Myofascial pain syndrome is a relatively common and often underdiagnosed condition that medical massage therapists often encounter. It is believed that 85% of the general population (that’s 283 million people, young and old) will experience myofascial pain throughout their lives.
What is Myofascial Pain Syndrome?
Myofascial pain syndrome is a soft tissue condition resulting from one or more hyperirritable trigger points that gradually develop in a muscle and the surrounding fascia.
Fascia is the thin white connective tissue that wraps around every muscle cell, muscle fiber, muscle, and muscle group. This connective tissue is found throughout the body, contains nerve endings, and surrounds your organs and blood vessels.
Trigger points are found along a tight band of tissue in your muscle and feel painful, tender, and bump- or knot-like. These tight bands are segments of muscle cells stuck in hypercontraction.
The muscle fibers that are stuck together slow and eventually stop blood flow, causing that immediate area of muscle not to receive the required oxygen it needs. Due to the lack of circulation, waste materials accumulate in the fibers and irritate the trigger point, sending out a pain signal. Your brain responds by “muscle guarding” and restricting your range of motion to avoid recreating that pain.
Unfortunately, the lack of use will cause the muscle to tighten further and become weak, causing more loss in the amount of movement you have. The musculature around the affected muscle must work harder, compensating to do the work of the affected muscle. These neighboring muscles can also develop trigger points and add to your pain and restricted movement.
How Is Myofascial Pain Syndrome Diagnosed?
While there are no standard or specific tests to diagnose myofascial pain syndrome, the criteria most commonly agreed upon for diagnosing myofascial pain syndrome include:
- Trigger point presence,
- Pain with palpation,
- Pain referral patterns,
- And local twitch responses.
A taut band can be felt in the affected muscle belly with a tender spot aggravated by simply pressing on it. Trigger points can be classified as active or latent. Active trigger points are found in symptomatic patients, and latent trigger points are found more often in patients that don’t report pain.
The clinician will ask the patient about the sensations they experience before and during a physical examination.
The patient usually identifies the pain as
- And/or aching
The muscles are also reported as sore, tender, and prone to weakness. Smooth movement in the neighboring joints and muscle coordination are compromised. These symptoms usually occur after muscle injuries or overuse activities. The onset of pain and restricted movement could be acute or gradual.
Is Myofascial Pain Syndrome The Same As Fibromyalgia?
Myofascial pain and fibromyalgia pain can feel similar. Both have trigger points and muscle pain. However, fibromyalgia patients experience tenderness in those points as opposed to the deep aching pain that myofascial syndrome patients experience. Additionally, myofascial pain is contained to one specific area or multiple on the same side of the body. In contrast, fibromyalgia pain is felt throughout the entire body. There are no known causes for fibromyalgia, and there is a consensus that myofascial pain can be caused by injury or overuse.
A patient with fibromyalgia will potentially have the following:
- More trigger points throughout,
- No referral pains or twitch responses,
- Widespread pain,
- Worse fatigue and sleep issues,
- Ongoing headaches,
- Bowel issues,
- A sensation of swelling,
- Sensory sensitivities,
- And sometimes a burning, prickling, or tingling feeling.
Some researchers believe that myofascial pain syndrome can transition into fibromyalgia. Still, there is no conclusive evidence to support that suspicion. Speaking with a specialist can help you differentiate whether you are experiencing one condition versus the other.
Best Treatment for Myofascial Pain Syndrome
The duration of myofascial pain syndrome varies from person to person. With treatment, it may go away after a day or a few weeks. Still, it can take longer for some, depending on their lifestyle and activities.
There are many treatment options, such as:
- Manual bodywork (massage)
- Physical therapy, post-isometric stretching
- Vapocoolant spray and stretch (assisted stretching after vapor coolant spray use on the affected area)
- Relaxation or cognitive therapies
- Acupuncture or dry needling (inserting thin needles directly into the trigger point)
- Trigger point injections (needle injection of local anesthetic into the trigger point)
- Transcutaneous electrical nerve stimulation, or “TENS” therapy (low-voltage electrical currents via electrodes)
- Cold laser or low-light therapies
- Ultrasound (sound waves)
Pain relief and the correction of perpetuating factors are the main goals of myofascial pain treatment. Therapists and clinicians should include ergonomic modifications and at-home stretching exercises in the treatment plan.
The most typical medications for myofascial pain are NSAIDs (nonsteroidal anti-inflammatory drugs, such as aspirin or ibuprofen) and muscle relaxants. However, current evidence suggests that their effectiveness is inconclusive.
Without treatment, though, it might go away on its own after a week or a few months but can become a chronic issue if it lasts longer than six months. Once it becomes a chronic condition, resolving the trigger points becomes difficult. The focus then shifts from getting rid of the trigger point(s) to managing the pain and other symptoms.
Once you start feeling stiff, achy, and restricted, it’s best to tend to your pains before they become a much larger and uncontrollable problem.
This blog was contributed by Lex Alvarado:
Lex Alvarado has over 14 years of experience working with patients, collaborating care to improve pain and posture.She is certified in Active Release Technique (ART) and neuromuscular massage (CNMT) and is a Board certified massage therapist (CAMTC). She is currently on the rehab. team at Irvine Spine and Wellness Center. When you are ready, contact us online or reach the team at 949-552-5535