Myofascial Pain Syndrome or MPS, is a chronic condition that affects the musculoskeletal system. Commonly referred to as muscle pain, MPS affects the fascia. This is the connective tissue that covers the muscles. It often occurs when scar from microinjury develops in the fascia affecting the underlying muscle. These micro-injuries result in the formation of ropey bands of taut muscle tissue which are referred to as trigger points. When the muscle is activated, either during activity or through targeted muscle resulting in focal pain due to irritation of the small nerves in the muscle. The overlying fascia, also scarred, contain nerves that have their pain pathways altered by the altered biomechanics and anatomy due to the micro injuries which result in exacerbated pain sensations. In addition, the pain may be felt in another part of the body due to altered nerve pathways and/or strain on the other parts of the kinetic muscular chain from the altered biomechanics of the muscle. This is known as referred pain.
MPS is a common condition. It affects an estimated 85 percent of the general population. Almost everyone has experienced some sort of discomfort related to muscle tension. However, for some people, the symptoms related to this condition persist or become worse. There are a wide variety of treatment options available to those that require intervention.
Symptoms of Myofascial Pain Syndrome
The main symptoms associated with MPS include:
- Localized deep muscular pain
- Pain persists and even worsens over time
- Presence of trigger points or ‘muscle knots’ which result in intense localized or referred pain when pressure is applied to them.
People affected by myofascial pain syndrome may also suffer the following symptoms:
- Stiffness of muscles
- Difficulty sleeping
- Frequent headaches
- Problems with posture e.g. hunching, forward head posture or rounding of the shoulders
What Causes Myofascial Pain Syndrome?
MPS often develops as a result of injury to the muscles. It may also result when there is excessive strain on a particular muscle or group of muscles, tendons, or ligaments. The excessive strain may be a result of repetitive motions or even a lack of activity. Often times a combination of various factors results in the formation of trigger points. Some of these risk factors include:
- Injury to muscles
- Sitting in awkward positions for extended periods
- Poor posture
- Lack of sleep
- Nutritional deficiencies
- Hormonal changes such as during menopause
- Severe lack of activity
- Intense cooling of muscles e.g. when you sleep in front of an air conditioner
- Anxiety, stress, depression, and other emotional problems
- Conditions that cause inflammation
When to See a Doctor
Almost everyone experiences muscular pain now and then. However, not everyone that experienced muscular pain or has developed trigger points requires treatment for myofascial pain syndrome. You should make an appointment to see your doctor if the pain persists or worsens over time despite resting and taking self-care measures such as having a massage.
How is Myofascial Pain Syndrome Diagnosed?
Diagnosis of MPS involves searching for trigger points. Your doctor will perform a physical exam on you where they will apply gentle pressure to your muscles. Your doctor will do this to feel for muscle knots that result in localized or referred pain. They also do this to feel for muscle twitches.
There are various types of trigger points that doctors may find during the physical exam. These include:
- Active trigger points: These are bands of tight muscle that are very tender or cause referred pain. These often twitch when touched.
- Latent trigger points: These muscle knots do not cause pain when they are touched. They can in fact remain inactive for years. They, however, can become active when there is trauma, stress, or altered biomechanics due to micro injuries within the kinetic chain.
- Satellite myofascial points: These are painful sorts that become active as a result of being located near a trigger point.
- Secondary trigger points: These are painful spots that become active when another muscle is put under strain.
Myofascial Pain Syndrome Vs Fibromyalgia
MPS is often confused for Fibromyalgia. These, however, are two distinct conditions. Like MPS, Fibromyalgia is a chronic condition. However, that is where the similarities end. Unlike MPS which causes pain in particular parts of the body, fibromyalgia results in tenderness and pain throughout the body. A person with fibromyalgia may experience pain even in the absence of taut bands.
Some people have both fibromyalgia and MPS. Sometimes MPS is misdiagnosed as fibromyalgia as well. It is therefore important to consult with a doctor if your pain persists or worsens over time. Your doctor can diagnose your condition and ensure the right treatments are applied.
Common Treatments for Myofascial Pain Syndrome
There are a wide range of therapies available for treating or managing MPS. Many people use a combination of these therapies to relieve muscular pain and stiffness.
There are several medications that can be prescribed to ease the symptoms associated with MPS. These include:
Nonsteroidal anti-inflammatory drugs (NSAIDs) – These include over-the-counter medications such as ibuprofen and acetaminophen (Tylenol) which are used to relieve swelling and pain.
- Muscle relaxants –these include medications such as tizanidine and benzodiazepines which are used to relax the muscles and stop muscle spasms.
- Analgesics – These include pain relievers such as diclofenac or lidocaine patches and tramadol.
- Botox injections – These can help to prevent muscle contractions and may also help to relieve pain.
- Anticonvulsants – these include medications such as pregabalin and gabapentin which reduce muscle spasms and relieve pain.
- Tricyclic antidepressants – are prescribed to treat conditions of chronic pain. They are often used for managing fibromyalgia, nerve pain, and other conditions that resemble MPS.
- Massage therapy
This is one of the most common forms of therapy applied for the treatment of MPS. Massage therapy helps to relax trigger points. It warms up the muscles and increases the flow of blood to the site. This helps relax the muscles, reduce stiffness and ease the pain. Some common types of massage that would be beneficial for this condition include trigger point pressure release, shiatsu (acupressure) as well as passive and active rhythmic release.
This is one of the quickest ways to inactivate trigger points. A needle is inserted into the trigger point and moved around. The needle may be moved in and out. This is one of the most effective ways to inactivate a trigger point and relieve pain. It, however, can be a painful process..
This involves the application of very high-frequency sound waves to the muscles. The sound waves heat up the muscles and cause them to relax. The heat also improves circulation to the muscle which promotes healing of the muscle. This therapy can also aid in the breaking down of scar tissue. It helps to improve mobility and stiffness when done prior to stretching.
Trigger point injections and myofascial hydrodissection
This therapy is similar to dry needling. However, doctors use hypodermic needles to inject a solution into the tissues to release the bands and scars. In many instances, a saline solution or a local anesthetic such as lidocaine is injected into the muscle. There is also the option of injecting steroids. This procedure is preferred by many patients over dry needling as it causes less discomfort and also gives longer-lasting pain relief as well as softening muscle scars so that manual therapy can be more effective. Myofascial hydro dissection releases the scar adhering to the surface of the muscle that is activating the nerve endings in the fascia. This uses fluid to form a plane between the superficial scar and the muscle releasing any adhesions. Both trigger point and myofascial hydro dissection are best done under ultrasound guidance so the whole area of abnormality can be treated. This ensures all the restrictions, not just the active ones, are released. The inactive restrictions can be the underlying cause of the painful spots.
Spray and assisted stretching
This therapy involves stretching the limbs to reduce pain and increase mobility. Some therapists also use a numbing spray on the muscles before assisting their patients through gentle stretches.……
Complications of Myofascial Pain Syndrome
MPS can affect your quality of life. It may make it more difficult to participate in some of the activities you enjoyed previously. It can even lead you to depression. Seeking treatment will help you decrease your pain sensations and improve your enjoyment of life.
—–If this has become a chronic issue for you, treating just the physical symptoms may not give you the results you desire, finding a practitioner that treats the whole person, such as an integrative pain physician may give you the best end result.