Myofascial Pain Syndrome

Before you rush into a stretching program for your pain, be aware of what myofascial pain is, what helps, and what is likely to aggravate it.

What is Myofascial Pain?
What is a Trigger Point?

What is Myofascial Pain

This is a common source of pain resulting from trigger points that is often seen by physical therapists. In spite of evidence  and substantial literature on the identification of trigger points, they often go undiagnosed by physicians and physical therapists. This can eventually lead to chronic pain. This can be the cause of jaw pain, shoulder or neck pain, hip or back pain, or pain in the extremities.

Pain resulting from trigger points is usually the result of muscle overload, either due to acute trauma, poor postures, or repetitive movements that place abnormal stress on particular muscles. The theory is that if normal healing does not take place, that sensitization of pain receptors can become prolonged causing increases in local tenderness and often a referred pain. This sensitization can also occur at the level of the spinal cord causing a hypersensitivity to stimuli of less intensity.
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What is a Trigger Point

A trigger point is a nodule within a taught band in an affected muscle. Pressure on this tender point causes a reproduction of the patient's pain and there is often weakness and a limitation in the muscles stretching range of motion. One theory on trigger points suggests that trigger points occur at motor end plates where hyperexcitable nerve endings release excessive acetylcholine. This results in prolonged muscle fibre contractions because of excessive calcium intracellularly. These muscle fibers contract around nearby blood vessels causing a local hypoxia so the contracting muscle fibers become deficient in oxygen.
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Typical characteristics of this type of pain is limitation in a muscle's stretch range of motion. Pain increases as it is stretched. This is usually worse first thing in the morning. Patients also complain of weakness. Muscles become accustomed to working  within pain limits and will only contract below the pain threshold. Patients with chronic myofascial pain often suffer from depression and sleep disturbances. This also lowers the pain threshold.

  • aching, deep, muscular pain
  • pain that doesn't improve
  • reduced stretching range of motion of the affected muscles
  • knots or tight areas within the muscle that are sensitive to touch
  • difficulty sleeping
  • muscle weakness

Passive and active stretching of muscles experiencing myofascial pain increases pain. Isometric contractions of the muscles experiencing myofascial pain also  increases the pain; whereas isotonic contractions of the muscle does not.

Pain is usually aggravated by the following:

  • passive stretching
  • contraction of the muscle in a shortened position
  • pressure on a trigger point
  • maintenance of the muscle in a shortened position for a prolonged period of time
  • prolonged or repetitive contraction of the muscle
  • stress
  • cold weather

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Treatment of Myofascial Pain Syndrome

Treatment of myofascial pain will include physical therapy, and may include trigger point injections if you are seeing a specialist.

Methods to deactivate trigger points causing myofascial pain are as follows:

  • ultrasound followed by stretch by a physical therapist
  • pressure release by a massage or physical therapist
  • spray and stretch by a physical therapist
  • injection of local anaesthetic by a medical specialist
  • dry needling followed by stretching by a physical therapist trained in acupuncture
  • massage
  • contract/relax techniques instructed by a physical therapist or massage therapist
  • rest
  • heat combined with slow stretching
  • short bouts of light exercise as prescribed by your physical therapist

Any of the above modalities followed by stretching is more effective than stretching alone when trying to manage a myofascial pain syndrome. Stretching alone may in certain instances increase trigger point sensitivity.  It is important that your physical therapist determine the cause of your myofascial pain, whether it be postural, or work related. If the mechanical cause is addressed only then can treatment be long lasting.

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Medications for Myofascial Pain

Your family doctor may prescribe anti-inflammatories, antidepressants, muscle relaxants, or medication to help you sleep. If you are investigating alternatives in the treatment of myofascial pain be sure to mention them to your doctor as certain herbs, juices, and supplements can interact adversely or affect the absorption of various medications.

Diagnosis of Myofascial Pain Syndrome

If you are experiencing what you believe to be a myofascial pain syndrome see your physical therapist or family physician for a full evaluation. Many of the symptoms of myofascial pain are identical or similar to those of other conditions so it is important to rule those out before embarking on treatment for myofascial pain.

After ruling out more serious conditions your family doctor or physical therapist will determine the source of your pain by palpating for trigger points  by applying pressure to the muscles and feeling for tension and nodules.  These trigger points may respond to the pressure by twitching and referring pain along specific patterns of distribution.

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