Myofascial pain syndrome is a chronic condition that mainly affects a person’s muscles and fascia. In the literal sense, “Myo” stands for muscle while “fascial” stands for fascia. Fascia is a narrow, white connective tissue that encloses every muscle. The fascia keeps muscles in place, enabling them to contract and relax. They also provide a smooth surface allowing individual muscle fibres, single muscles, and muscle groups to rub against each other while preventing any excessive friction, tearing, or similar issues. The fascia is a complex tissue that contains nerve endings and engulfs muscles, and is also connected to blood vessels and organs. The entirety of the fascia’s functions is still not completely comprehended and is being researched even now.
Almost everyone experiences muscular pains at some point in their life. Usually, a person suffers from this syndrome after the repetitive contraction of a muscle. Such repetitive contractions could result from repetitive motions in jobs or even stress-related muscular pains. It is estimated that at least 85% of the population suffers from myofascial pain syndrome at some point in their life.
This syndrome occurs when pressure is exerted on sensitive muscles, which causes pain in those muscles and occasionally in what appear to be unrelated parts of the body (Mosby, 2009). The pain in unrelated parts of the body is categorised as referred pain. As per scientists, a person experiences referred pain as the actual area of injury initiates the development of trigger points in a person’s body, which causes pain in the other regions.
Muscle pain can affect anyone at any point in their life, and it is not necessary that all forms of muscular pain can be categorised as myofascial pain syndrome. However, some individuals experience an unbearable amount of pain that lasts for a much more extended period than it should. Such pain usually means that the person is suffering from the syndrome.
What is a trigger point?
A trigger point is a sensitive area within your muscles that people usually refer to as “knots.” It is a group of tense or stressed muscles that spreads pain and twitches when pressure is exerted on them and is called referred pain. To take an example, a person’s body might have a trigger point in their neck but could transfer pain onto their shoulder when pressed. These trigger points make muscles contract and increase stress in them. This continuous stress causes muscle fatigue, numbness, and weakness and limits the range of motion of the muscles.
There are four categories of trigger points: active, satellite latent, secondary, and primary. Primary/central trigger points cause severe pain and are the most well-established trigger points. Usually, when a person refers to a trigger point, they are referring to primary trigger points. They always exist at the point where a motor endplate enters a muscle, in the middle of the muscle belly. Furthermore, the arrangement of muscle fibres also plays a significant role in this regard. For example, in multipennate muscles such as a deltoid (muscles having fibres at multiple different angles), there may be several primary trigger points.
Secondary/satellite trigger points are usually caused in response to a primary trigger point in an adjacent or nearby muscle that lies within the referred pain area. For such circumstances, the central trigger point is usually the solution to therapeutic intervention. Secondary/satellite trigger points usually get cured once the central point has been treated. Resultantly, treating secondary/satellite trigger points can prove to be burdensome and ineffective until the primary trigger point is effectively rendered inactive. This is usually the scenario for abdominal or spinal muscles.
Inactive/latent trigger points can develop anywhere in the body and generally feel like small lumps or nodules. They are usually secondary trigger points and do not cause pain or draw out a referred pain pathway. The more latent trigger points that are present, the more likely a person is to develop muscle stiffness. Some studies show that such latent points generally affect people who live a sedentary lifestyle. Furthermore, there is the possibility of a latent trigger point reactivating if a central trigger point is prompted, and such reactivation can occur because of trauma or injury.
Lastly, active trigger points can refer to both central and satellite trigger points. A range of stimulating factors can reactive an inactive trigger point. An active trigger point usually refers to when a trigger point is both sensitive when palpated or elicits a referred pain pattern.
Symptoms of Myofascial Pain Syndrome
The symptoms experienced by people who have been diagnosed with myofascial pain syndrome usually differ. Some people experience a sharp and sudden pain that is typically referred to as a flare-up, whereas others might have experienced a persistent and dull pain that remains in the background. The direct symptoms that a person may experience are:
- Deep aching, stiff, or throbbing pain
- Different forms of trigger points
- Muscle soreness
- Muscle tenderness
- Muscle weakness in the affected area
- Limited range of motion of affected muscles
Furthermore, people diagnosed with myofascial pain syndrome usually have other health issues which co-exist with the main syndromes. The common health problems associated with it are:
- Lack of sleep, non-restorative sleep, difficulty in lying down for long periods, hot flushes in sleep
- Anxiety, depression, and/or stress
- Fatigue
- Headaches
- Postural abnormalities such as shoulder rounding or hunching
- Irritable bowel syndrome
- Balance problems
- Ear pain
- Blurred vision
- Reduced exercise tolerance
Myofascial Pain Syndrome vs Fibromyalgia
Myofascial pain syndrome is often confused with fibromyalgia as the pain present in both conditions can lead to it being confused for one another, or worse, lumped together as one condition. The critical difference between the two conditions is that people with myofascial pain syndrome experience localised pain in specific muscle regions such as the neck, shoulder, or lower back. In contrast, people with fibromyalgia feel pain throughout their entire bodies.
A person diagnosed with fibromyalgia has significantly more trigger points, and those points are referred to as “tender points.” Even though trigger and tender points are both localised areas of pain, they cannot be classified as the same. Trigger points cause referred pain, whereas tender points do not and are simply discrete areas of pain. Additionally, tender points are symmetrical and exist on both sides of the body, whereas trigger points do not have a fixed symmetrical pattern.
The pain caused by fibromyalgia diffuses; it affects both the muscles as well as joints. There is also a possibility of the pain migrating from one part of the body to another over a period of time. Researchers have suggested that myofascial pain syndrome has the potential of developing into fibromyalgia in certain people. Research shows that people diagnosed with fibromyalgia become more sensitive to pain over time, and this process is sometimes initiated by myofascial pain syndrome. A person could have both conditions, so it is crucial to consult a doctor to ensure both of them are treated accordingly.
Cause and risk factors of Myofascial Pain Syndrome
Generally, myofascial pain syndrome is caused by the overuse or over-exertion of a muscle, trauma or injury, and psychological stress. Trigger points start to form due to repetitive activities such as working on a computer all day, exercising, or lifting heavy things. However, there is always an amalgamation of contributing factors that lead to the syndrome, and no single factor alone can be responsible for its development. These additional factors include:
- Staying in an awkward position for extensive periods
- Lack of nutrients
- Lack of exercise
- Injury or trauma to the musculoskeletal system
- Lack of sleep or fatigue
- Hormonal imbalances or changes
- Staying in a cold environment for excessive periods of time
- Psychological problems such as stress, anxiety, and depression
- Other conditions that may cause pain or inflammation
- Obesity
- Smoking
- Bad posture
- Old age
- Presence of chronic infections
Heartland Rehab treatment process
Diagnosis
Most of the time, myofascial pain syndrome is underdiagnosed, ignored, and mistaken for conditions affecting nerves, ligaments, bones, or tendons. Diagnosing this condition requires physical examination most of the time as there are no laboratory tests, imaging tests, or biopsies that can properly diagnose it. Furthermore, it does not even show any visual signs such as swelling, redness, or muscle warmth. Usually, palpating or applying pressure to potential trigger points is used to detect the presence of the condition. The usual signs that are considered in diagnosing myofascial pain syndrome are:
- The preliminary beginning of pain originates from a muscle
- The area of the trigger point is tender
- The pain is localised or at a close distance from the trigger point
- Muscle fibres are stiff, passing through the tender spot in a short muscle
- Stimulating the trigger point results in a twitch response.
The different trigger points that are usually diagnosed are:
Active trigger points
These are susceptible areas of extreme tenderness that are generally present within the skeletal muscle and are linked to local or regional pain.
Latent trigger points
These are inactive points that are not sensitive per se but have the potential of turning into an active trigger points. They may potentially restrict muscle movement or cause weakness.
Secondary trigger points
These are present in muscles other than those that contain the active trigger point and can be irritated concurrently with the active trigger point.
Satellite trigger points
These are inactive trigger points as they overlap with another trigger point’s region.
Myofascial Pain Syndrome Trigger Points Chart
Treatments
Many treatments are available to cure the effects of myofascial pain syndrome. The medical professionals at Heartland Rehab provide musculoskeletal physiotherapy which treats all conditions relating to bones, joints, muscles, tendons, and ligaments through a tailored and person-specific programme. A combination of the following treatments is used to manage your pain and restore affected muscles:
Dry needling
Dry needling involves the use of a sterile, fine filament needle. The needle is inserted into areas of the muscles known as the trigger point. These trigger points are often hyperirritable spots that might be a source of pain. Inserting a needle to the trigger point areas often induces a local twitch response from the muscle, causing a cramping-like sensation. This process lasts for a short 10-15 seconds and is repeated along with other trigger point areas.
Trigger points are often formed due to injuries that cause the muscle fibres to get damaged. These damaged muscle fibres often go into a contracted and protective state, limiting the flow of oxygen-rich blood from reaching the injury site. This causes a lack of oxygen to the injured area, causing chemical imbalances, which leads to pain, weakness, and reduced flexibility of the muscles. Dry needling elicits a local twitch response from the trigger point area, normalizing the chemical environment around it. This allows the muscle regeneration process to occur, reducing tension on the taut band of the muscles, allowing for a better flow of oxygen-rich blood to the area. This helps relieve any pain or tightness felt and improves movement and range of motion.
Ultrasound therapy
There are two main types of ultrasound therapy. Both use sound waves generated by a transducer head (which looks a bit like a microphone) to penetrate soft tissues. The difference between the two types of ultrasound therapy is the rate at which the sound waves penetrate the tissues. The types are:
- Thermal ultrasound therapy
- Mechanical ultrasound therapy
A person diagnosed with myofascial pain syndrome is usually treated with thermal ultrasound therapy. Thermal ultrasound therapy uses a more continuous transmission of sound waves. The sound waves cause microscopic vibrations in the deep tissue molecules, increasing heat and friction. The warming effect encourages healing in the soft tissues by increasing the metabolism at the level of the tissue cells.
Massage therapy
A physiotherapist will be able to palpate and identify trigger points that cause pain, stiffness, and tightness. As such, myofascial release will be used to relieve the hyperirritable taut spot. This is done by applying a gradual, sustained pressure along with the myofascial trigger point of a muscle. It frees up the tissue, restrictions, and adhesions along the muscle to reduce your pain, stiffness, and tightness.
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