Zusammenfassung
Hintergrund: Kennzeichen der häufig vorkommende Diagnose myofasziales Schmerzsyndrom (MPS) sind myofasziale Triggerpunkte (MTrP).
Ziel: Die Arbeit liefert einen aktuellen Überblick der Ätiologie und Pathophysiologie von MPS sowie ihrer physiotherapeutischen Befunderhebung und Behandlungsmöglichkeiten.
Methoden: Die in den letzten 20 Jahren veröffentlichte Literatur wurde gesichtet. Die Informationen stammen größtenteils aus medizinischen Zeitschriften (mittels Suchmaschinen wie PubMed) und mehreren Büchern.
Ergebnisse: In der Literatur der vergangenen 20 Jahre ist MPS gut dokumentiert. Der Befunderhebung und der Therapie liegen die für die Erkrankung ausschlaggebenden MTrP zugrunde. Zur Pathophysiologie gibt es derzeit 3 Hypothesen mit interessanten Überschneidungen. Für eine Diagnose sollte der Patient mindestens regionale und übertragene Schmerzen, palpierbare straffe Bänder, Empfindlichkeit in lokalen Bereichen und eingeschränkte Beweglichkeit aufweisen. Eine detaillierte Anamnese und geschickte Palpation sind ausschlaggebend zur Diagnosestellung.
Einige physiotherapeutische sowie manualtherapeutische Methoden und in geringerem Maße andere physikalische Verfahren bieten wirksame Behandlungsmöglichkeiten. Trockene Nadelung mit einer Akupunkturnadel scheint in der klinischen Praxis höchst wirksam zu sein, bisher gibt es dazu jedoch keine definitiven Erklärungsmodelle. Ein weiterer wichtiger Aspekt ist die Analyse prädisponierender und perpetuierender Faktoren und deren Behandlung in Kombination mit einem vorbeugenden Übungsprogramm.
Schlussfolgerungen: Für bessere wissenschaftlich fundierte Methoden zur Befunderhebung und Behandlung der bei MPS bedarf es noch weiterer wissenschaftlicher Forschung.
Abstract
Background: Indicators of the common diagnosis Myofascial pain syndrome (MPS) are myofascial trigger points (MTrP).
Objective: The article presents a current review on the etiology and pathophysiology as well as the physiotherapeutic assessment and treatment options of MPS.
Methods: The literature published in the last 20 years was investigated. Information largely originates from medical journals (by means of search engines like PubMed) and several books.
Results: In the literature over the last 20 years MPS has been well documented. MTrP are the diseas’s determining factors and the basis of assessment and therapy. At present 3 hypotheses exist of the pathophysiology of MPS with interesting overlaps. For a diagnosis a patient should show at least regional and referred pain, palpable taut bands, local area sensitivity and limited mobility. A detailed anamnesis and skillfull palpation are essential for diagnostics.
Some physical as well as manual therapy methods and to a lesser degree other physical techniques offer effective treatment measures. Dry needling with an acupuncture needle seems to be highly effective in clinical practice, although definite explanation models are not yet available. Another important factor is the analysis of predisposing and perpetuating factors and their treatment in combination with a preventative exercise program.
Conclusion: More scientific reseach is necessary for better evidence based assessment and treatment options.
Schlüsselwörter
Triggerpunkt - myofasziales Schmerzsyndrom - Physiotherapie - trockene Nadelung
Key words
Trigger point - myofacial pain syndrome - physiotherapy - dry needling
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Frank Timmermans, Reg, PT, MT, CIMS, MCPA
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CA-Penticton, BC V2A 8S7 Canada
Email: uplandsphysio@shaw.ca
