What is Myofascial pain syndrome?

Overview

Myofascial pain syndrome is a musculoskeletal system related chronic pain condition.

Most people have muscle soreness at some point in their lives, which usually goes away after a few weeks. Muscle pain, however, remains in some persons.

Trigger points are painful sites in patients with myofascial pain syndrome (MPS). These regions form in the muscles' tense, ropey bands (the fascia). When pressure is applied to these trigger points, pain is felt in a different place of the body (referred pain).

Symptoms

The following are some of the most common MPS symptoms:

• Profound muscle ache in specific places
• Pain that worsens when the affected muscle is stretched or strained 
• Muscle pain that worsens or does not improve over time 
• Presence of painful knots in muscles that produce intense localised or referred pain
• When pressed muscles that are weak, stiff, inflexible, or have a limited range of motion
• Mood or sleep disturbances

Causes and risk factors

Muscle overuse, muscle trauma (injury), or psychological stress are the most common causes of points. Sustained repetitive actions, such as carrying heavy objects at work or working on a computer all day, can lead to trigger points. Myofascial trigger points occur as a result of a combination of factors. A number of factors may have a role, including:

• bad posture
• long periods of time spent in uncomfortable positions
• vitamin and mineral deficits
• any harm to the musculoskeletal system or intervertebral discs any substantial absence of exercise or movement
• generalised exhaustion
• sleep deprivation
• hormonal shifts (menopause)
• Muscles are rapidly cooled (such as when sleeping in front of an air conditioner)
• various pain or inflammation conditions emotional issues (depression, anxiety)
• obesity 
• smoking

Diagnosis

A physical exam will be performed by your doctor to look for myofascial trigger points. Your doctor will touch delicate nodules in the taut bands of your muscles to see if they cause discomfort. When your doctor presses a trigger point, he or she will look for a muscle twitch (also known as a "jump sign").

Other tests are unable to detect the existence of MPS. Your doctor will rely on you to describe the location and nature of your discomfort. It's critical that you inform your doctor about all of your present symptoms, as well as any previous injuries or procedures.

Your doctor may discover various distinct forms of myofascial trigger points, including:

Active trigger points, which are nodules within a taut band.

Latent trigger points: they do not elicit pain when touched. They can stay latent for years before becoming active in response to stress or trauma.

Secondary trigger points: This is a painful spot in the muscle that activates when another muscle is strained.

A satellite myofascial point is a painful place that becomes activated due to its proximity to another trigger point.

Treatment

Physiotherapy

Myofascial release therapy

Myofascial release therapy is a type of physical therapy that is frequently used to treat myofascial pain syndrome. Myofascial pain syndrome is a chronic pain illness caused by myofascial tissue sensitivity and tension. These tissues envelop and support your muscles all around your body. The discomfort is frequently caused by "trigger points," which are specific places within your myofascial tissues.

Your therapist will work on the myofascia and feel for places that are stiff or tight. Myofascia should be supple and stretchy in nature. With light hand pressure, the therapist will begin working on and stretching the regions that feel stiff. The therapist then assists in the release of pressure and tightness in the tissue and supporting sheath. The treatment is continued on the same trigger point as well as other trigger points until the therapist feels the tension has been released completely. In addition to myofascial release therapy, Cryotherapy or icing over the muscles and fascia helps relax the areas that have undergone dysfunction due to pain.

Ultrasound therapy

Ultrasound machines transmit sound waves into tissue through an aqua sonic gel applied to the skin. The sound waves can heat up and relax muscles through a micro massage improving blood flow, and remove scar tissue. The pain-relieving effects may be minimal. But, this treatment may reduce stiffness and increase mobility if done before stretching.

Exercise therapy

After the muscles and adjoining fasciae are released, it is imperative to perform certain structured exercises to help relieve pain, improve functional health and activities of daily living. 

Other treatments

Analgesics and muscle relaxants can have a short term impact on pain. In several cases when pain is severe resulting in reduced mobility, dry needling injections can help reduce symptoms of myofascial pain syndrome.

Lifestyle modifications

• Choose a better chair at work and improve your posture.
• Try adjusting the height of your computer so that it falls in your natural eye line.
• Try a new mattress, or adjust your sleeping position.
• Start an exercise program as advised by your Physiotherapist and get your muscles moving every day.

References

• Desai MJ, et al. (2013). Myofascial pain syndrome: A treatment review. doi.org/10.1007/s40122-013-0006-y

• Pastore EA, et al. (2014). Recognising myofascial pelvic pain in the female patient with chronic pelvic pain. DOI: dx.doi.org/10.1111/j.1552-6909.2012.01404.x

• Shah JP, et al. (2015). Myofascial trigger points then and now: A historical and scientific perspective .doi.org/10.1016/j.pmrj.2015.01.024

• Jafri MS. (2014). Mechanisms of myofascial pain. dx.doi.org/10.1155/2014/523924