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Myofascial trigger point perpetuating factor: infections and infestations

 

Infections are caused by an invasion of a microorganism, which are bacterial, protozoal, ectoparasitic/endoparasitic or viral in nature.  While viruses are considered by most to be microorganisms or pathogens several authors are of the opinion that viruses do not portray true characteristics of an organism.

Potentially there are numerous infections, which can cause muscle pain and aggravate trigger points.  However, when these infections exist, they are usually accompanied with additional symptoms such as fever, fatigue, muscle weakness and possibly skin lesions, nausea, vomiting, diarrhea or hemorrhage.

Low-grade viruses seem to be the most prevalent means of infection in western society. However, viruses such as herpes (all types), arbovirus (transmitted by ticks, mosquitoes and sand fleas), arenavirus (transmitted by rodents and mosquitoes) viral stomatitis, mumps, measles, and chicken pox viruses are among a few of the infectious viruses that can result in trigger points. While all these infectious viruses have somewhat different causes and symptoms, they all affect the muscles.

Drs. Travell & Simons placed significant emphasis on primary herpes simplex being a perpetuating factor of myofascial pain syndrome TrPís and stated that its propensity for perpetuation was far more prevalent in perpetuating TrPís than that of secondary herpes simplex or even herpes zoster.  Our experience has been that while the secondary form of HS or genital herpes does not seem to have the propensity to perpetuate or activate triggers in comparison to primary herpes simplex, the post hepatic neuralgia experienced with herpes zoster has the potential to be far more severe, persistent and difficult to obtain amelioration than that of herpes simplex. 

Herpes zoster (shingles) can be a devastating illness and the inescapable neuralgia with secondary myalgia can frequently be so painful that the individual can become suicidal. Elderly persons or those with a compromised immune system in addition to severe psychological stress are at the greatest risk for severity of pain and reoccurrence. Pain reoccurs on numerous occasions, with the absence of lesions, occasionally for months or even years after the initial eruptions.

While this condition usually affects the dorsal root ganglia of the thoracic nerves, occasionally dermatomal distribution is noted in the lumbar sacral region or with the eyes, ears and face from the ophthalmic or facial cranial nerves (Ophthalmic herpes zoster, Ramsay Huntís syndrome or herpes zoster oticus).  According to the NIH, this virus is a form of chicken pox and can be transmitted during the acute phase to individuals, whom have not been previously infected by the chicken pox virus, if the vesicular dermatomal eruptions are disturbed.

Soft tissue techniques applied by a person whom has never been exposed to the pox virus may result in the contraction and possible transmission of this virus during the acute phase. While gentle rubbing along the dermatomal pathway can be beneficial in reducing postherpetic neuralgia, soft tissue technique would be contraindicated during the acute stage. Dermatomal pain usually precedes eruption for approximately 3 to 5 days. The lesions are active for approximately five days to two weeks. Should the lesions be persistent for over three weeks, consider possible metastatic disease.

Occasionally, this condition affects the viscera and can present chest pain or symptoms consistent with pleurisy or appendicitis prior to the erythematous eruptions. As peripheral nerve compression also causes a hyperesthesia of dermatomes, palpation should be conducted with latex gloves. Herpes simplex is also transmittable and the same precaution should be used when working around or in the mouth or groin. 

A few other viral infections which cause muscle pain, weakness and fatigue are the common cold, influenza, pneumonia, viral hepatitis, malaria, poliomyelitis, upper respiratory infection, GI infections, viral meningitis, viral encephalitis, small pox and HIV (acute retroviral syndrome).

While multiple sclerosis is considered an autoimmune disease, the true cause of degeneration of the myelin sheath is unknown. However, numerous authors attribute its causation to either a virus or retrovirus with frequent correlations to herpes. Symptoms are dependent upon area affected. Symptoms may be intermittent or when more progressive, persistent and degenerative. The symptoms range from virtually no effect to fluctuations in mood to severely depressed, weakness, tremors, hypertonicity with ischemic bands and triggers, hyperreflexia, gait abnormalities with proprioceptive dysfunction, paralysis, constipation and urinary incontinence. With cerebral involvement you may see difficulty in speaking, swallowing, and visual disturbances.  Like several other forms of neurologic disease (neuropathy) heat is contraindicated. It is not uncommon that following a very warm whirlpool that the symptoms are worsened, such as a foot drop which may occur and take several days to ameliorate.

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Bacteria or germs are single cell organisms that while very small are approximately 100 times larger than a virion.  Unlike viruses bacterial invasion are usually responsive to antibiotics.  However, there are certain forms of bacteria, which are antibiotic resistant. These resistant strains are usually the product of an individual being administered liberal and frequent doses of antibiotics thus diminishing the effectiveness of these medications.

Bacterial infections may be localized or systemic. They may be recent in onset or acute, sub-acute or chronic. Dependent upon the type of bacteria, the immune system of the individual, and resistance to antibiotics, most superficial infections are easily managed.

Chronic infections, especially those that are in the bloodstream have a tendency to be antibiotic resistant and in low-levels, are more difficult to diagnose. Usually cultures or elevated white counts are excellent diagnostic indicators for infection. However, with chronic infections it is not uncommon to have a normal or slightly elevated white blood cell count, which is misleading as it pertains to the infection. This occurs due to the body releasing immature leukocytes thus requiring more specialized testing than a CBC.

Localized infections can be spread through the use of soft tissue manipulation and therefore massage would be contraindicated.  Depending upon the type of infection, whirlpools would also be contraindicated, and if ordered by a physician, the water would have to have an antibacterial agent added (i.e. burn patients). The CDC recommends cleaning of whirlpools and equipment with a 20% chlorine solution.  Obviously, to avoid cross contamination frequent hand washing with an antibacterial soap is required. 

Viruses cannot replicate outside of a host cell. Anaerobic bacteria require a warm, moist environment.  Aerobic bacteria require oxygen for replication. 

A few conditions caused by bacterial infections which result in muscle pain are Legionnaireís disease, streptococcal myositis, poststreptococcal arthralgia, septic arthritis, oral abscess, anthrax, upper respiratory infection, urinary tract infection, sinusitis, toxic shock syndrome, salpingitis, prostatitis, endometriosis, bacterial meningitis, and encephalitis.

A Protozoan is a single cell organism, which can be microscopic or macroscopic in nature. Some forms move freely throughout the body with the use of their tail (flagella). They are parasitic in nature and significantly larger than bacteria with some having the ability to eat, eliminate, and conduct respiration on their own.  The main two protozoa that are responsible for muscle pain are giardiasis and amebiasis.

Parasites live in (endoparasitic) or on (ectoparasitic) another living creature. Some bacteria, viruses and protozoa are essentially parasites. The worst offenders of parasites causing muscle pain or TrPs are adult tapeworms and pinworms, which can have severe and even life threatening side effects. While ectoparasites such as fleas, scabies, mites, ticks, leaches, and lice frequently act as vectors; the manual medicine practitioner is usually more concerned with coming in contact with these parasites than having to confront the disease process that they may cause. Drs. Travell & Simons do reference Deer Tick Fever, Rocky Mountain spotted fever, and Lymeís disease as perpetuating factors for TrPs.

Fungal infections usually do not present muscle pain, nor are they listed as a perpetuating factor for TrPís. However, several of them can be spread and are noteworthy of consideration. Systemic Candidiasis can cause a multitude of symptoms ranging from fatigue, confusion and lethargy to the direst of consequences when progressive, if the individual has a suppressed immune system. In healthy individuals bacteria normally keeps this fungal development in check. However, with the persistent use of antibiotics there are not any bacteria to fight off its progression.  Persons with Diabetes Mellitus, women on birth control pills or who are pregnant also have a propensity for systemic candidiasis. Prevalent sites of localized candidiasis are the skin, nails, mouth, mucus membranes, vagina, gastrointestinal tract, penis, and anus.  These localized sites of candidiasis infection, while extremely troublesome, can be managed with medication, diet, and naturopathic or homeopathic remedies.  As in most cases involving a suppressed immune system, the ability to reduce psychological stress is important.

 

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