What is Myofascial Pain?
Myofascial pain syndrome (MPS) is a musculoskeletal pain syndrome associated with multiple painful sites. The pain is induced by fascial constrictions and areas of hyperirritable muscle known as trigger points. Generally, a deep aching sensation will be present in involved areas such as the back of the shoulder. Trigger points can cause local or referred pain and the location of symptoms may vary somewhat over time. Myofascial pain syndrome and fibromyalgia share common characteristics but are separate conditions. Fibromyalgia is a widespread condition effecting multiple body sites; whereas, myofascial pain is a more localised phenomenon.
Myofascial pain syndrome (MPS) is a musculoskeletal pain syndrome associated with multiple painful sites.It refers to the pain originating from the skeletal muscles and the fascia around it. Fascia is a tough, elastic soft tissue that covers the muscles.
Causes of Myofascial Pain
Myofascial pain commonly occurs in people who sit at a desk for prolonged periods of time. Chronic poor posture can give rise to a gradual process of adaptation in muscles that lead to myofascial pain. Manual treatment methods such as myofascial trigger point release can alleviate symptoms and is an effective treatment when applied alongside a thorough postural assessment to identify possible causes of muscle overload. Specific strengthening & stretching exercises may be used to address poor posture and bring about long-term relief. Myofascial restrictions are often present in multiple areas and are reflective of biomechanics flaws & tissue stress
Poor postures maintained for a long time give rise to a gradual process of adaptation in muscles that may lead to myofascial pain. Awkward postures can effect resting muscle length and create imbalances in tissue loading, giving rise to lasting changes in the muscles and surrounding fascia that can evolve into a scar, which you might feel as a lump in the tissue. Initially the tissues will respond to moderate stress by adapting and healing. However, when the rate of injury exceeds the rate of repair, the muscles become damaged and this can lead to the gradual evolution of myofascial overload and pain. When these muscles are subjected to more stresses they develop areas of increased tension (or knots). The fascia covering the muscle becomes constricted. These highly irritable muscle knots are referred to as trigger points.
These knots can be quite stubborn and give rise to a state of chronic pain in the neck and back. Most often people report a feeling of wanting “to stretch or crack the back”.
Is myofascial pain syndrome the same as fibromyalgia?
Myofascial pain syndrome is considered a subset of fibromyalgia by many researchers.
Fibromyalgia syndrome (FMS) is a chronic condition characterised by generalised pain and tenderness over the entire body. The patients report feeling tired all the time. Headaches, disturbances in sleep, and irritable bowel syndrome (IBS) are also frequently seen in patients with fibromyalgia. The syndrome is believed to occur due to a problem with pain processing within the central nervous system, thus, suggesting that the nervous system may also play a role in the development of myofascial pain also.
Myofascial pain syndrome is more localised to a couple of points in the muscles of the neck and back (trigger points). Patients may complain of headaches and pins and needles in the arms or legs (referred pain), although such symptoms can also be produced by a disc herniation in the neck and requires assessment by a Physiotherapist. The symptoms can be reproduced on pressing the trigger points.
What are trigger points?
Trigger points are areas of increased tension (state of sustained contraction) in the muscles. Repeated contraction of an already tense muscle, makes it even more prone to the production of pain. This results in the formation of highly sensitive points in the muscle. On pressing these points, a visible muscle contraction and a ‘jump’ response is noted in the muscle. Attempting to lift the arm/leg or move the neck becomes extremely painful.
Trigger points can be of different types:
- Active trigger point:This is a typical trigger point in the muscle which gives rise to a sudden intense pain deep palpation.
- Latent trigger point:These refer to knots in the muscle that are not painful on deep palpation. These knots if not released have the potential to become active trigger points later.
Symptoms of myofascial pain
- Deep/dull achy sensation in neck, back or shoulder
- Muscle pain with pinpoint tender areas
- Stiffness in the neck, shoulder or low back
- Significant tenderness on pressing the trigger point areas
- Specific posture or movement triggers the pain
- Referred pain to the arm, leg, or head
How to deal with myofascial pain? – Effective ways to treat it
Myofascial restrictions are often present in multiple areas and are reflective of biomechanical flaws & tissue stress. Since chronic posture is a major factor in myofascial pain syndrome, posture correction is an important element in its management. Making the patient aware of correct and faulty postures is the first step. Mirrors are an excellent way to provide feedback and make corrections.
The next step is to identify the weak and tight muscles that result from bad posture. Specific exercises to stretch and strengthen these muscles are important for good static or dynamic postures.
Addressing the problem of muscle strength imbalances also helps to avoid any muscle overload. It also helps the muscles to match the demands of an activity, thereby preventing overuse injuries. Good muscle strength in the neck, lower back, and core helps one to move effectively and efficiently.
Is stretching effective in treating myofascial pain?
Stretching an already tense muscle makes it more tense, as it triggers a reflex muscle contraction. The muscle instinctively resists the pull caused by a stretch as it attempts to guard against reinjury. Relaxing the muscle before stretching can be achieved by (heat) moist packs. Myofascial trigger point release and stretch techniques are more effective in relaxing a muscle with trigger points.
Is massage effective for treating myofascial pain?
Myofascial trigger point release involves application of deep pressure over the trigger point for a few seconds. Deep pressure causes momentary localised ischaemia (lack of oxygen). This triggers a reflex dilatation of blood vessels locally. This results in increased blood supply to that area. This removes metabolic byproducts (lactic acid) and brings in oxygen which together initiate muscle relaxation. A few cycles of myofascial release followed by stretching is highly effective in soothing the knots and relieving pain.
The best replacement is ice. Stroking ice over the muscle containing the trigger point results in instant relaxation. The mechanism is simple. Ice numbs the skin overlying the tense muscle. The brain now perceives no pain as the ice blocks the pain sensation (referred to as pain-gate-theory). The brain just notices a sudden drop in temperature and reacts by attempting to warm the area by increasing the blood supply. The fresh blood washes away the metabolic waste products of muscle contraction and brings in heat and oxygen. This relaxes the muscle. A relaxed muscle can be stretched more easily.
Stubborn trigger points are best managed by deep soft-tissue work and extensive rehabilitation to address muscle imbalances, thereby decreasing the stress being placed on overloaded muscles. This eases symptoms and should be sustained to prevent reoccurrence of the issue.
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