What is myofascial pain syndrome?
Myofascial pain syndrome is simply a medical term for muscle pain. The muscles in our body have a lot of different roles they help your heart beat they help you lift, walk and even help you blink. The muscles most commonly involved in myofascial pain syndrome are the skeletal muscles that connect to the bones in your body. These skeletal muscles are classed a voluntary muscles which means they only move when your brain instructs them to. Skeletal muscles come in different shapes and sizes according to their job and some of the largest and strongest muscles are in the back close to the spine making this area a lot more prone to developing myofascial pain. Most muscles attach to one bone then stretch over a joint to attach to a different bone. This arrangement means that when the muscle contracts and shortens, the joint bends with it and when the muscle relaxes the joint also returns to its normal relaxed state, giving your body strength and the power to move and lift.
Each muscle is made up of thousands of small fibres that have a powerful elastic property. This allows the muscle to stretch and be flexible yet strong. The muscle fibres are in what we class the muscle belly and they all converge to one point and are connected to the bone at this point by a very strong tendon which looks similar to a cord or piece of string. Myofascial pain is normally pain from the disruption of the small muscle fibres either through mild injury like repetitive movements, tightness or inflammation. More severe injuries to the muscles are classed as muscle strains, and any injury to the muscles tendons are covered under the condition tendonitis.
What are muscle knots and trigger points?
Tight muscles that are stretched create pain and count for some myofascial pain cases. However in a lot of cases, the muscular pain comes from what are commonly referred to as knots in the muscle. This is when contracted and tight muscle builds up in a small focal area to the point where it almost feels like a little lump or nodule. Medical professionals and therapists refer to these knots as trigger points. Trigger points can occur in any muscle in the body and can be isolated in one single muscle or multiple. It is believed that painful trigger points form in the muscle at the point where it has been injured or overworked. The pain can stay localised to this trigger point and muscle however in a lot of cases the pain experienced isn’t actually at the site of the trigger point but referred to a completely different area. The referral zones for trigger points are shown below.
Why & when does myofascial pain syndrome happen?
Myofascial pain can result from a variety of sources including sprain or strains of a joint, excessive repetitive movements and high stress levels. There are many risk factors such as poor posture, fatigue, heavy lifting and even muscle weakness that may make you more susceptible to myofascial pain. Specific causes like stress normally cause quite a lot of tension in the upper shoulders and neck (the upper trapezius muscle to be exact) which can then lead to quite bad headaches. Injury to the spinal discs causes very specific muscle spasms in the neighboring muscles either side of the spine. In most cases an injured joint has induced a muscular reaction; your body not only uses your muscles to give your body power and strength but also to give it stability. In reaction to pain levels coming from your injured joint, your brain orders the muscles that surround the joint to contract and spasm preventing the injured joint from moving. Essentially this is to rest the joint and allow it to heal. Once the pain levels subside the muscles are allowed to relax, however this doesn’t always end up as a straight forward process and quite often when a joint has been badly injured the muscles don’t relax and stay in their tight contracted position.
What does myofascial pain syndrome feel like?
Myofascial pain symptoms vary depending on the nature of the injury sustained. If there is a severe and abrupt injury that involves the muscles then the pain is sharp and possibly burning from quite intense muscular spams leading to limited movement of the affected area. In some cases the sharp pain continues and in others it is replaced by an intense dull ache a day or two after the injury. If on the other hand it is a slow and gradual injury either from repetitive lifting or poor posture whilst sitting at a desk every day then the pain levels will build slowly from a general discomfort particularly in the evenings after work to a constant dull ache that varies in intensity and that eases with stretching and movement. In some instances a burning sensation is experienced within the muscle and very occasionally symptoms like pins and needles have been reported. The pain is normally very intense over the actual injured muscle or trigger point however its referral pain into the surrounding muscles can be more of a general ache. Pain levels are aggravated by sudden or repetitive movements that stretch the affected muscle and also in contrast by sitting or standing in one position for too long.
How will myofascial pain syndrome be diagnosed?
Your GP or therapist will be able to diagnose you by both listening to your history and examining you by palpating your muscles and checking your range of motion. No X-rays or any further investigations are needed to confirm the diagnosis.
What treatment options are available for myofascial pain syndrome?
Your GP may prescribe a short course of anti-inflammatory painkillers to reduce and control any painful inflammation that occurs or muscle relaxants to reduce spasms. Many people find massage therapy including trigger point therapy, acupuncture and bowen therapy all very effective in reducing pain levels quickly as they relax out any tight muscles and also help eradicate any active trigger points. Massage, combined with heat or ice therapy can give fantastic results. Ice packs are helpful after sudden muscular injuries whereas heat is great for more gradual dull ache pains from tight muscles, although many people use a combination of both. When applying a covered ice pack to the area please make sure the ice pack is covered to prevent any ice burn and for best results use the icepack use regularly for 10-15 minutes with intervals of 30 minutes. When applying heat make sure you leave it on for 20-30 minutes and if you are using a hot water bottle then please make sure that it is covered to ensure you do not burn your skin. If the underlying cause of the muscle tightness is an injured or stiff joint then any manipulative therapy like osteopathy and chiropractic combined with massage is extremely helpful.
Avoiding all aggravating movements and postures is advisable, however complete rest is not. Try to move gently and often this will prevent stiffness levels from building in your muscles. When you have to sit for a long time don’t try to over force a good or correct posture. Instead go with what is comfortable for you even if that is slouching a little. The key element is not to stay in that posture for too long. The golden rule basically is be a fidget!
Once you have recovered, it is important to prevent any myofascial pain from developing again. If the tension has built up from poor posture or weakness then it is extremely important that you look at your office chair and desk layout, as well as trying to strengthen your postural muscles. Rehabilitation training, Pilates or Yoga are very good at strengthening your core and improving your posture and treatments such as the Alexandra technique are very good at educating your posture. If your muscular tension comes from high stress levels and you can’t eradicate the cause of the stress then you may find it is helpful to receive regular massage treatments to control the myofascial pain levels.
Trigger point referral pain patterns for the shoulder and upper arm
