Myofascial pain syndrome is most commonly seen in people having pain in neck upper back, lower back , gluteal, hams and quads muscle . myofascial pain symdrome is more in people who are inactive, having sedentary lifestyle. They have presented with tender points over the muscle area. They ace like dull, nagging and burning kind of pain. Myofacial pain is seen mainly on muscles. It is also present on fascia, cutaneous tissue, periosteal, non muscular fascial tissues.
Let us know about the muscle, its properties and its functions as we are deal with myofascial pain. Muscle constitutes about 40 to 50 percent of the total body weight. Its main function is to support the body parts. Muscles also cover the bony structures which give shape to our body. Second important function of muscle is its movement along with the bones to carry our varies activities of daily living. The human beings are there to be active and move from one place to another. If they are not moving means they are said to be dead in a way. Third function of the muscle is to maintain upright posture which is responsible for alignment of body and suitable for walking.
The characteristic features of muscle is
- Excitability, contractability extensibility and elasticity. Skeletal muscle is mostly affected in myofascial pain. There are two types of skeletal muscles one is phasic and tonic muscles. Phasic muscles comprises of mainly movement of body parts for example trapezius, triceps brachi, quadriceps, biceps femurous, gluteus medius, gluteus maximus. Tonic muscles are basically antigravity muscles or postural muscles which supports and hold the body in one position as if in standing, sitting and lying. Example for tonic muscles are scalenes, sternocleidomastoid, levator scapulae, piriformis, gracilis, tensor fascia latae.
Before we understand the injured muscle, lets know about the healthy muscle how it looks on palpation. When touched its shortened and once released it comes back to its original position as its elasticity is maintained, it is well supplied by blood and lymphatic drainage. The injured muscle will be in shortened state. Its elasticity is reduced. It fails to return to normal state thereby its blood supply is diminished, lymph drainage and range of motion are affected.
The major factor which is causing pain and dysfuntion of a muscle is the development of trigger point within it. It is otherwise called as taut band inside the muscle bundle. The trigger point is defined as a hyperirritable locus within a taut band of skeletal muscle, located in the muscular tissue and/or its associated fascia. It is the degree of hyperirritability of the taut band that defines the degree of pain. Trigger point is seen in increased mechanical strain or impaired circulation and postural imbalance or stresses.
In general there are four types of trigger points seen:
- An active trigger point which typically lies within a muscle and when movement of the muscle causes pain.
- A latent trigger point has the power to be active, but it remains to be dormant. On palpation pressure on that causes pain
- A secondary trigger point is situated in a muscle other than the one that holds the active trigger point. This can cause irritation as same as that time as the active trigger point.
- A satellite trigger point is one that becomes inactive because it overlaps with the region of another trigger point.
Causes of myofascial pain
When there is muscular strain in the neck, upper back or lower back the muscles goes into shortness. Later its elasticity reduces. After crtain period of time muscle looses its mobility and blood circulation. Hence it starts aching at certain points causing taut bands in the muscle.
Because of injury the muscle gets shortened and presence of pain there is loss of movement in the muscle thereby diminished circulation causing accumulation of lactic acid in that area causing trigger point.
Poor posture and reduced physical activity that causes trigger point in the individualsNo single factor can be held responsible for the production of TPs. The possible causes are mentioned below.
- Injury to the musculoskeletal system, connective tissue and intervertebral disc
- Over or under exercising the body and not maintaining proper positioning while wxercising
- Heart related conditons like myocardial ischemia
- Inflammation of the internal organs like cholecystitis, gastritis
- Getting tired easily, having trouble in sleeping and feeling stressful
- Overweight and obesity
- Being in cold atmosphere for long duration like air conditioners
- Poor eating habits, not good intake of nutrients
- Post-menopausal hormonal changes
What are the symptoms of myofascial pain syndrome?
Signs and symptoms of myofascial pain syndrome consists of :
- A painful knot in the muscle on palpation
- Pain that lasts for longer duration or gets worst
- Presence of dull, nagging, pricking pain in the muscle
- Feels better after walking or exercise
- Taking a hot water bath feels better for sometime
- Pain is deep inside the muscle rather than in joint
- Involved limb may feel stiff, heavy and weak
- Pain is localized at specific points
- Sudden increase in pain during excessive exercise or more of activity
- Feels good after a massage
What is the difference between myofascial pain syndrome and fibromyalgia?
Fibromyalgia is a condition which is chronic and charecterised by widespread pain, tender on palpation, absence of taut bands. Few are the symptoms which are common to myofascial pain and fibromyalgia. They are easy fatigability, inadequate sleep, development of muscle weakness, tingling and feeling of numbness in the affected area, presence of headache or maigrane, irritable bowel syndrome.
The differences in both of them are
Myofascial pain fibromyalgia
Localized pain Widespread pain
Presence of taut bands Absence of taut bands
Referred pain Generalized pain
Trigger point tender point
How to diagnose a myofascial pain?
Myofascial pain diagnosis is through palpation and examination of the patient by performing different movements to check for pain and weakness or stiffness.
Patient is made to rest either in sitting or lying comfortably on chair or bed.
Ask the patient where the pain area is then gently press the skin to check the trigger point. By palpation patient will know how experienced is the examiner. The examiner finds knots or nodules on the pain spot in myofascial syndrome. Patient is told to move the muscle in certain direction to check the range of motion and strength of the muscle. Most of the time pain is referred to other areas of the body
Does dry needling work for myofascial pain?
Dry needling is a mode of treatment used to relieve muscular pain. In dry needling, a therapist inserts needles into your skin. These needles are fine, short, stainless steel needles that don’t inject fluid into the body. That’s the reason it is called as “dry”. Dry needling is done to stimulate intramuscular region. Therapists inserts the needle on the trigger points of the muscle. These points are areas of knots.
Dry needling helps to release the knot and relieve muscle pain or spasms. The needles will remain in the skin for sometime. This time is determined by the therapist. The therapist moves the needle in and out like a piston on the skin to irritate the structure and cause stimulation of the surrounding tissues. Later the needle is removed by the therapist under asceptic precautions. Dry needling is most oftenly performed by physical therapist and sports injury therapist.
Uses of dry needling are
- Reduce pain
- Improve flexibility
- Reduce stiffness
- Increase blood circulation
Some of the risk factors of dry needling are bruising, needling soreness, bleeding.
How to loosen Your Fascia?
. Fascia is a thin connective tissue that covers the internal organs, blood vessels, bones, muscles and nerves in place. As we move it is going to stretch and gets elongated. Because of inactivity and pain in the muscle fascia gets thickened leading to reduced range of motion.
Stretching: Best thing to perform early the morning before getting up to relieve the tension inside the muscles. Stretching has to be done from head to toe. Starting from neck movements up , down, rotating left, right, neck bending left side, right side. Rotating upper trunk left to right, side bending right to left. Bilateral Shoulder rotation, flexion, extension, abduction, adduction. Move elbow flexion, extension. Wrist rotation, fingers flexion and extension.
Trunk forward and backward bending, trunk rotation, trunk extension either in standing or lying down.
Lower limb : supine lying, Straight leg raising to stretch hamstrings. Hip abduction and adduction, also internal/ external rotation. Knee flexion and extension. Ankle plantar and dorsi flexion, inversion and eversion also clockwise and anticlockwise rotation. Toes flexion and extension.
Hydration : Being hydrated is important as our body is filled with 70 % of water. Every other organ or tissue in our body is made up of water. It functions better when hydrated, orelse it dries up thereby causing thickening or hardening of the structure. Hence movement becomes difficult.
Stretch your postural muscles like scalenes, , lavetor scapulae, pectoralis major, sternocleidomastoid, biceps brachi, the cervical and lumbar portion of erector spinae, quadratus lumborum, ilio psoas, hamstring group ( biceps femoris, semitendinosis, semimembrenosis), rectus femoris, tensor fasacia latae, the adductor group ( adductor magnus, longus and bravis) pectineus, gracialis, piriformis, gastrocnemius and soleus. Move these muscles as much as possible to retain flexibility and complete range of motion. Gently stretch your muscles for holding upto 30 secs to 3 mins to release tension in the muscles.
FOAM ROLLER: Use of foam roller on your fascia is a best possible thing to look for when someone is looking for self treatment. It works wonders on sore and tight muscles. It relaxes the muscles and stretches to a certain extent. When you find a hard or knotted surface while rolling on the skin, hold there for a period of 3 to 5 mins with a gentle pressure. So that gradually after several moves the knots or hardened surface disappears slowly.
How do you self stretch a muscle with myofascial pain?
Now let us know how to stretch few of the important muscles that are often affected by myofascial pain.
- Stand against a wall, feet shoulder width apart and spine straight.
- Take a tennis ball and place it over the tender point on the trapezius muscle. This muscle is placed just between your upper shoulder and neck.
- Press the ball against the wall with your body gently on a tender point.
- Hold the pressure for 30 secs to 3 mins, until you tolerate.
1.Sit/ stand against a wall with a ball placed on your upper back above your shoulder blade on your levator scapulae muscle.
2. Apply gentle pressure on the ball
3. move the ball over the tender spot in and around it. When you find a tender point hold the ball on that spot apply as much pressure as possible for 30 seconds to 3 mins of duration,
- Stand against the wall, place the tenis ball over the most pain area on your back.
- Roll the ball over the skin to get a gentle pressure on your painful back.
- When you find a tender spot on the skin while rolling, hold there for 30 seconds to 3 mins. Focus on the tender point not on the spine.
This is for people who sit long hours before a computer and work without a break. Piriformis muscle runs from outside of the hip to your sacrum bone which gets tight when there is minimal or no movement of your body.
- Take a seat on a chair with a firm surface. Keep your feet flat on the floor and spine straight.
- Place the ball bellow the piriformis muscle which is between the outside hip and tailbone
- Rest against the ball and hold pressure on the muscle for 30 seconds to 3 mins.
How does instrument assisted soft tissue mobilization helps in myofascial pain syndrome?
For soft tissue mobilization there is a skilled technique called instrument assisted soft tissue mobilization. It works on the principles of James cyriax cross friction massage. The instruments used in this are made up of stainless steal, it has beveled edges and contours that can conform to different body location and allows deeper penetration. Instrument assisted soft tissue mobilization is used for the detection and treatment of soft tissue disorders. . IASTM is “a skilled intervention that includes the use of specialized tools to manipulate the skin, myofascia, muscles, and tendons by various direct compressive stroke techniques
Benefits of IASTM are:
Increase range of motion
When IASTM is applied using these 6 steps
- Examination of the body part to be treated
- warm-up the body for 10-15 mins by light jogging, elliptical machine, stationary bike or an upper body ergometer
- IASTM, done at 30-60 degrees angle for 40-120 seconds
- Stretching is done for 3 repetitions for 30 seconds
- Strengthening is done, with high repetitions with low load exercise
- Cryotherapy, 10-20 min
After treatment it is necessary to clean the instrument with disinfectant to avoid transfer of infection.
Best treatment for myofascial pain syndrome?
Myofascial pain syndrome is usually due to lack of movement, improper posture and weakness of the muscles. To correct this it is important to follow certain guidelines which are mentioned below:
i) Selecting the right correct chair, mattress, and posture to sit or sleep. Frequent change of position is advised as it may cause stress inside the muscle.
ii) Back support are given to stabilize the vertebral column and maintain normal posture.
iii) stretching can be used in between to reduce the stiffness and increase flexibility of the muscles.
iv) Massage: massage can be of help for myofascial pain. As it causes relaxation of the muscles, increases blood circulation to the area, removing lactic acid that is accumulated in the soft tissue.
v) Walking for longer distance causes release of feel good hormones like endorphins and encephalin which makes the pain sensation less. Walking controls the body weight
vi) Regular meditation and relaxation techniques help in reducing emotional stress and helps in being positive even in difficult situations.
vii) Yoga: Regular yogic breathing practices, muscle stretching and progressive deep relaxation by “lying down” are said to have positive effect on fibromyalgia.
viii) Application of acupressure in trigger points over period of 30 secs to one minute will have better results. As there is sudden cessation of blood to that part and when released it passes good rush of blood to the trigger point
ix) Hot and cold packs: Cold packs are given in the initial stages of pain to reduce the inflammation. Ice pack is covered with a thin cloth and then applied to the painful part for a period of 10 to 15 mins.
Hot packs are given at a later stage of pain to increase flexibility, reduce pain and stiffness. Hot pack is given by covering a wet cloth on the hot pack and placed it on the affected part to reduce stiffness and increase blood circulation.
x) Electrical stimulation: Transcutaneous electrical nerve stimulation is used on the trigger point to relieve stress and stimulate the muscle knot and break the stiffness caused due to knots formation in the muscle.
xi) Ultrasound therapy: This is given on the trigger point to reduce stiffness, increase flexibility and improve circulation in that part. Sound waves are passed through the transducer of the ultrasound machine to the deep underlying tissues that is treated. These sound waves generates heat inside the tissue thereby increases blood circulation and reduces pain.
These topics are interlinked with my other blogs which are written earlier will be mentioned here you also read them