Cause of Trigger Points in the Masticatory Muscles of Adult Humans (Research Paper Sample)

Scoping Review: Trigger Points in the Masticatory Muscles of Adult Humans
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Scoping Review: Trigger Points in the Masticatory Muscles of Adult Humans
Research Topic: What is the underlying cause of trigger points in the masticatory muscles of adult humans and how does dry needling work against this at the muscle level?”
Keyword: Muscle pain, Trigger points, temporomandibular disorders, myofascial pain, dry needling and Websites including: https://pubmed.ncbi.nlm.nih.gov/, PMID: 29037648 DOI: 10.1016/j.jbmt.2017.03.023, https://www.aafp.org/afp/2015/0315/p378.html
Inclusion Criteria and Decision for Inclusion of Articles
This study focuses on a systematic literature search by applying a framework to determine the inclusion and exclusion of literature in the analysis. The inclusion criteria for this study included all the articles, journals and books published by the PUBMED and Web science up to 2021. These journals and peer-reviewed articles were retrieved from the web of science that explores information on the needling technique and other therapies for treating cases of intense chronic pain in the myofascial and limb muscles. The study included specific articles that describe the work of dry needling on the muscle level and the differences in trigger points between limb and masticatory trigger points (Liu, 2018) 20. Hence, this study focused on the search query to get as many medical articles and journals from the PubMed and science web as possible. Key search words included Dry needling, TDN, DN, Trigger point dry needling, and trigger points in limb muscles. Trigger points in masticatory muscles, muscle level. The inclusion criteria further included titles and abstracts of articles and journals to get those that could help answer the research question, respond to the hypothesis and provide the data required for validating and filling the research gap, as illustrated in the flow chart below.
Exclusion Criteria
Various articles and scientific journals have been extracted from web science on dry needling and related content. However, despite having some of the search words, they failed to respond to the research question. Others had available content that was less significant to this study. Others were outdated, having been written over 20 years ago. The first query helped in selecting the articles used in this study. It was necessary to use an extra query using the exact keywords and phrases to obtain the required extra journal articles for quality content analysis and study conclusion. The researcher used the additional query to select additional twenty articles adding to the 30 that had already been selected. These additional sources were necessary for analyzing the knowledge gap through the scoping review method. The following flow chart shows the inclusion and exclusion criteria used in this study.
Fig.1.1 Inclusion and exclusion criteria from the search query
Results
Understanding trigger points and dry needling
Dry needling is an essential technique in alleviating pain in patients with chronic muscle involvement. This technique involves the insertion of a needle into myofascial trigger points, irritable nodules of a tensed band of muscle fibers). There are two needling techniques depending on how deeper a needle is inserted. They include superficial needling and deep needling. Superficial needling refers to the needle insertion into the subcutaneous cellular tissue that covers the myofascial trigger points (Calvo-Lobo, 2018). Deep needling refers to the insertion of the needle into the muscle to reach the myofascial trigger point. This technique generates controlled micro spasms in the affected muscle area, alternating with periods of muscle relaxation, thus achieving therapeutic effectiveness.
Trigger points in the masticatory muscles may result from injuries to the muscles resulting from clenching or grinding teeth (Atalay, 2020) 23. The repeated injuries result in ischemia of the local muscle tissue and activation of pain sensors in the affected area, causing nociception. Prolonged and constant cases of masticatory muscle pain affect the Central Nervous System leading to the development of unusual referral patterns.
The levels of pain before and after needling varies in adults. Using digital occlusion indicated a decrease in the time of posterior dis-occlusion and time needed to get maximum force after needling the muscle. This indicates the varying static position and the trajectory of the jaw (Rezaeian, 2020) 16. Facial pain reduces significantly, followed by a reduction in muscle activity after needling the trigger points. There is also a variance in pain before and after the needling.
Situations where patients endure chronic pain require an understanding of the mechanism behind the pain. It is also essential to understand the role of trigger needling, the interventions in nociceptor, [pathways], and how the technique helps relieve pain. Using the needling method in combination with techniques such as the neuromuscular deprogrammer is an effective therapeutic method of easing myofascial pain.
Work of Dry Needling on Muscle level
Overused muscles experience energy crisis due to inappropriate prolonged contraction. This phenomenon reduces blood supply in the fibres, thus denying them enough oxygen and nutrients required to enable the muscle to return to its resting state. Tissues surrounding the trigger point become acidic, and the nerves become reactive, thus causing a painful sensation or making the affected area sore. Dry needling helps release the muscle tension by causing the tight muscles to twitch and then relax (Calvo-Lobo, 2018) (4). Simulating the trigger point at the muscle level using a needle helps normalize the blood supply, thus releasing muscle tension. The sensation from the prick fires off nerve fibres that send messages to the brain to release endorphins. The process of dry needling begins with the therapist inserting a needle directly into the trigger point. The twitch signifies that the muscle is reacting, thus releasing the oxygenated blood, which restores normalcy in the muscle position.
Differences in trigger points between limb and masticatory muscles
Muscles including masseter, lateral gastrocnemius, biventral cervices, medial gastrocnemius