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C h e c k o u t A B M P P o c k e t P a t h o l o g y a t w w w. a b m p . c o m / a b m p - p o c k e t - p a t h o l o g y - a p p 85 such as holding a challenging posture for prolonged periods, is a common cause. For example, excessive forward-head posture associated with a poorly designed computer workstation can lead to excess hypertonicity. Mechanical stressors are not the only cause of increased hypertonicity. Chemical stresses, such as metabolic challenges or consumption of substances like caffeine or nicotine, also play a role in the development of hypertonicity. Psychological stress also frequently leads to excess hypertonicity. Those who experience high levels of stress in their home or work lives frequently report specific regions of their bodies that feel tight or painful when these stresses increase. MYOFASCIAL TRIGGER POINTS Another common muscular dysfunction is the myofascial trigger point (MTrP). They are defined as "hard, discrete, palpable nodules in a taut band of skeletal muscle that may be spontaneously painful (i.e., active), or painful only on compression (i.e., latent)." 1 There is extensive debate in the scientific community in recent years about the actual physiology of trigger points. 2 We still have a lot more to learn about what is actually going on below the skin with this condition. We do know there are clearly identifiable areas of tissue density that massage therapists are able to palpate. Pressing on these areas produces common characteristic responses, so something is happening there. Exactly what that something is remains for additional research. Researchers have found altered cellular muscle metabolism at the site of MTrPs, but it has not been determined whether this is a cause or an effect. In other research, electromyographic activity at the site of the MTrP also seems altered. Also notable is that pain-referral patterns appear to be related to perception errors by the brain. MTrP identification is primarily based on clinical examination and not on reproducible diagnostic testing. Consequently, enhanced palpation skills are essential for identifying and appropriately treating MTrPs. Massage therapists play a critical role in the investigation of trigger-point phenomena because we spend more time providing detailed soft-tissue palpation than any other health-care profession. Unfortunately, most studies on trigger-point phenomena have not included massage therapists as practitioners. Not using massage therapists in these studies is critical because identification of these nodules within muscle may not be picked up by someone with less palpation skill and experience. Knowing the characteristic referral patterns for MTrPs is helpful in recognizing them. There are charts and maps of MTrP pain-referral patterns that are useful references. However, practitioners are encouraged to use these diagrams only as a starting reference point since pain referral patterns can differ between individuals. Muscles develop trigger points in reaction to stress. As with muscle hypertonicity, these stresses often involve biomechanical overload on the muscle but could also be chemical, thermal, or psychological. Referred pain created by a trigger point can increase muscle tightness either in the muscle housing the trigger point and/or in other tissues that lie within the pain referral zone. Muscles that perform similar actions as the affected muscle can also develop trigger points while compensating for the dysfunction. ATROPHY Muscular atrophy is a decrease or wasting of muscle size and is caused by denervation or disuse. Denervation is a loss or impairment of motor nerve supply to the muscle and results from nerve compression or tension syndromes, systemic disease, or damage to the nerve, central nervous system, or neuromuscular interface. The lack of proper neurological stimulation leads to loss of size and contractile strength, as well as to abnormal biomechanics. Disuse atrophy is relatively common and can also lead to other biomechanical problems from the muscle impairment. Disuse atrophy often develops from a traumatic injury where a limb must be immobilized for a long period. Atrophy can also develop when Because we focus so much on muscles with our treatment, it is valuable to have a good understanding of how muscles function in a healthy system, as well as common muscle pathologies that may affect them.