Pain Management: Myofascial Pain Syndrome (Muscle Pain)
Myofascial pain syndrome (MPS) is a chronic type of muscle pain. It refers to pain, tightness, muscle knots, referred pain which does not have a pathological cause, but will not go away or keeps coming back.
Myofascial pain is a chronic condition that affects the fascia (connective tissue that covers the muscles). Myofascial pain syndrome may involve either a single muscle or a muscle group. In some cases, the area where a person experiences the pain may not be where the myofascial pain generator (the trigger point) is located. Experts believe that the actual site of the injury or the strain prompts the development of a trigger point that, in turn, causes pain in other areas. This situation is known as referred pain.
- Trigger Points (TPs) are NOT normal. There should be NO trigger points in normal muscle tissue.
- Most active Trigger Point (TP) is felt more by the patient, NOT the examiner. The well-trained practitioner’s hands can feel big TPs. All the smaller ones are too small and often too deep to feel by the therapist.
What Causes Myofascial Pain?
Myofascial pain may develop from a muscle injury or from excessive strain on a particular muscle or muscle group, ligament or tendon. Other causes include:
- Injury, accident, whiplash, fall, near fall or a blow to the body
- General fatigue or overwork of muscles
- Repetitive motions, poor posture, poorly designed work station or chair
- Medical conditions (including arthritis, movement problems)
- Lack of activity (such as a broken arm in a sling, a result of a cast or immobilized body part after surgery)
What Are the Symptoms of Myofascial Pain?
Myofascial pain symptoms usually involve muscle pain with specific "trigger points". The pain can be made worse with activity or stress. In addition to the local or regional pain associated with myofascial pain syndrome, people with the disorder also can suffer from depression, fatigue and often drug related issues either as a result of treatment or self-medication.
How Is Myofascial Pain Diagnosed?
Trigger points can be identified by pain that results when pressure is applied to an area of a person's body. In the diagnosis of myofascial pain syndrome, four types of trigger points can be distinguished:
- An active trigger point is an area of extreme tenderness that usually lays within the body of a skeletal muscle and which is associated with referred pain. The pain is often in an area far from the TrP, but when the TrP is compressed, the pain is felt or increases. There are many important and noticeable characteristics that allow the therapist or often know they are on the trigger point even if the client does not verbally respond.
- A latent trigger point is a dormant (inactive) trigger point that has the potential to act like a trigger point. Most people have many of these and are unaware of them. Like the Active TrP they can be found in the body and can be felt from the outside as a "knot" or/and "ropey muscles". Latent TrP have many of the same characteristics as Active TrP, but they only cause referred pain on compression.
- A secondary trigger point and satellite myofascial point are other trigger points that are in muscles either near the primary trigger points or within the referred pain area. They can become active due to the referred pain from another trigger points and muscular overload in another muscle as a result of the other trigger points. Often the LONGER the trigger points are active and causing pain, the MORE secondary and satellite trigger points will form. This is why it is more effective to address the trigger points as soon as possible and why treatment often takes longer to eliminate pain when dealing with an old injury.
How Is Myofascial Pain Treated?
- The very best way to treat trigger points is to find and expert a "Myofascial Trigger Point Therapist"
- "Stretch and spray" technique: This treatment involves spraying the muscle and trigger point with a coolant and then slowly stretching the muscle.
- Massage therapy if the therapist is well trained and understands the referred pain patterns
- Trigger point injection. Ask your doctor where they go the training; do they really know where the actual trigger point is?
In some chronic cases of myofascial pain, combinations of physical therapy, trigger point injections, and massage are needed. In select cases, medication is used to treat other conditions that often occur with myofascial pain, such as insomnia and depression.