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This blog post, What You
Should Know About Chronic Myofascial Pain,
originally appeared on ProHealth, January 7, 2019. Because the article
continues to garner attention, I am sharing it in its entirety here on The
Pained Ink Slayer with ProHealth’s permission.
If you have questions, be sure to
comment.
_______________________________________________________________
We have all
experienced a tight muscle that causes pain and restriction of motion, such as
sleeping on our neck wrong, but this is not myofascial pain syndrome (MPS). So,
what is?
Myofascial Pain Syndrome
The primary job of a skeletal muscle
is to provide locomotion by attaching to other muscles and to joints. When
knotted up pieces of muscle fiber called trigger point/s develop,
the muscle is shortened and becomes dysfunctional. Myofascial trigger points
(TrPs) prevent normal contraction and relaxation of the muscle involved. These
self-sustaining nodules in the hyper-irritable area of the muscle/s cause sensory,
motor, and autonomic symptoms.
myofascial = pertaining to the
covering (fascia) of muscle
When TrPs are not treated early and
appropriately, the tug and pull of the dysfunctional muscle fibers creates
stress and leads to development of TrPs in either the same muscle, compensatory
muscles on the same or opposite sides of the body, or in all four quadrants of
the body as our musculoskeletal system perpetually tries to adjust.
Diagnosing
Diagnosis can be complicated if the
examiner is not familiar with MPS. Myofascial disorders are generally poorly
understood in the medical community. Bourgaize S, et al. (April 2018) allege MPS is
confused with fibromyalgia, because both MPS and FM are prominent forms of
chronic musculoskeletal pain in their literature review. This delays proper
treatment.
A history of chronic myofascial pain
and muscle and/or joint dysfunction is what usually gets us to the doctor. As
previously noted, MPS pain and dysfunction usually occurs in more than one
quadrant of the body and includes:
- Pain that lasts three to six months.
- Trigger point/s that can usually be felt by the examiner.
- A taut muscle band. (You may or may not be able to feel the TrP in the band depending on the amount of muscle contraction. There may be one or more in the same muscle.)
- Referred pain. (A referral pattern for the TrP is consistent between patients. Pain can be well away from the primary trigger point.)
- Twitch response of the muscle by some mechanical method (i.e.: manual pressure or needle insertion).
- Decreased mobility related to the affected muscle.
- Weakness in the affected muscle.
Myofascial pain syndrome is known as
the great imitator for a reason. For instance, MPS involving the piriformis muscle (a
small deep muscle that cuddles the sciatic nerve) may be misdiagnosed as
sciatica.
Myofascial Pain Syndrome And Fibromyalgia
Many of the
conditions known to cluster with FM, like severe headache, restless leg
syndrome, teeth grinding, balance problems, TMJ, chronic pelvic pain, chest wall pain, and more have a myofascial component of their own. Pain specialist,
Dr. Karl Hurst-Wicker, MD, explains it like this.
“There
is a good deal of overlapping between MPS and fibromyalgia (FMS). Likely this
is related to the consistent long-term activation of peripheral pain pathways
causing central [nervous system] sensitization and other changes in the nervous
system that contribute to the development of FMS. Conversely, it can work in
the other direction too; a patient with a primary FMS can develop MPS, in no
small part because the FMS can amplify and perseverate even minor myofascial
pain and injury to the point where it can propagate and become a regional
issue.” (Health Central, Fibromyalgia Centralization and
Peripheral Myofascial Pain: Interview with Karl Hurst-Wicker, MD,
accessed December 31, 2018)
Unlike FM, MPS is not gender
prevalent. Many of the perpetuating factors are genetic, such as short upper
arms, short lower legs, one leg shorter than the other, curvature of the spine,
or other musculoskeletal deformities. Some metabolic dysfunctions are thought
to perpetuate myofascial pain syndrome, too. People with skeletal structural
defects, both inherited or the result of injury, surgery, post-polio syndrome,
or poor posture, and people who experience undue stress on a muscle, including
repetitive motion, can contribute to MPS.
What We Can Do
Treatments for myofascial pain
syndrome include manual treatment by a certified myofascial trigger point specialist,
a physical therapist or chiropractor that specializes in myofascial therapies,
guided self-treatment, electrical stimulation, ultrasound guided trigger
point injections by a pain specialist, and more. But, the best treatment is
prevention. We should be aware of perpetuating factors, so we can avoid them or
manage them.
Conclusion
Consistent diagnostic criteria that
can be used by all healthcare professionals are needed to ensure patients get
the right diagnosis and the right treatment in a timely manner. Both MPS and FM
cause pain, but that pain is NOT the same. Myofascial pain is a peripheral
nerve problem that can usually be isolated; FM is a central nervous system
problem that causes body-wide sensitivity.
Perpetuating factors of MPS can, and
do, vary among us. Some of us may have a disorder like joint hypermobility. We
may have both MPS and FM. Some of us work at computers, and yes, I must remain
astutely aware of my body positioning. Maybe you had a surgery that left you
with scarring of tissue that puts a strain on normal movement. There are a
myriad of things that can lead to development of chronic myofascial pain.
But, the important thing to remember is that trigger points are
treatable, and the longer we go without addressing the problem, the greater the
risk to developing trigger points that seemingly breed like rabbits and become
resistant to treatment.
Additional Reading:
- Fibromyalgia Tender Points or Myofascial Trigger Points: Knowing the Difference for the Right Diagnosis
- Restless Leg Syndrome: Sleep, Fibromyalgia, and Myofascial Pain Syndrome
- Fibromyalgia Centralization and Peripheral Myofascial Pain: Interview with Karl Hurst-Wicker, MD
In healing,
Celeste Cooper, RN / Author, Freelancer, Advocate
Think adversity?-See opportunity!
~ • ~ • ~ • ~ • ~ • ~
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