Myofascial Pain

What is Myofascial Pain Syndrome?

Myofascial pain syndrome is a pain disorder that puts pressure on trigger points in your muscles. This causes pain and tenderness in the muscle and surrounding areas. This generally happens when a muscle group has been activated and contracted repeatedly in motions used for work or exercise. This also may result in continuous pain brought about by muscle tension, altered muscle posture, and behavior that would reinforce pain. Chronic myofascial pain may greatly manifest if the affected individual fails to seek proper myofascial pain treatment.

Sometimes, a person may feel pain but not where the source of myofascial pain generator is. This is usually prompted when a muscle injury or strain impacts or creates a trigger point. When this happens, the pain is called referred pain.

Myofascial Pain Syndrome Treatment

Seeking immediate treatment at the first signs of myofascial pain is extremely important in order for the doctor to assess and find the right treatments. Although there is no evidence that would favor the use of one treatment option over the other, it is still important to discuss with the doctor the preferred treatments to alleviate myofascial pain. Basically, treatment plans are often multifaceted and comprehensive, which would mean the use of more than one type of treatment. Apart from educating the patient as to what to expect in the approach to treatment, taking medication, receiving injections on potential trigger points, and/or getting pain relief through physical therapy are some of the other sound options. Generally, the treatment can be dependent on the patient’s level of health or severity of the injury, as well as the existence of other factors like poor posture, workplace ergonomics, and mechanical problems.

 

Myofascial Pain Medication

Pain relief is an important part of any myofascial pain treatment strategy. This would greatly help a patient with myofascial pain cope with the ongoing pain of the condition. Medication for myofascial pain can be administered either temporarily or on a long term, depending on the doctor’s assessments. Oftentimes, they are administered in trials to help determine the best medicine for the patient.  

• Pain relievers – These include over-the-counter drugs such as ibuprofen and naproxen, as well as stronger pain relievers that would help alleviate pain. Some pain relievers are taken orally, while some are available in patches that are placed on the affected area.
• Antidepressants – These pain relievers don’t only ease muscle pain, but also help the patient sleep soundly. These include Amitriptyline, Nortriptyline and Cymbalta.
• Muscle relaxant – Medications of this kind help in relaxing the muscles affected by localized and referred pain. These include cyclobenzaprine and tizanidine, all of which help aid sleep.
• Sedatives – Klonopin treats for poor sleep and anxiety that come with myofascial pain syndrome. These medications should be used sparingly as side effects are drowsiness and they are habit forming.

Myofascial Pain Physical Therapy

A therapy plan is devised depending on the patient’s signs and symptoms related to myofascial pain syndrome.

• Stretching: Doing stretching exercises would help ease the pain on the affected area. If the patient experiences pain from the trigger point while doing stretches, a numbing solution is sprayed on the skin. This method is called “spray and stretch” and is an effective way to increase mobility while stretching.
• Massage: Physical manipulation by the trained physical therapist can help alleviate the pain associated with the disorder. Massage movements can be done in long strokes over the area where the trigger point is, applying enough pressure to relax the tensioned muscles.
• Heat: Applying a hot pack over the affected area, or taking a hot shower, can help relieve muscle tension, as well as reduce pain.
• Ultrasound: The use of this method helps in increasing the blood circulation and warmth, which then heals the muscles affected with myofascial pain.
• Posture training: This strengthens your posture which relieves pressure on certain muscle groups. Exercises that strengthen core muscles will help reduce overworking any specific muscle.
• Transcutaneous Electrical Nerve Stimulation (TENS) Therapy: This uses pads that are attached to your skin to deliver low voltage currents into affected muscle groups.

The likelihood of the individual with myofascial pain improving from the disorder may vary based on his or her overall physical fitness and health, compliance with self-care and at-home treatment, any abnormalities in the skeletal system, coping mechanism against anxiety or stress, diet, sleep, and other medical conditions. Meanwhile, anyone from Los Angeles or Santa Monica who is dealing with myofascial pain should consult with an expert medical professional from a Los Angeles pain clinic.

Dry / Wet Needling Trigger Point Injections

Myofascial pain can also be treated with the use of needles. Wet needling is when a numbing agent such as lidocaine is injected on a trigger point. Doing so can help alleviate pain. Other trigger point injections involve inserting a needle into several places on and around the trigger point, which is also known as dry needling. Acupuncture is also an alternative way to treat myofascial pain. This method stimulates circulation and is said to activate a healing response. 

Lifestyle and Home Remedies for Myofascial Pain

Myofascial pain syndrome can be mitigated through health lifestyle choices and self-care.

• Exercise: Mild to moderate exercise can help build stronger muscles that are conditioned to deal with more activity and resistance.
• Relax: Tension and stress go hand in hand which is why relaxation is key to minimizing myofascial pain syndrome trigger points.
• Eat healthy: Eating healthy will help optimize sleep and ensure that your body functions optimally. Poor nutrition and unhealthy food choices will increase the odds of poor recovery.

Coping and Support for Myofascial Pain

Dealing with any chronic pain syndrome can feel hopeless and frustrating. This is especially true when treatments are only partially working. Having a network of people to talk to is important and finding resources like counselors and support groups is a great way to learn more about the challenges ahead of you. Please also lean on the support of your doctor to help guide you through how to best deal with a chronic ailment like myofascial pain syndrome.

What Happens When Myofascial Pain Starts?

When you hear of “knots” in muscles, these are generally what are known as trigger points. These small nodules are a point in the muscle fibers that are unable to become uncontracted. When this happens, blow flow is restricted which deprives the rest of the muscle fibers from receiving the oxygen they need to support healthy function. Without the flow of blood to clear waste, a buildup of lactic acid in the muscle fibers aggravates the trigger point which is when an individual perceives pain or soreness. This in turn reduces that individual’s reliance on that muscle group which causes strain on other muscle groups that have to overcompensate for the lack of support. 

Myofascial Pain Causes

Myofascial Pain Disorder is the most prevalent muscle pain disorder and yet this is not completely understood. Myofascial pain typically arises from muscle trigger points that are much localized areas in the muscle tissues or tendons. The muscle around these hypersensitive areas is usually hard and can appear as a nodule or as a taut band. The cause and etiology of myofascial pain is complex, and it is considered to be multi-factorial. Often when the muscle pain becomes chronic, the central nervous system (CNS) can become the origin of the pain. For treatment to be effective, it is crucial that the clinician recognizes that in the case of the myofascial pain, the pain in the muscle is influenced by the CNS.

The trigger points are unique in a sense that they are a source of constant pain and in general result in a predictable pain referral pattern according to their location. For example, a headache felt in the temples may be caused by myofascial trigger point pain in the neck area that refers pain to the temples. Or pain that is felt in the temporomandibular joint can be in reality coming from the facial muscles. Therefore, the clinician should always search for the source of the pain and not the site.

What Can Cause Myofascial Pain?

There are certain local and systemic factors that can cause myofascial pain. These include the following but not limited to:

• Muscle injury
• Low levels of vitamins C, B1, B6, B12, and D
• Iron deficiency and anemia
• Emotional stress
• Chronic infection – viral, bacterial or parasitic
• Prolonged immobility
• Poor posture
• Repetitive overuse injury
• Increased use of a muscle or strain on the muscle
• Direct trauma – motor vehicle accidents, slip / trip and falls, contact sport injuries
• Indirect trauma – clenching and grinding teeth
• Impaired sleep
• Fatigue
• Nerve impingement
• Pinched nerve
• Metabolic / hormonal problems

 

When Does a Trigger Point Become Active?

A trigger point can be either active or latent. Trigger points do not resole without the proper treatment. They can become latent or dormant giving a temporary relief of the referred pain meaning that they are not sensitive to palpation. However, the trigger points can become active by various factors such as injury, abuse of muscles, emotional stress, or even poor sleep.

Myofascial Pain Risk Factors

Myofascial pain is generally the result of muscle tightness that impacts trigger points in different muscle groups. There are several groups at risk that have much stronger chances of aggravating trigger points.

• Injured: Injuries are also some of the common causes of MPS. Studies indicate that accidents that cause muscle injury can lead to muscle tension that aggravate trigger points. An injury could also leave a part of your body inactive. Inactivity of a particular muscle groups could also create trigger points that can be aggravated at a later time. 
• Stressed: The negative effects of stress to the body are very serious. Stress and anxiety are more likely to develop trigger points in their muscles. Being stressed could make you end up clenching your muscles, causing increased muscle tension, making it very susceptible to become trigger points.
• Middle Aged: Middle-aged people are some of the most vulnerable to MPS. Older people have muscles that have been weakened by wear and tear, making them prone to MPS. Middle-aged people should consider staying active but avoiding activities that could be too strenuous for them.
• Women: Studies have revealed that women are vulnerable to get MPS because it can be an underlying component of Chronic Pelvic Pain (CPP). This is often overlooked and untreated and can be caused by several reasons related to female body functions that men are not impacted by.
• Inactive: Very little use of some muscle groups can also get trigger points as well. Inactivity can leave a muscle weak; this in turn raises the chance of it becoming an MPS trigger point. 

Myofascial Pain Symptoms

Other than referred pain, muscle pain that is characterized with chronic myofascial pain involves dull aching of a muscle, as well as the associated muscle group.

 The features of a single trigger point include the following:

• Tenderness of the focal point
• Occurrence of pain on the trigger point upon palpation
• Muscle hardening upon palpation
• Pseudo-weakness of the muscle
• Limited range of motion on the muscle or muscle group that comes after more than 5 seconds of continual pressure over the trigger point

 Symptoms of this disorder include the following:

• Muscle pain that is characterized as aching and deep
• Persistent pain that may worsen
• Tender knot in the muscle or muscle group
• Inability to sleep comfortably because of pain
• Headaches caused by muscle strains prompted by poor posture
• Fatigue and poor sleep due to pain at night
• Stress, anxiety, & depression

Where Does Myofascial Pain Syndrome Occur Most Frequently?

Myofascial pain can emerge in any muscle group in the body. That said, the most frequently affected muscles are the muscle groups that bear the most consistent strain from pulling and rotating actions:

• Trapezius: This back muscle is the broad flat triangle muscle group that controls the turn and tilt of your head, rotates the arms, and shrugs and stabilizes the shoulders. This runs from the base of your spine down the middle of your back.
• Infraspinatus: This group helps rotate and control your shoulder joints and makes up part of the rotator cuff.
• Rhomboids: These upper back muscles connect your arms to the shoulder blade and shrug when they contract. These run from the neck and vertebrae to the back of the shoulder blades.
• Levator Scapulae: This muscle helps rotates your shoulder blades and connect your cervical vertebra and your shoulder
• Sternocleidomastoid: This neck muscle helps turn your head from side to side and runs from behind your ear to your collarbone.

Myofascial Pain Complications

Myofascial pain can cause discomfort that can indirectly impact quality of life in other ways:

• Sleep problems: Myofascial pain can cause pain strong enough to prevent or disrupt sleep. Finding a comfortable position can be extremely difficult when trigger points are activated and causing pain. Movement while sleeping can also aggravate pain receptors which can cause an individual to awaken.
• Fibromyalgia: Myofascial pain syndrome and fibromyalgia share similar symptoms and are often difficult to differentiate without a deeper understanding of the signs and indicators. Fibromyalgia is another chronic pain disorder that causes tenderness and soreness but does not involve trigger points. Some research suggests the possibility that myofascial pain syndrome may develop into fibromyalgia in some people. Both pain syndromes can impact an individual which is why seeing a professional myofascial pain treatment specialist is important. Diagnosing the right problem is critical to determining the most effective treatment plan.

Myofascial Pain Syndrome Diagnosis

Myofascial pain is often overlooked, misdiagnosed, or undiagnosed. This is because there are no tests that can diagnose myofascial pain syndrome and there are no visible signs. Diagnosis requires an in depth understanding of the muscular system and a physical exam to feel for trigger points and tenderness.

The presenting pain complaint in myofascial pain is almost always a referred symptom with a deep, dull aching quality. The referred pain sites in the head and neck include the teeth, sinuses, cheeks, forehead, temple, ear and TMJ. Overlapping pain referral patterns from several different trigger points can mimic certain headache disorders. Familiarity with the typical pain referral patterns enables the clinician to identify possible trigger points. Trigger point palpation is a skill that must be learned and practiced. Diagnosing Myofascial Pain depends on accurate palpation with 2-4 kg/cm2 of pressure for 6-10 seconds over the suspected trigger point to allow the referred pain pattern to develop. The diagnosis is then confirmed by an immediate pain reduction of greater than 50% after each trigger point is injected by local anesthetic.

Myofascial Pain Trigger points

For developers: Replicate graphic if applicable *see example below*

Trigger points are classified as being “active” or “latent”, depending on their clinical characteristics. It is considered an active trigger point when it causes pain at rest. It is tender to palpation with a referred pain pattern similar to the patient’s pain complaint. This referred pain is felt not at the site of the trigger point origin, but remote from it. The pain is often described as spreading or radiating. A latent trigger point does not cause spontaneous pain, but it may restrict movement or cause muscle weakness. Trigger points will alternate between latent and active states depending on how much psychological stress an individual is under, and the amount of muscle overexertion being placed on an aggravated muscle.  There are also:

• Secondary trigger points: This is an area that becomes painful when you stress a completely different muscle.
• Satellite myofascial points: This is an area that becomes painful because it is located near a trigger point.

How Common is Myofascial Pain Syndrome?

Myofascial pain happens to roughly 85% of people in their lifetimes and both men and women tend to be equally impacted. Even as high as that number is, there is a large portion of people who have MPS that go undiagnosed or misdiagnosed due to similarities to other pain syndromes and muscle ailments.

Some Incorrect Attributes to Myofascial Pain

Sometimes, people think that the feeling of pain is caused by common health conditions. However, there are many times when myofascial pain is mistaken for headaches, arthritis, TMJD (temporomandibular joint disorders), or fibromyalgia.  

So how do these illnesses differ from each other and what causes them?  

Headaches. Usually there are many causes of headaches. Although there’s this feeling of pain, most of the causes of these are brought about by the release of some chemicals by the brain.

• Arthritis. Myofascial pain is caused by problems with one’s connecting tissues. On the other hand, problems with joints are caused by arthritis.
• Temporomandibular Disorder (TMJD). TMJD is not at all related to Chronic Myofascial Pain (CMP). This pain that is felt near the jaw is caused by a number of things. Too much pressure on the TMJ, dislocation of the soft cushion or the disc between the ball and the socket of the joint, the presence of osteoarthritis or rheumatoid arthritis in the TMJ, and stress can cause this disorder.
• Fibromyalgia, like CMP are flashes of pain with stiffness and localized tenderness in different parts of the body. However, this, like rheumatism, is another rheumatic condition that is caused by a muscular or musculoskeletal pain.

When to See a Doctor for Myofascial Pain

If you experience muscle pain that is debilitating, persistent beyond what would be “normal” recovery time, disruptive to day-to-day activity, or does not improve with self-care and home treatment, it may be time to see a myofascial pain doctor.

 

Preparing for Your Myofascial Pain Doctor’s Appointment

Since myofascial pain can by misdiagnosed, you may end up seeing several doctors before finding a specialist familiar with MPS. Before each appointment, it is important to:

• Follow any pre-appointment directions: When making an appointment for specialists, there are certain steps you must take before administering different types of tests. Be sure to get instructions, if any, and then follow them in preparation of your appointment.
• Document relevant ailment information: Keep track of symptoms, when they started, how long they have lasted, and things that have made those symptoms improve or decline.
• Keep a list of any relevant medical information: In addition to ailment information, any other existing medical conditions, medications, supplements, & therapies should be disclosed to the doctor.
• Bring questions to ask: Think about things that have prompted concern and be sure to have follow up questions.

What to Expect from Your Doctor?

During your exam, your doctor will need to ask a series of questions to determine the best potential treatment option. Be prepared with ready answers will likely streamline the exam and help you provide better answers.

• When did symptoms start?
• What symptoms are prompting the visit?
• Where is the pain / discomfort most severe?
• Are the symptoms persistent or come and go?
• What makes symptoms worse / better?
• Do symptoms feel worse at the start of the day or as the day passes?
• What activities have been done recently?
• Any injuries?

Questions to Ask Your Doctor About Myofascial Pain

The follow up portion of an exam will allow you to get information that can help relieve your stress. Be sure to ask about anything that you are uncertain about including:

• What are the possible causes of my symptoms?
• What kind of treatments are available?
• Is treatment necessary or are home remedies sufficient?
• How long is treatment expected to take before results are felt?

What’s the Outlook for Myofascial Pain?

Just like any persistent pain condition, MPS can prove to make day to day life difficult to deal with. It is critical to consult with a myofascial pain doctor to find an effective treatment strategy that works for you. There is no “one size fits all” solution to MPS so there may be several attempts necessary to fully address the problem. That being said, with successful treatment and a healthy lifestyle, most pain caused by myofascial pain should be managed effectively.

Can Myofascial Pain be Prevented?

There are certain factors that can exacerbate myofascial pain and adjusting habits and making lifestyle changes can drastically improve the severity of the condition.

• Follow a proper sleep cycle
• Practice self-care and stress reduction therapies
• Get comfortable levels of exercise
• Minimize straining / overexerting muscles
• Eat a healthy diet free of foods that cause inflammation

Contact a Myofascial Pain Syndrome Doctor Today

If you or a loved one is impacted by severe and persistent muscle pain, call the Headache TMJ Los Angeles Pain Clinic today to schedule an appointment. Dr Kathy Omrani is a myofascial pain specialist with over a decade of experience treating myofascial pain and other muscle pain related ailments.