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Faculty of Physical Education & Rehabilitation Department of Human Physiology & Sports Medicine

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. Referred muscle pain. INTRODUCTION. 1. An infitration….

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Faculty of Physical Education & Rehabilitation Department of Human Physiology & Sports Medicine

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  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 1. Mechanical pressure… A 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 2007;68:144-50.

  6. Referred muscle pain is primarily peripheral in origin:“The 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) …downstream…and in turn via spinal transduction… 6. …actives the CNS

  7. Referred muscle pain is primarily peripheral in origin:“The barrier-dam theory” New hypothesis: Farasyn A.: “The barrier-dam theory” Co-activates parallel sensitive nerves (E => C) creating adjacent zones of referred pain… B A E C

  8. Referred muscle pain is primarily peripheral in origin:“The 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 origin:“The 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 Gray’s 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 Gray’s 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 origin:“The 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 origin:“The 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 origin:“The barrier-dam theory” Thank you for your attention…!

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