Fascial Distortion Model (F.D.M) || Part:-2

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Introduction to Herniated Triggerpoints (HTPs)

Herniated Triggerpoints (HTPs) are a specific type of fascial distortion discovered by Dr. Stephen Typaldos as part of the Fascial Distortion Model (FDM). These distortions are characterized by the abnormal protrusion of tissue through the fascial plane. The fascial plane acts like a smooth, flexible sheath that allows muscles and other tissues to move without friction. When this tissue protrudes through the plane, it results in pain and discomfort.

Why Do HTPs Occur?
HTPs are often linked to weaknesses in the fascial matrix, particularly where neurovascular bundles (nerves and blood vessels) pass through the fascia. These passage points are inherently weaker and more susceptible to herniation or tissue protrusion. While HTPs can form anywhere in the body, they are most commonly found in regions subjected to repetitive motion or pressure.

Common Symptoms of HTPs:

• Localized pain: The pain is often pinpointed to a specific area.
• Pinching or catching sensations: Patients may feel a pinching or catching feeling in the affected area.
• Reduced range of motion (ROM): HTPs can restrict joint and muscle movement, making it difficult to perform everyday activities.

Patient Indicators

When diagnosing HTPs, a patient’s body language and self-reported symptoms are key indicators. Unlike other conditions, patients with HTPs often have a strong instinctive understanding of where the pain is coming from.

Body Language:
Patients will frequently press directly on the painful area using multiple fingers, a thumb, or a knuckle. This gesture is an intuitive attempt to reduce the protruding tissue back beneath the fascial plane. They may even ask others to apply pressure to these spots for relief.

Verbal Descriptions:
Patients often describe the sensation as a dull ache, tightness, or localized pain. It’s common for them to express relief when pressure is applied to the painful area, but once the pressure is released, the pain returns.

Worsening with Movement:
Movements, especially those involving the affected muscle or joint, may exacerbate the pain. However, direct pressure on the HTP provides temporary relief, further confirming its presence.

Treatment of Herniated Triggerpoints (HTPs)

The treatment of HTPs is relatively straightforward but requires precise manual manipulation by the practitioner. The aim is to reduce the herniated tissue back below the fascial plane.
Key Points in HTP Treatment

There are several important factors to keep in mind during HTP treatment:

1. Gradual Increase of Pressure:
The practitioner should always start with a gradual increase in pressure to avoid causing the patient excessive pain. This also helps to gently coax the tissue back into place without causing further trauma.
2. Proper Angle of Force:
The angle at which pressure is applied is critical. The practitioner needs to apply pressure in the direction that corresponds with the patient’s pain, as this often aligns with the direction of the herniated tissue.
3. Hydration:
Adequate hydration is crucial for the timely closure of the fascial plane and preventing the recurrence of HTPs. Dehydrated fascia is less pliable and more prone to further distortions.

Subtypes of Herniated Triggerpoints (HTPs)

HTPs can be categorized into two subtypes:

1. Non-Banded HTPs:
Non-banded HTPs occur when a small opening in the fascial matrix allows tissue to herniate through. The herniated tissue often has a larger diameter than the opening through which it passed, making spontaneous reduction difficult.
2. Banded HTPs:
Banded HTPs are associated with triggerbands, another form of fascial distortion. In these cases, the banded tissue prevents the herniated tissue from being easily reduced. Treating the associated triggerband is often necessary before fully resolving the HTP.

Fascial Rent

In some cases, the herniation of tissue occurs through a fascial rent, which is a larger, linear opening in the fascial plane. When this happens, a longer portion of tissue protrudes through the fascial matrix. The treatment for a fascial rent is similar to that of HTPs, but the entire length of the protruding tissue must be reduced.

Once the herniated tissue is reduced, it is important for the practitioner to palpate for any remaining firm edges of the fascial opening. These edges should also be tucked below the fascial plane to ensure complete closure and prevent recurrence.

Conclusion

Herniated Triggerpoints (HTPs) are a common yet often misunderstood source of musculoskeletal pain. If left untreated, they can persist and lead to long-term discomfort and restricted movement. However, with proper identification and manual reduction techniques, such as the Thumb Technique, practitioners can provide significant relief to their patients.

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