The protective model of myofascial trigger points: a testable systems-level framework based on strain-repair mismatch

Myofascial trigger points (MTPs) are frequently identified in clinical practice, yet their underlying physiology remains conceptually fragmented across biochemical, mechanical, and neurophysiological domains. Commonly reported features, including spontaneous electrical activity, increased stiffness, nociceptive sensitization, hypoxia, and elevated inflammatory mediators, are well documented but are not consistently interpreted within established frameworks of tissue stress and repair biology. This paper proposes a systems-level integrative framework, the Protective Model of Myofascial Trigger Points, which conceptualizes MTPs as localized tissue responses emerging when cumulative mechanical strain exceeds local repair capacity. Within this model, increased stiffness, sustained motor endplate activity, nociceptive sensitization, and localized neuroimmune signaling are interpreted as coordinated responses to strain-repair imbalance rather than independent pathological abnormalities. Variability in clinical presentation, including atent and active classifications, is proposed to reflect differences in the magnitude and duration of mechanical overload rather than biologically distinct entities, with persistent MTPs representing indicators of unresolved load-recovery mismatch. Eight falsifiable predictions are outlined, addressing load modification, recurrence patterns, elastographic stiffness, electromyographic behavior, biochemical signatures, and temporal resolution dynamics, providing explicit criteria for empirical testing. By situating MTP-associated phenomena within established principles of tissue injury, repair, and neuromuscular stress physiology, the Protective Model offers a coherent framework to guide systematic experimental investigation of MTP formation, persistence, and resolution.