Myofascial trigger point, falls in the elderly, idiopathic knee pain and osteoarthritis: an alternative concept.

Knee malalignment and associated pathological abnormal forces transmitted through the knee is thought to provoke joint protective mechanism in reflex arthrogenous muscle inhibition (AMI) and the start of the idiopathic knee osteoarthritis process. The current prevailing hypothesis is AMI initiates quadriceps muscle weakness, cause aberrant loading of the knee joint and focal cartilage destruction. This paper investigates for evidence in the literature if this conceptual framework is consistent with the clinical evidence, and if there is an alternative explanation to AMI hypothesis for the pathogenesis of idiopathic knee osteoarthritis. One crucial question yet to be answered by the AMI hypothesis is; where are the initial aggravating factors of reflex AMI emanate from? AMI hypothesis relies on joint damage and changes in joint homeostasis to provoke a reflex arthrogenous response which can be found later in the development of knee OA. Myofascial trigger point (MTrP) hypothesis only relies on muscle tightness, pain and weakness to detect early pathological neuromuscular changes including knee instability and falls in the elderly. AMI is implicated in the knee OA pathological process but much later on when there are changes in joint homeostasis and joint cartilage damage have occurred. Falls in the elderly is a result of early pathological neuromuscular changes. The MTrP hypothesis is more sensitive and advanced in the early detection of neuromuscular impairment and pathological changes, allowing early intervention, prevention of falls in the elderly and idiopathic knee osteoarthritis.

Trigger point therapy and plantar heel pain: A case report.

The cause of plantar heel pain and fasciitis has continued to be a diagnostic challenge even though it is one of the most common musculoskeletal disorders of the foot and ankle. The subject has evoked strong emotions and sparked intense debate regarding the likely causes and effective treatment options. Myofascial trigger point as a treatment option for plantar heel pain and fasciitis has been inconspicuous. The full extent of its significance and potential is largely unexplored in podiatric literature and medicine. Myofascial trigger point may offer an alternative explanation of the etiology of plantar heel pain and fasciitis.