直时不能提重的手提箱，不能玩网球和羽毛球；而且在这些活动后，休息也疼痛。

尽管许多肌都与网球肘有关，但是最多涉及网球肘疼痛还是旋后肌的触发点。

旋后肌触发点造成的肌肉高张力会压迫桡神经的深支，而且造成该神经支配的远侧肌肉无力；触发点治疗后，这个压迫可以松开。

旋前圆肌的位置较浅，从内上髁斜向下扎到肱桡肌的深面，在皮下可触到该肌肉。

旋前圆肌触发点就在肘窝下尺侧，其牵涉痛在前臂前面从尺侧上端弥散到远端桡侧，并在桡骨茎突和桡侧腕部集中；常是所谓桡骨茎突炎的元凶。

旋前圆肌触发点的发生还可能会造成对正中神经的压迫症状。

患有旋前圆肌触发点的患者会感到桡骨茎突部位的疼痛，手半握拳抓杯状时无法旋后，而且疼痛。

通过牵涉痛和触诊，怀疑旋后肌有触发点时，应该检查前臂抗阻力旋后试验，疼痛和无力是阳性。

同样，前臂抗阻力旋后试验可以测试旋前圆肌的张力。

关联因素：上面已经谈到网球肘疼痛涉及到多块肌肉，一旦怀疑可能是网球肘，不但应该检查旋后肌，还要检查肱三头肌、肘肌、肱桡肌、腕伸肌、指伸肌，如果发现触发点，需要一同治疗。

同样，如果有桡骨茎突处的疼痛，除了旋前圆肌外，还要考虑肱肌、桡骨腕长伸肌。

肌筋膜疼痛触发点的常用治疗方法无论是触发点的诱发或引发因子，还是易感或维持因子，在治疗肌筋膜触发点时都应考虑去纠正或消除。

另外，还需注意由其他疾病引发的继发性触发点，如骨科疾病，只有治愈这些疾病才能阻断疼痛触发点的复发。

肌筋膜疼痛综合征的治疗原则就是以各种方法灭活触发点，使肌肉内的挛缩肌束松开，使机体或各关节的生物力学处于一个正常平衡状态。

本着这个原则，只要能灭活疼痛触发点，任何治疗方法均可被应用。

值得注意的是，最好将牵张疗法作为各种疗法的辅助疗法在临床中加以应用，会取得事半功倍的治疗效果。

1 针法各种针都可用来穿刺定位的触发点。

准确刺到触发点，肌肉会有抽搐反应(跳动)或扎(针)牵涉痛。

目前有4种方法：湿针疗法：即对触发点反复穿刺，尽量引出肌肉的跳动。

当患者感觉难忍的酸胀痛时，给予0.1-0.2 mL局部麻醉剂，以减轻穿刺时的疼痛。

一般情况下用Ф0.4 mm的注射针头可以减少针后的针眼处的疼痛感。

此法对于任何急慢性疼痛触发点综合征效果最好。

注射浸润疗法：一些患者无法忍受或过于敏感穿刺时的酸胀痛，选择此方法。

一旦引出抽搐反应，注射大约 0.5 mL的局部麻醉剂，然后对局部用手指轻柔地按摩，使麻醉剂在局部浸润开。

这种方法可以显著地避免患者的治疗时的疼痛，但施针后的效果不能长久，因此需要一个较长时间反复的治疗过程。

干针疗法：不加任何局部麻醉剂进行针刺触发点，可以反复针刺，引出跳动；但是为了减轻患者的疼痛，这种干针疗法可以用Ф0.3 mm 的细针，引出抽搐反应后，留针8-15 min，反复应用较好。

小针刀疗法：在触发点的治疗中，小针刀仅被用于对增厚和挛缩的触发点上的肌筋膜横向切割予以松解，也可直接穿刺触发点。

同时可以在局麻下用于对肌肉附着处触发点和附着处粘连以及挛缩硬化关节囊和韧带进行松解。

热凝射频疗法：治疗肌筋膜疼痛很有效，因为触发点可以在温度45 ℃左右可被灭活，但前提是最好能定位触发点，使针尖进入触发点。

[转载]肌筋膜触发点(激痛点)疼痛的诊断与治疗引言根据近年来的对临床观察和基础研究的不断深入,肌筋膜触发点的存在已被广泛的接受。

一个触发点区域通常存在许多个活化的触发点。

而一个触发点则由两部分组成:敏感小点(有局部抽搐反应:LTR locus)和活化部位(终板噪音:EPN locus)。

基础研究表明,敏感小点是致敏的神经末梢,而活化部位是功能失调的终板,并伴有过渡的乙酰胆碱的释放。

乙酰胆碱的过渡释放导致终板区域的肌纤维局灶性收缩,渐而渐之局部形成肌筋膜疼痛特点之一的紧张带。

几乎在每一块正常的骨骼肌我们能够发现触痛点,即潜在的触发点(有触痛,但无自发性疼痛)。

这个潜在的触发点在出现一些病理损害时被激活变为活化的触发点(有自发性疼痛或活动时疼痛)。

当这个病理损害得到恰当的治疗后,活化的触发点能被抑制失活。

而这个触发点不会消失,只是从一种形式转化成另一种形式。

肌筋膜疼痛综合症就是一种因潜在触发点受一些病理条件(如慢性反复的微小劳损、不良姿势、全身系统性疾病或软组织撕裂伤等)的作用后活化,从而引起疼痛。

所以触发点疼痛治疗的基础也就是对这个基础病理的治疗。

肌筋膜疼痛的治疗方法已经有比较全面的描述,本文的重点是对肌筋膜疼痛治疗的基本原则进行综述。

几乎每一个人都经历过肌肉疼痛,有时还会引起严重的临床问题。

急性损伤可以直接引起肌肉疼痛,例如:挫伤、贯穿伤、撕裂伤、牵拉伤、过用伤、等。

如果这些急性疼痛得不到良好的治疗和彻底治疗,就可以发展为慢性骨骼肌疼痛。

更常见是,这种慢性骨骼肌疼痛以后不需要有肌肉本身的损伤,只要对机体无论任何组织和结构有损伤,都可以被引发。

在临床上,这种情况被称为慢性肌肉疼痛综合征或肌筋膜疼痛综合征(MPS);而这种疼痛综合征都是由肌筋膜触发点(Myofacial Trigger Points: MTrP)所引起的。

这个病名术语是Travell在1942年通过大量的临床观察和治疗后首先提出的。

【干货】全身激痛点手册——图文并茂非常全面全身疼痛点手册一、头部头痛主要激痛点斜方肌(Trapezius)胸锁乳突肌（胸骨侧）(Sternocleidomastoid, Sternal)颞肌(Temporalis)头夹肌（Splenius capitis）颈夹肌(Splenius cervicis)枕下肌群(Suboccipital group)头半棘肌(Semispinalis capitis)额肌（Frontalis）颧大肌（Zygomaticus major）二、颈部颈后痛激痛点斜方肌（Trapezius）多裂肌（Multifidi）肩胛提肌（Levator scapulae）颈夹肌（Splenius cervicis）冈下肌（Infraspinatus）三、肩部肩前痛主要激痛点冈下肌（Infraspinatus）三角肌（Deltoid ）斜角肌（Scaleni）冈上肌（Supraspinatus）胸大肌（Pectoralis major）胸小肌（Pectoralis minor）肱二头肌（Biceps brachii）喙肱肌（Coracobrachialis）胸骨肌（Sternalis）锁骨下肌（Subclavius）背阔肌（Latissimus dorsi）肩后痛主要激痛点三角肌（Deltoid）肩胛提肌（Levator scapulae）斜角肌（Scaleni）冈上肌（Supraspinatus）大圆肌（Teres major）小圆肌（Teres minor）肩胛下肌（Subscapularis）上后锯肌（Serratus posterior superior）背阔肌（Latissimus dorsi）肱三头肌（Triceps brachii）斜方肌（Trapezius）胸骼肋肌（Lliocostalis thoracis）肩部痛主要激痛点斜角肌（Scaleni）肩胛提肌（Levator scapulae）冈上肌（Supraspinatus）斜方肌（Trapezius）激痛点2、3、4、5 多裂肌（Multifidi）菱形肌（Rhomboidei）颈夹肌（Splenius cervicis）肱三头肌（Triceps brachii）肱二头肌（Biceps brachii）背阔肌（latissimus dorsi）胸骼肋肌（Lliocostalis thoracis）上后锯肌（Serratus posterior superior）冈下肌（Infraspinatus）前锯肌（Serratus anterior）四、背部背部痛主要激痛点斜角肌（Scaleni）肩胛提肌（Levator scapulae）冈上肌（Supraspinatus）斜方肌（Trapezius）激痛点2、3、4、5 多裂肌（Multifidi）菱形肌（Rhomboidei）颈夹肌（Splenius cervicis）肱三头肌（Triceps brachii）肱二头肌（Biceps brachii）背阔肌（latissimus dorsi）胸骼肋肌（Lliocostalis thoracis）上后锯肌（Serratus posterior superior）冈下肌（Infraspinatus）前锯肌（Serratus anterior）五、胸部胸前痛主要激痛点胸大肌（Pectoralis major）胸小肌（Pectoralis minor）斜角肌（Scaleni）胸锁乳突肌（Sternocleidomastoid）胸骨肌（Sternalis）肋间肌（Intercostals）项髂肋肌（Iliocostalis cervicis）锁骨下肌（Subclavius）腹外斜肌（External abdominal oblique）膈肌（Diaphragm）六、上肢部肘痛主要激痛点旋后肌（Supinator）肱桡肌（Brachioradialis）桡侧腕长伸肌（Extensor carpi radialis longus）肱三头肌（Triceps brachii）冈上肌（Supraspinatus）第四第五指伸肌（Fourth and fifth finger extensors）肘肌（Anconeus ）胸大肌（Pectoralis major）胸小肌（Pectoralis minor）前锯肌（Serratus anterior）上后锯肌（Serratus posterior superior）肱肌（Brachialis）肱二头肌（Biceps brachii）腕和手外侧痛主要激痛点桡侧腕短伸肌（Extensor carpi radialis brevis）桡侧腕长伸肌（Extensor carpi radialis longus）拇短伸肌（Extensor digitorum ）食指伸肌（Extensor indicis）尺侧腕伸肌（Extensor carpi ulnaris）肩胛下肌（Subscapularis ）喙肱肌（Coracobrachialis ）小斜角肌Scalenus minimus）背阔肌（Latissimus dorsi ）上后锯肌（Serratus posterior superior ）第一背侧指间肌（First dorsal interosseus）拇指痛主要激痛点旋后肌（Supinator）斜角肌（Scaleni）肱肌（Brachialis）冈下肌（Infraspinatus）桡侧腕长伸肌（Extensor carpi radialis longus）肱桡肌（Brachioradialis）拇指对掌肌（Opponens pollicis）拇收肌（Adductor pollicis）锁骨下肌（Subclavius）第一背侧骨间肌（First dorsal interosseus）拇长屈肌（Flexor pollicis longus ）手指内侧痛主要激痛点屈指浅肌和屈指深肌（Flexores digitorum superficialis and profundus ）骨间肌（Interossei）背阔肌（Latissimus dorsi）前锯肌（Serratus anterior）小指展肌（Abductor digiti minimi）锁骨下肌（Subclavius ）手指外侧痛主要激痛点手指伸肌（Extensor digitorum）骨间肌（Interossei）斜角肌（Scaleni）小指展肌（Abductor digiti minimi）胸大肌（Pectoralis major）胸小肌（Pectoralis minor）背阔肌（Latissimus dorsi）锁骨下肌（Subclavius）七、腰部腰痛主要激痛点胸髂肋肌（Iliocostalis thoracis）多裂肌（Multifidi）下后锯肌（Serratus posterior inferior）腹直肌（Rectus abdominis）肋间肌（Intercostals）背阔肌（latissimus dorsi）髂腰肌（Iliopsoas）腰髂肋肌（Iliocostalis lumborum）背最长肌（Longissimus thoracis）臀中肌（Gluteus medius）八、下肢部臀部痛主要激痛点臀中肌（Gluteus medius）腰方肌（Quadratus lumborum）臀大肌（Gluteus maximus）腰髂肋肌（Iliocostalis lumborum）背最长肌（Longissimus thoracis）半膜肌和半腱肌（Semitendinosus and semimembranosus）梨状肌（Piriformis）臀小肌（Gluteus minimus）腹直肌（Rectus abdominis）比目鱼肌（Soleus）足弓及足中部痛主要激痛点腓肠肌（Gastrocnemius）趾长屈肌（Flexor digitorum longus）拇收肌（Adductor hallucis）比目鱼肌（Soleus）足部骨间肌（Interossei of foot）拇展肌（Abductor hallucis胫骨后肌（Tibialis posterior）第8期特色疼痛技术培训班肌筋膜链、激痛点、运动医学与表面活体解剖定位与诊断、功能解剖、临床局部解剖六大课题2017年9月8日·白求恩医学培训学校疼痛患者日益增多，疼痛类型转变，已经达到人人有痛。

原文：在可触摸的紧绷肌带的结节上有圆周状的点状压痛，并且患者对于施加压力在压痛点上所诱发出来的疼痛指认是他所熟悉的----摘自肌筋膜疼痛與機能障礙肌痛點手冊IX分析：当我们在需要进行按摩的肌肉上发现粗大的条索状阳性反应物的时候，其中将有一个最核心的治疗区如上描述，在该点上按压能够诱发出引起患者难受的症状，而对该店的静态持续按压超过90秒时间可以有效缓解疼痛或相关症状。

肌痛点的活性小点：在肌肉的一个小区域内出现自发性电位活动的地方，它可能会或也不可能会展现单纤维动作电位特征性的尖峰。

活动性肌筋膜肌痛点：会导致临床疼痛抱怨的肌筋膜肌痛点，它总是压痛的，会阻碍肌肉被完全地伸展，弱化肌肉的强度，在直接压迫时还会引出患者确定的疼痛，而如果刺激够强的话，会引起肌肉纤维抽搐反应，在患者疼痛忍受限度内压迫的话，会在它的疼痛引传区域内产生压痛，以及引传性运动现象和自主神经现象。

----摘自触发点治疗手册摘要P1分析：什么是我们需要进行分筋力筋手法的区域，是有上述问题的区域，这种按压先是诱发了疼痛并按照一定的方式传到如经络传导，同时可能会诱发出运动出现，如果一个区域不具备上述特征，我们可以放弃，因为它可能不是我们要选择的关键性治疗点。

关联性肌筋膜激痛点：一块肌肉上的激痛点会和另一块肌肉上的激痛点同时发生，这些关联性激痛点可能由一个引发出另一个，也可能两个都来自于相同的机械性或神经性源头。

分析：康复中提倡治疗的时间的叠加，空间的叠加，传统针灸讲究配伍，往往我们在治疗部分疼痛性疾病时，往往要清除不同区域的阳性反应点，或者整体性调整脊柱，这些关联性的疼痛的存在应该存在着合理有效的规律，而在掌握不到其中的规律，仔细寻找肌筋膜激痛点，全面的清除应该可以提高治疗疗效，在临床中发现坐骨神经痛不仅在梨状肌上出现肌筋膜激痛点同时在斜方肌上也出现肌筋膜激痛点，二者同时治疗加强疗效，而肩井配合环跳的针灸配伍在古代早有，因此合理的辨证在我们分析的取穴的区域上仔细探查是否有关联性激痛点，并给与合理的解决，将帮助我们提高疗效，而如果我们的预估区域上没有肌筋膜激痛点，将提示我们反思诊断是否正确，这个位置是否需要针灸或者压揉？附着性激痛点：位于肌肉肌腱结合处或肌肉骨骼附着处的激痛点，会造成肌腱附着点病，那是来自于中央性激痛点其特征之紧绷带所无法缓解的张力所致----摘自触发点治疗手册摘要P2分析：在反阿是穴医术中，详细描述了肌肉的起点\止点—肌腹上都存在可能解决问题的阳性反应点，而二者在治疗中所赋予的意义不同，因此如果一个肌肉是我们疑似的损伤区域，如果在肌腹上没有阳性反应点，则应该仔细探寻两端的骨性机构，将力垂直与骨膜按压下如果诱发处症状，可以采用压揉手法或者关节松动结束给与处理。

《触发点疗法：精准解决身体疼痛的肌筋膜按压疗法》读书札记目录一、内容概述 (2)1. 肌筋膜疼痛的基本概念 (3)2. 触发点疗法的起源与发展 (4)二、肌筋膜疼痛的常见原因与症状 (5)1. 肌筋膜疼痛的常见原因 (7)2. 肌筋膜疼痛的主要症状 (8)三、触发点疗法的基本原理与操作方法 (8)1. 触发点的定义与特点 (9)2. 触发点疗法的基本原理 (10)3. 触发点疗法的操作步骤与技巧 (11)四、肌筋膜疼痛的临床应用与案例分析 (13)1. 肌筋膜疼痛的临床应用 (14)2. 触发点疗法在特定人群中的应用 (15)3. 案例分析与讨论 (16)五、触发点疗法的注意事项与风险防范 (17)1. 治疗过程中的注意事项 (19)2. 治疗过程中的风险防范措施 (20)六、触发点疗法的疗效评估与长期管理 (21)1. 治疗效果的评估标准 (23)2. 长期管理的策略与方法 (24)七、总结与展望 (25)1. 触发点疗法在疼痛管理领域的价值 (27)2. 对未来研究的展望与建议 (28)一、内容概述这本书主要介绍了一种专门解决身体疼痛的肌筋膜按压疗法——触发点疗法。

这是关于运动损伤修复和疼痛管理领域的重要知识，其内容包括理论知识和实际操作技巧。

在阅读过程中，我深感其内容的实用性和科学性，对于理解身体疼痛的原因和寻找解决方法具有极大的帮助。

书中首先介绍了触发点疗法的概念、发展历程和理论基础。

触发点是指肌肉中紧张、疼痛的区域，这些区域可能引发全身性的疼痛。

通过按压这些触发点，可以有效缓解肌肉紧张，减轻疼痛。

书中详细解释了触发点的识别和定位方法，使读者能够初步掌握寻找触发点的技巧。

书中详细阐述了触发点疗法的具体实施方案和步骤，这些内容包括如何进行按压、按压的力度和频率、按压的时间和顺序等。

这些内容对于想要学习并实施触发点疗法的人来说，具有极高的指导意义。

书中还介绍了与触发点疗法相关的其他疗法，如肌肉拉伸和热身运动等，为读者提供了更全面的疼痛解决方案。

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肌筋膜触发点（trigger point）是骨骼肌肌肉能够激惹疼痛的某一特定位置，这个位置通常可以摸到一个疼痛结节和绷紧肌纤维痉挛带，触压时有疼痛加重和局部肌肉颤搐以及可能引起的远处牵涉痛。

触发点则是指来自肌筋膜痛的敏感点，压之可诱发整块肌肉痛，并扩散到周围或远处部位的放散痛。

激痛点的形成起初是肌肉功能失调，继之生理组织营养不良，局部代谢增加而血流相对减少，结果在肌肉中产生不能控制的代谢区，代谢物中的神经激活物质如组织胺、5-羟色胺、前列腺素等类物质使血管严重收缩，这些局部反应通过中枢或交感神经的反射作用使肌肉束紧张，并出现感觉痛区。

按压或针刺激痛点可引起不同形式的感应痛点，激痛点可诱发植物神经症状，如血管收缩、局部肿胀、头痛、头晕、耳呜等。

触发点除了引发疼痛及放散痛外，并会增加肌肉的紧张度，使肌肉缩短，缩短了的肌肉又会拉紧不同结构组织，所以肌肉缩短是引起肌筋膜痛的关键，亦是引致其它软组织及关节痛症的主要原因。

肌肉缩短使附着肌肉的其它结构受到机械性的张力，增加肌腱的损伤，如肌腱炎、腱鞘炎，如果腱内有籽骨，则会引致软骨磨损和疼痛，若脊椎旁之肌肉缩短，则使椎间盘的压力增加，最终导致椎间盘退变或椎间盘脱出，肌肉缩短可引起肌肉排列的改变和关节话动异常，从而又可引起关节疼痛及退行性变化，肌肉对神经的压迫可引起神经压迫症状。

所以有学者认为，肌筋膜疼痛的临床表现多种多样，人们习惯上根据痛处位置来定名，例如“肱骨外上髁炎”、“跟腱炎”等等，但其根本原因都是因为肌肉缩短所致。

图中“×”字处为触发点的位置，红色区域是它关联痛的区域。

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肌筋膜疼痛触发点学习之经典著作推荐——《MyofascialPainandDysfunct。

该书由肌筋膜疼痛触发点研究先驱David G. Simons , Janet G. Travel, Lois S. Simons合力所著，并由Lippincott Williams & Wilkins出版社于1998年11月1日正式出版。

亚马逊中国售价为720元RMB。

此外，我国著名海外留学博士黄强民教授根据自己二十余年触发点诊断与治疗的经验，结合这本巨著已编写成中文版《肌筋膜疼痛触发点的诊断与治疗》，中文版更加通俗易懂，深入浅出，内容详尽，更多地结合了国内临床病例从整体上介绍了肌筋膜疼痛触发点技术在治疗慢性疼痛方面的优越性和安全性，大幅度地提高了国内临床医生对该疾病的临床诊断效率和治疗效果。

【信息拓展】肌筋膜炎，又名肌筋膜疼痛触发点，扳机点、激痛点、肌筋膜疼痛综合征等。

作为“肌筋膜疼痛触发点（MTrPs）”的专业术语，最早是由美国临床教授Janet Travell在1942年提出的，可分为潜在MTrPs和活化MTrPs。

一般状态下，骨骼肌上会存在一些因慢性损伤而引起的潜在MTrPs，这些MTrPs长期处于隐性状态，并不会引起疼痛或只有轻微局部疼痛。

但是它们可以被某些致病因素活化转变成为活化MTrPs，例如：创伤、疲劳、抵抗力下降、反复感冒、某些营养物质缺乏等因素。

这些活化MTrPs在骨骼肌上会出现异常挛缩结节样的病理性肌纤维,而且活化MTrPs常表现为自发性疼痛，并可激发局部或远处牵涉痛，针刺和触压这些MTrPs时会引发肌肉局部抽搐反应。

【四大客观指标和科学依据】（1）针刺或进行缺血性按压MTrPs时，可在肌电图仪上记录到大量高频高幅自发性肌电电位，而正常骨骼肌不存在该电位变化。

（2）临床检查可触摸到骨骼肌内的挛缩条束，在这个挛缩条束上可触及疼痛结节，对疼痛结节进行触压或针刺可引发带有强烈酸胀痛感觉的局部抽搐现象。

我的偶想（baohanyi）：内蒙古巴彦淖尔市临河区妇幼保健医院疼痛科主任张文良副主任医师，将宣老和韩老回他的信在网上公布后，我为张医生开阔的胸襟而折服，现将我本人阅读的《无痛一身轻》中文版的笔记也同诸位分享，希望能给大家带来帮助。

宣老生前，我曾请教过他，压痛点（tender point）同激痛点(trigger point)的区别，他回答道：“压痛点在骨骼肌附着处（起止点），激痛点在骨骼肌的肌腹上（肌筋膜），压痛点是原发痛，激痛点是继发痛，治疗过程中，应该先治疗原发痛再治疗继发痛（如果引起继发性无菌性炎症的话），因为附着处（起止点）是应力的集中点，最容易损伤，针对激痛点而言，肌腹不易损伤，要治痛必须先治疗原发痛，否则在作镇痛疗法，疗效将大打折扣，病情将反复发作，缠绵得很，只有目标明确，心中有数，才能打准靶点，事倍功半，切忌本末倒置，不妨作一比较”。

以上这就是宣老对压痛点和激痛点所作的精辟阐述，值得我们思考，同时，我将宣老专著中第十九章的有关内容附上，全部笔记内容也在本专栏中刊登——宣蛰人软外专著精选，建议诸位在阅读《无痛一身轻》时，结合宣老的软外理论，必将有更大的收获。

第十九章椎管外软组织损害性压痛点和传导痛的介绍及其检查方法（P303——P381）一、概述一、压痛点（tender point）1、特定部位的压痛点在人体某个疼痛部位的出现，不是孤立的一个压痛点，而是由不少具有规律的一群压痛点。

2、一群压痛点由点成“线”、由线成“面”，由面成“体”，在人体某个疼痛部位构成一个立体致痛区域——软组织损害性病变区。

3、压痛点的解剖特点：在软组织（特别是骨骼肌、筋腱）骨骼附着处。

4、压痛点病理特点：存在无菌性炎症病变。

5、压痛点同激痛点（区）的区别：前者在肌肉筋膜等起止点的骨骼附着处，后者在神经肌肉的运动点上。

6、人体疼痛部位出现的压痛点应有原发和继发之区分。

原发性痛点散发出来的疼痛会波及病变区周围的正常软组织，形成一疼痛反应区，出现与主诉痛不相上下的早期反应痛。

第六章肌筋膜触发点的诊断与治疗肌筋膜疼痛综合征是由肌筋膜触发点引起的一个临床上常见的肌肉疼痛问题。

根据临床观察和科学研究的证实，肌筋膜触发点的存在已被广泛的接受。

证明1.对MTrP的按压会再次引起和加重病人经常疼痛部位的疼痛。

消除(更恰当的方法，使失活)MTrP可以缓解任何不舒服的症状.2.对不同病人的每个肌肉的MTrP 进行按压可以引出相类似的牵涉痛.3.对MTrP高强度的刺激(包括深度按摩和针刺)可以抑制疼痛.4.在MTrP区域针刺微小的位点(疼痛感受器,即敏感的位点或是局部抽搐反应位点)可以减轻疼痛和牵涉痛,而且LTR可以用肌电图描记记录出.5.如果在针刺MTrP时可以引出局部抽搐反应,那麽立即消除MTrP疼痛是可以.6.所有的MTrPs都位于终板区域内,而且MTrP区域上的终板噪音比正常的肌肉组织上的更多地被记录到.7.电子显微镜和超声波研究提供了形态学证据即MTrP区域上(终板区域)绷紧带和挛缩的结节。

MTrP已经被定义为是骨骼肌纤维绷紧的带上应激性过度的结节。

潜在的MTrP（压痛，但是不是自发性疼痛）可以变成由病理病变继发的活动的MTrP （压痛和自发性疼痛）。

在对病理因素进行恰当治疗后，活动的MTrP会被抑制成它的失活状态。

但是，MTrP不会永久消失，它只是从一种活动的状态转变为潜在的形式。

肌筋膜疼痛综合征是潜在的MTrPs在一定的病理条件下转变为活动的MTrPs而引起的疼痛现象，包括微小肌肉的慢性重复性损伤,不正确的姿势，系统性疾病,或是骨骼肌神经损伤（例如损伤，扭伤，创伤，关节炎，或是椎体椎间盘病变）。

通过对肌筋膜触发点的病因学、病理解剖学和病理生理机制的认识，尽管这些认识还需要进一步探索和研究；但是，根据临床的观察和治疗研究，以及对临床治疗有效性调查，我们还是可以把许多临床现有的、以疼痛为主体、较为混淆病症和综合症常可以归类到肌筋膜疼痛触发点综合症或肌筋膜疼痛触发点的理念中去。

IntroductionJennifer, twenty-eight, who loved to run for her health every day in the fresh morning air, has had to stop running and is reluctant even to walk any distance because of relentless pain in her knees and heels.harry, fifty-two, can think of little else but the constant pain in his back It's hard to get in and out of bed His back hurts whether he's sitting, standing, or lying down. It makes him hate his job and has ruined his love life.Melanie, thirty-six, spends her days at a computer keyboard and her nights worrying about her future and the unremitting pain in her arms and hands. As a single mother, she has to keep working no matter whatJack, forty-five, has shoulder pain that wakes him up at night He can't raise his arm to comb his hair. Reaching up to scratch his back is impossible. A sudden movement brings a jolt of pain that feels like an electric shock and doubles him over, grimacing and breathless. Is this the start of the inevitable decline into old age, disability, and death?Howard, twenty-three, is a gifted violin student After years of hard work under some of the best teachers in the country, he now fears a professional career is out of reach , because of constant pain and an unexplained, increasing stiffness in his fingers.Do you know anybody like these people? They’re everywhere—on every job, in every office, in every home. The thing all these people have in common, other than chronic pain, is that they aren't getting the help they need. It's not that they haven't looked They’v e gone the rounds. Hiey've seen doctors, had tests, done physical therapy, and filled out insurance forms, or~sick at heart~have paid the exorbitant bills themselves-They’ve tried chiropractic, acupuncture, magnets, pain diets, and herbal therapy. They take iiieir pain medicine and dutifully do their stretching exercises. Sometimes they feel better for a while, but the pain always comes back- Nothing really seems to get to the bottom of the problem- They fear surgery may be the only solution, despite being told there are no guarantees of success- They're beginning to wonder if anybody really knows anything about pain.If all this describes your own situation or that of someone you care about, this book may provide the help you've been seeking. It proposes to give you a sensible explanation of what's wrong and help you find the real cause of your pain. Even better, it may well show you how to get rid of the pain youirself, hands-on. No doctors，No pills. No bills-There is growing evidence that most of our common aches and pains and many other puzzling physical complaints are actually caused by trigger points, or small contraction knots, in the muscles of the body. Pain clinic doctors skilled at detecting and treating trigger points have found that they're iiie primary cause of pain roughly75 percent of the time and are at least a part of virtually every pain problem. Even fibromyalgia, which is known to afflict millions of people, is thought in many instances to have its beginning with trigger points. (Travell and Simons 1999: 12-19; Gerwin 121; Fishbain 181-197).Trigger points are known to cause headaches, neck and jaw pain, low back pain, the symptoms of carpal tunnel syndrome, and many kinds of joint pain mistakenly ascribed to arthritis, tendonitis, bursitis, or ligament injury. Trigger points cause problems as diverse as earaches, dizziness, nausea, heartburn, false heart pain, heart arrhythmia, tennis elbow, and genital pain. Trigger points can also cause colic in babies and bed-wetting in older children, and may be a contributing cause of scoliosis- They are a cause of sinus pain and congestion. They may play a part in chronic fatigue and lowered resistance to infection. And because trigger points can be responsible for long-term pain and disability：that seem to have no means of relief, they can cause depression.The problems trigger points cause can be surprisingly easy to fix; in fact most people can do it themselves if they have the right information. That's good, because the time has come for ordinary people to take things into their own hands. The reason this is so is titiat an appallingly high percentage of doctors and other practitioners are still pretty much out of the loop regarding trigger points, despite their having been written about in medical jour¬nals for over sixty years. There has been, and continues to be, great resistance to the whole idea-Why has title medical profession not embraced the idea of trigger points? Partly it's because trigger points are commonly confused with acupressure points- Acupressure, which has come down to us from ancient Chinese medicine, is alleged to have a positive effect on supposed flows of energy throughout the body. Although acupressure and other Eastern metiiods of healing do seem to have a beneficial effect, they,re very resistant to solid scien- tific investigation and are viewed by many doctors and a large segment of the public as quack medicine with no proven results. If you don,t know the difference, the claims about trigger points sound like quack medicine too.Our knowledge of trigger points, however, comes right out of Western medical research. Trigger points are real. They can be felt with the fingers. They emit distinctive elec¬trical signals that can be measured by sensitive electronic equipment. Trigger points have also been photographed in muscle tissue with the aid of the electron microscope. (Travell and Simons 1999: 57-67)Most of what is known about trigger points is very well documented in the two-volume medical text Myofascial Pain and Dysfunction: The Trigger Point Manual, by Janet Travell and David Simons. These books tell virtually all that is known about trigger points, and the pros¬pects for pain relief are very exciting. Much of the information in The Trigger Point Manual is couched in difficult scientific terms, but basic trigger point science isn't hard to grasp if it's put into everyday language. Travell and Simons describe a trigger point as simply a small contraction knot in mus¬cle tissue. It often feels like a partly cooked piece of macaroni, or like a pea buried deep in the muscle. A trigger point affects a muscle by keeping it both tight andweak. At the same time, a trigger point maintains a hard contraction on the muscle fibers that are directly con¬nected to it. In turn, these taut bands of muscle fiber keep constant tension on the muscle's attachments, often producing symptoms in adjacent joints. The constant tension in the fibers of the trigger point itself restricts circulation in its immediate area. The resulting accumula¬tion of the by-products of metabolism, as well as deprivation of the oxygen and nutrients needed for metabolism, can perpetuate trigger points for months or even years unless some intervention occurs. It's this self-sustaining vicious cycle that needs to be broken (Travell and Simons 1999: 71-75).Ihe difficulty in treating trigger points is that they typically send pain to some other site. Most conventional treatment of pain is based on the assumption iiiat the cause of pain will be found at the site of the pain. But trigger points almost always send their pain else¬where* This referred pain is what has always thrown everybody off, including most doctors and much of the rest of the health-care community* According to Travell and Simons, con¬ventional treatments for pain so often fail because they focus on the pain itself, treating the site of the pain while overlooking and failing to treat the cause, which may be some distance away,.Even worse than routinely treating the site of the pain is the pharmaceutical treatment of the whole body for what is usually a local problem. PamJdlling drugs, the increasingly expensive treatment of choice these days, give us the illusion that something good is hap¬pening, when in reality they only mask the problem. Most common pain, like headaches, muscle aches, and joint pain, is a warning~a protective response to muscle overuse or trainna. Pain is telling you that something is wrong and needs correctic?n«It's not good med¬icine to kill the messenger and ignore the message When pain is seen in its true role as the messenger and not the affliction itself, treatment can be directed to the cause of pain.Luckily, referred pain is now known to occur in predictable patterns. The valuable. medical advance made by Travell and Simons and their brilliant illustrator, Barbara Crnnmings, has been in delineating these very patterns. Once you know where to look, trig¬ger points are easily located by touch and deactivated by any of several methods. Unfortunately, the two clinically oriented methods put forth in The Trigger Point Manual don't lend themselves to self-treatment. The goal of tliis book is to build on the work of Travell and Simons and provide a more practical and cost-effective approach to pain ther¬apy: a classic do-it-yourself approach, rather than 迁reliance on multiple professional office visits. This new approach is a system of self-applied massage directed specifically at trigger points. Significant relief of symptoms often comes m just minutes. Most problems can be eliminated within three to ten days. Even long-standing chronic conditions can be cleared up in as little as six weeks. Results may be longer in coming for tiiose who suffer from fibromyalgia, chronic fatigue, or widespread myofascial pain syndrome, but even they can experience continuing progress and can have genuine hope of significant improvement in their condition.Self-applied trigger point massage works by accomplishing three things: it breaks into the chemical and neurological feedback loop that maintains the muscle contraction; itincreases circulation that has been restricted by the contracted tissue; and it directly stretches thej trigger point's knotted muscle fibers. The illustrations in this book show you how to find the trigger points that are generating your specific problems, as well as the exact hands-on techniques for deactivating them- Special attention has been given to designing methods of, massage that, do no damage to hands titiat may already be in trouble from overuse.This book's primary use is as a self-instniction manual, but it can also be used as a text¬book for classroom use. This simplified and direct approach to treating pain with self-applied massage can constitute a foundational course in trigger point therapy in any professional training curriculum. Students in chiropractic colleges, physical therapy depart¬ments, and massage schools will derive particular benefit. If they can leam how to interpret their own referred pain and how to find and treat their own trigger points, they will know exactly what to do when they encounter similar problems in their future clients.A class in self-applied trigger point massage would be a boon in medical schools for exactly the same reasons. When new doctors can learn how to fix their own pain with self-applied massage, they are in better touch with the realities of pain and with the great potential in the treatment of trigger points. Such an addition to medical education would profoundly improve the treatment of pain and lower much of its cost And it's not too late for physicians already in practice to learn about trigger points and myofascial pain and put the knowledge to good use. They will find this book a quick and practical introduction to the magnificent work of Travell and Simons and this neglected branch of medicine. Hopefully, many will be encouraged to go to Travell and Simons' Trig¬ger Point Manual for a deeper scientific understanding and for even greater benefit to their practice, A large segment of the public needs help and encouragement in learning how to deal with their trigger point-induced pain. No one is better positioned-to pro vide- this-help than the medical commtuoity.The medical profession is not unaware of the deficiencies of current methods of treating pain. Doctors hurt too. Many of them worry like the rest of us about the relentless popping of pills, and many experience frustration with their inability to offer better solutions to their patients. Trigger point therapy, whether self-applied or administered by a professional, has the potential to truly revolutionize pain treatment throughout the world.。