Myofascial Pain

What is myofascial pain?

Myofascial pain is probably one of the least understood and most frequently misdiagnosed types of pain. It is also one of the most common sources of pain in our population and results in a large number of doctor visits, missed work days, and missed social activities. The word "myofascial" means related to muscle and fascia. Fascia is the connective tissue which surrounds the muscles in the body. So myofascial pain means pain that is coming from muscles and connective tissues.

How would I know if I have myofascial pain?

The symptoms of myofascial pain can vary depending on the location and severity of the problem. People describe deep aching pain which can be either constant or intermittent (comes and goes). This can be accompanied by burning or stabbing pain, weakness, tingling, increased or decreased sweating, stiffness, sleep difficulties, or dizziness. Myofascial pain can be made worse by staying in one position for too long, repetitive activities such as painting a wall or scrubbing the bathtub, cold or damp weather, exposure to a cold draft, or stress.

What are trigger points and how do they develop?

There are approximately 400 muscles in the human body, and any one of these can develop what is called a myofascial trigger point (TP). Trigger points are irritable spots within abnormally taut bands of muscle or fascia that, when pressed, cause local pain, as well as referred pain to somewhere else in the body. This referred pain is frequently what leads people to schedule an appointment with their doctor. The TPs of myofascial pain may occur for many different reasons. Direct trauma such as whiplash is a common cause. Frequently, overload of a muscle is the culprit. Overload occurs when a muscle is being used in an improper way, causing stress on the muscle fibers. These muscles will often respond by developing TPs. If this problem goes untreated for a period of time, compensation in multiple areas of the body can occur, making the problem widespread and complicated. When this occurs, it is frequently referred to as myofascial pain syndrome.

How is myofascial pain diagnosed?

The fact that a person can experience pain in areas far from the problematic muscles makes diagnosis difficult. A thorough history and examination, including which activities may increase or decrease pain, helps differentiate between possible diagnoses. Sometimes what appears to be a muscle condition is actually due to conditions arising in the nerve, spinal cord, or brain. Diagnostic testing such as MRIs or EMGs may help identify the specific tissue or location causing the pain. However, myofascial pain itself is not readily identified by testing and, therefore, is diagnosed based upon exclusion of other conditions and specific features identified on physical examination. Myofascial pain can and often does coexist with other disorders such as arthritis, nerve root compression, or migraine. In addition, when TPs are activated by aggravating activities, they can sometimes trigger a migraine attack.

Treatment options for myofascial pain

Once the physician has determined that a person's pain is all or in part myofascial, they will often refer the patient to a physical therapist. It is important to find a physical therapist experienced and knowledgeable in treating myofascial pain. The therapist will help identify the location of the TPs and design a program to address the pain and the contributing factors.

Myofascial pain requires a two-part treatment strategy. First, factors in an individual's life which act to exacerbate myofascial pain must be addressed. Ergonomic changes to work stations, postural corrections, and alterations in performance of repetitive activities such as vacuuming or painting may be required. Long periods of sustained repetitive activity or prolonged positioning will likely need to be broken up with stretch breaks. Exercise routines may need to be altered.

Patients can also learn specific techniques to utilize abortively when they feel their pain is beginning to escalate. Family members can be of assistance as well, learning massage techniques which may help acutely.

Second, the musculoskeletal system must be addressed directly. Since tight muscles can contribute to the occurrence of trigger points (TPs) characteristic of myofascial pain, specific stretching exercises, deep soft tissue work, and myofascial techniques may need to be utilized.

Problems with the back and neck which may have resulted from years of poor posture may need to be addressed with manual (hands-on) techniques to restore proper mobility and alignment. Muscles which have become weak over time will need to be gradually strengthened. Patients will also need to continue with an exercise program which has been specifically designed to address identified problem areas, in order to maintain good muscle health.