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Myofascial trigger point perpetuating factor: visceral disease

 

As with the viscera referenced in the metabolic perpetuating factors, visceral disorders may initiate a somatic pain response and conversely persistent somatic pain will elicit a visceral response. Clinically silent triggers (Phase 3) will not initiate a referral into the abdominal region until palpated or snapped transversely. However, active (Phase 1-2) will.  As previously referenced, triggers may form not only in the muscles and the fascia surrounding them, but also may form in the fascia surrounding organs, adhesions, and periosteum. 

Also, as previously mentioned, mid thoracic nerve compression may only have minor tenderness at the site of compression but will initiate a wide array of autonomic and somatic abdominal symptomatology to include nausea, vomiting, distention, flatulence, and pain. 

Usually visceral disease has progressed prior to initiating pain. As the metabolic dysfunction is usually disturbed, triggers have multifaceted perpetuating factors to be considered.  Just as one can treat out pectoralis triggers and reduce the pain complaint of ischemic heart disease, this is also true of other visceral diseases.  Obviously this is poor health care to unwittingly do so. 

Therefore, extreme care must be utilized when assessing abdominal or pelvic pain for the underlying systemic causation. Triggers in the rectus abdominis, pectoralis group, obliques, sternalis, rhomboid group, pyramidalis, iliopsoas, and pelvic floor are renowned for mimicking visceral complaint. 

Additionally, persons are frequently surgerized in the abdominal/pelvic regions with those resulting post surgical adhesions developing triggers with unique referral patterns.  Therefore sites of previous incisions should be noted on a body form chart especially when the pain complaint has a visceral implication.

Common sites of Surgical Adhesions

Visceral Reflex Pain

However, all of the above listed conditions can either perpetuate triggers or generate reflex pain. Therefore, if there is the most remote question of etiology, further diagnostics are required prior to treating.  

 

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