The Ins And Outs Of Chronic Myofascial Pain

Understanding chronic myofascial pain relies on our understanding of the illusive myofascial trigger point (TrP).

WHAT IS A TRIGGER POINT?

Trigger points (TrPs) are those knotted up pieces of muscle fiber that feel like a frozen pea in a taut band of average sized muscle. Anyone can usually feel a TrP unless it/they: 

• are behind bone,
• are in muscles that are under other muscle,
• the muscle is too tight to locate the TrP.

If the band of muscle affected is too tight, it may be difficult to isolate the TrP causing pain. A specially trained physician or therapist may only be able to identify the TrP/s by the dysfunction and radiation of symptoms they create. A specific pattern is associated with the location of each specific TrP.

THE GREAT IMITATOR

Myofascial trigger points are the root cause of chronic myofascial pain, also called myofascial pain syndrome or MPS. The cranky knots can cause symptoms that mimic many things. They are not only responsible for pain, they can also cause muscle and joint dysfunction, and they do not have to be big to be mighty. They can cause numbness and tingling, burning and other nerve symptoms when a TrP is entrapping a nerve. These symptoms can be local or radiate in a specific pattern that remains consistent among all patients. Circulation and temperature changes can occur if TrPs are located next to a blood vessel and swelling can develop if the TrP is located next to a blood or lymph vessel.

Trigger points can develop in anybody who experiences muscle strain or injury. Generally, these isolated events can be successfully treated with lasting results. However, that is not the case in myofascial pain syndrome. In MPS trigger points resist treatment, develop in other parts of the body, and persist for a prolonged period.  

You can read more about trigger points, how they are classified and additional resources in “What Is a Trigger Point?”, which is also provided in the header tab of this blog.

WHAT IS CHRONIC MYOFASCIAL PAIN?

“Chronic myofascial pain is a disease that affects the chemicals that cross between nerve endings and muscles. It is literally, a disease at the neuromuscular junction—nerve to muscle... [it] is a chronic disorder in which myofascial trigger points (TrPs) cause sensory, motor, and autonomic symptoms. This condition may develop in muscles that are overstressed, overused, or injured. Different from isolated incidental occurrences of trigger points that can happen to normal individuals, CMP develops when TrPs are apparent in several quadrants of the body and have become chronic. The trigger points may be active, latent, or secondary.”

Excerpt from Fibromyalgia, Chronic Fatigue Syndrome, and Myofascial Pain: The Mind-Body Connection by Celeste Cooper, RN and Jeffrey Miller PhD

Mayo Clinic (accessed February, 2020)  suggests sleep problems and development of fibromyalgia are complications of untreated myofascial pain syndrome. 

Myofascial pain syndrome coexists with many painful conditions. These include ─ but are not limited to ─ fibromyalgia and chronic fatigue/myalgic encephalomyelitis, migraine, spinal degeneration, teeth grinding, restless leg syndrome, TMJ, interstitial cystitis, irritable bladder, arthritic joints, congenital musculoskeletal malformation, repetitive motion, a static position, and more. Chronic myofascial pain can develop from the effect of diseases, such as polio, and can result from injury or post surgical scaring, too.

Hands on myotherapies, ultrasound guided trigger point injections, self-treatment of TrPs, controlling perpetuating factors are things we can do. It is helpful to know I have some control over the beast that can create so much agony.

Additional Reading:

Do Tight Muscles Cause You Pain? What You Should Know About Chronic Myofascial Pain

What You Should Know About Myofascial Pain for ProHealth
The Lessons Of Myofascial Pain Syndrome And Fibromyalgia for ProHealth

In healing,

Celeste Cooper, RN / Author, Freelancer, Advocate

Think adversity?-See opportunity!

http://www.CelesteCooper.com

~ • ~ • ~ • ~ • ~ • ~

Learn more about Celeste’s books here. Subscribe to posts by using the information in the upper right hand corner or use the share buttons to share with others. 

When Your Frozen Muscles Need Help: Myotherapies for Managing Myofascial Pain

When the myofascia isn’t free to move, other muscle movement is also impaired. This leads to joint dysfunction and chronic PAIN. This pain is universal with distinctive patterns that remain consistent in all people. In some cases, restrictions can be so extensive joints become frozen, meaning joint motion is severely restricted. The goal of all myofascial therapies is to restore normal muscle function. Following are helpful hands-on therapies that work to release restrictions and help our body achieve full normal range of motion.

MYOFASCIAL TRIGGER POINT THERAPY

Myofascial pain syndrome  (MPS) is a constant pain source when trigger points (TrPs) are left untreated.

Trigger point therapy done by a specially trained therapist releases the knotted muscle fiber (TrP) using a compression technique. The therapist will know to look for other TrPs, which are sometimes well away from the one that is causing you so much pain. They know there is a consistent pattern related to the specific location of a TrP in that taut band of muscle. Release TrPs returns muscle to normal function.  That said, the work isn’t all up to the therapist. A good therapist will help you learn the importance of knowing what things are perpetuating your pain. A big one for me is sitting here at this desk staring at my computer screen, or riding in a car for too long.

Chronic myofascial pain from MPS is often accompanied by other disorders, such as fibromyalgia, migraine, spinal degeneration, irritable bladder, arthritis, joint hypermobility, and more. Dr. Karl Hurst-Wicker explains “Fibromyalgia Centralization and Peripheral Myofascial Pain” in an interview I did for Health Central.

Created by Celeste Cooper, The Pained Ink Slayer(c)

Chronic myofascial pain can be the primary source of pain or it can perpetuate pain in other disorders, injuries, or anatomical deformities. The good news is that myofascial pain syndrome is treatable. The goal is to release the trigger point/s so that the muscle tissue returns to its normal functioning position.

MYOFASCIAL RELEASE (MFR)

As so many of us who write about myofascial pain explain, the myofascia is like chicken skin. It’s attached to the muscle, but still moves freely. If you have ever cut up a chicken, you can visualize what that is. Each muscle is covered by myofascia (muscle covering) that draws together on each end to form a tendon. Tendons attach muscle to bone so our joints can function. The goal of myofascial release is to free up myofascial restrictions so our body can function properly.

Developed by physical therapist John F. Barnes, myofascial release is a manual therapy performed by a skilled therapist with the goal of improving movement and promoting wellness.

My personal experience with MFR was enlightening to the physical therapy student following my therapist. During a session, my back starting twitching like a flickering light bulb, the student became tongue-tied. She stated she had not witnessed such a phenomenon. The physical therapist was glad her student was able to see firsthand what restricted myofascia can do and how it contributes to chronic pain.

It’s important to always check the credentials of anyone doing body work. They must have a firm understanding of anatomy of physiology. Here is a directory of myofascial release therapists recommended by John Barnes. http://mfrtherapists.com/

NEUROMUSCULAR THERAPY AND REPROGRAMMING (NMR)

The goal of Neuromuscular Therapy and Reprogramming (NMR), founded by body-worker Jocelyn Olivier, is to balance the central nervous system and the musculoskeletal system by engaging the motor center of the brain.  Therapists specifically trained in NMR treat soft-tissue restrictions, which relaxes muscles, rebuilds strength, improves flexibility, restores venous and lymph flow, and relieves the underlying cause of pain. The therapist will assess blood flow, myofascial TrPs, nerve compression, problems with gait, posture and body alignment, and perpetuating factors.

Other types of bodywork include spray and stretch, Bonnie Prudden Myotherapy, strain counter-strain technique, and deep tissue bodywork, such as Rolfing and Active Release Technique (ART). I caution those with fibromyalgia on deep tissue work. It can be too painful for some. I am lucky to have a physical therapist that does ART. Some chiropractors also use this technique, but the most important thing is to have a working relationship with your therapist and keep the lines of communication open.  

WHAT WE CAN DO

Any myofascial therapy requires us to contribute for the best outcome. We can identify perpetuating factors and practice preventive strategies like stretching and strengthening to maintain muscle health, stamina, and general overall wellness. (Caution: strengthening should be done once the muscle is functioning properly again.) We can be persistent in finding the right therapy or the right therapist. Both are equally important. Maybe you find a therapy you want to try, insurance covers it and all seems well. However, I offer a word of prudence, the type of therapy doesn’t matter if you don’t have a knowledgeable therapist who is willing to work with you and teach you why certain things are important.

A guidebook that focuses on the work of doctors Travell and Simons will help you learn methods of self-treatment and a good therapist will suggest that you do just that. There is information to suggest that when home therapy is encouraged, we do better.

IN CLOSING

Always talk with your doctor for medical clearance. Sports medicine physicians and physical therapists are often a good resource for those of us living with chronic myofascial pain.

Additional Reading:

Physical Therapy for Chronic Pain

In healing,

Celeste Cooper, RN / Author, Freelancer, Advocate

Think adversity?-See opportunity!

http://www.CelesteCooper.com

~ • ~ • ~ • ~ • ~ • ~

Learn more about Celeste’s books here. Subscribe to posts by using the information in the upper right hand corner or use the share buttons to share with others. 

Part II – Proprioception in FM and MPS: Are you a bull in the china cabinet? What can we do? by Celeste Cooper

In “Part I, Proprioception: Are you a bull in the chinacabinet? Is it fibro or myofascial pain syndrome?”  we talked about proprioception, what it is and how it relates to fibromyalgia (FM) and myofascial pain syndrome (MPS). 

PART II

It’s morning and if you are like me, you can see that your feet are attached to your body as you place them on the floor. Unfortunately, for some of us, as we start to walk, our appendages seem completely unaware of where they are. Our feet should go in the direction we believe we are headed, and our arms should not hit door jams that we have lived with for 10+ years. Slam, bang, crunch, there’s that darn wall again.

What can we do to improve balance and minimize 

the bull in the china cabinet effect?

Treating the myofascia

For the myofascial pain syndrome group (considered by many as the most apparent comorbid disorder to FM, usually a pain specialist, physical therapist, or body-worker) treating trigger points  in sternocleidomastoid and its branches is imperative.

The first treatment suggestion is to identify and correct perpetuating factors and adapt trigger point therapies that calm the hypersensitive areas in the myofascia.

Perpetuating factors include poor spinal alignment, repetitive motion, static positioning, carrying a purse or backpack that is too heavy, head forward posture, extended computer time, ill fitted chair, out of control comorbid conditions, etc.

Releasing trigger points by manual techniques can reduce or alleviate pain. However, it is important to remember that if you also have FM or CFID, the release of cellular byproduct from muscle manipulation can instigate a flare of FM or CFID symptoms. Stay hydrated, even after self-treatment. 

“Trigger points do not respond to positive thinking, biofeedback, meditation, or progressive relaxation. They respond only to physical intervention. However, positive thinking, biofeedback, meditation, and progressive relaxation can help prevent the stress that is thought to aggravate chronic myofascial pain.” (Cooper and Miller, 2010)

Therapies to improve balance

Therapies that are thought to improve balance and proprioception are T’ai Chi, gentle chair Yoga, gentle stretches, whole body vibration, and myofascial release. Also helpful is to balance on a therapeutic ball to improve your kinesthetic awareness (in this case, knowing where your legs and feet, and arms and hands are located). Neuroscience validates that we can train our brain. People with traumatic brain injury are learning to live life again. 

“The only way we could remember would be by constant re-reading, 

for knowledge unused tends to drop out of mind. 

Knowledge used does not need to be remembered; 

practice forms habits and habits make memory unnecessary. 

The rule is nothing; the application is everything.” 

― Henry Hazlitt, Thinking as a Science

Also see:

Five Safety Tips for the Holidays for Persons Living with Fibromyalgia and Myofascial Pain Syndrome by Celeste Cooper

http://fmcfstriggerpoints.blogspot.com/2014/11/five-safety-tips-for-holidays-for.html#.VHjBzjHF86w

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Update 2015

"Adversity is only an obstacle if we fail to see opportunity."  

Celeste Cooper, RN

Author—Patient—Health Central Chronic Pain Pro —Advocate

New Website

Celeste’s Website: http://CelesteCooper.com

Learn more about what you can do to help your body function to its potential in the books you can find here on Celeste's  blog. Subscribe to posts by using the information in the upper right hand corner or use the share buttons to share with others.

All answers and blogs are based on the author's opinions and writing and are not meant to replace medical advice.  

Resources:

Carson JW1, Carson KM, Jones KD, Bennett RM, Wright CL, Mist SD. A pilot randomized controlled trial of the Yoga of Awareness program in the management of fibromyalgia.

Pain. 2010 Nov;151(2):530-9. doi: 10.1016/j.pain.2010.08.020.

Castro-Sánchez AM1, Matarán-Peñarrocha GA, Arroyo-Morales M, Saavedra-Hernández M, Fernández-Sola C, Moreno-Lorenzo C. Effects of myofascial release techniques on pain, physical function, and postural stability in patients with fibromyalgia: a randomized controlled trial. Clin Rehabil. 2011 Sep;25(9):800-13. doi: 10.1177/0269215511399476. Epub 2011 Jun 14.

Cooper, C and Miller, J. Integrative Therapies for Fibromyalgia, Chronic Fatigue Syndrome, and Myofascial Pain: The Mind-body Connection. Healing Arts Press: Vermont. 2010.

Prado ET1, Raso V2, Scharlach RC1, Kasse CA1.Hatha yoga on body balance.Int J Yoga. 2014 Jul;7(2):133-7. doi: 10.4103/0973-6131.133893.

Sañudo B1, Carrasco L, de Hoyo M, Oliva-Pascual-Vaca Á, Rodríguez-Blanco C. Changes in body balance and functional performance following whole-body vibration training in patients withfibromyalgia syndrome: a randomized controlled trial. J Rehabil Med. 2013 Jul;45(7):678-84. doi: 10.2340/16501977-1174.

Jones KD1, Sherman CA, Mist SD, Carson JW, Bennett RM, Li F. A randomized controlled trial of 8-form Tai chi improves symptoms and functional mobility in fibromyalgia patients.Clin Rheumatol. 2012 Aug;31(8):1205-14. doi: 10.1007/s10067-012-1996-2. Epub 2012 May 13.

Is the prevalence of joint hypermobility purely a coincidence in CFS and FM? by Celeste Cooper

Shared by ProHealth is Dr. Peter Lowe’s assessment of joint hypermobility in chronic fatigue syndrome.

Is The Physical Examination Normal in CFS? Part 2: Joint Hypermobility, here.

As you will see, I too made this connection in our book “Integrative Therapies for Fibromyalgia, ChronicFatigue Syndrome, and Myofascial Pain: The Mind-Body Connection (rated in the top 100 books on Diseases & Physical Ailments on Amazon in 2013) if you read more about joint hypermobility and Ehler’s Danlos Syndrome on my website here. 

How coincidental could this be?

Another study suggests this phenomenon goes undiagnosed in irritable bowel syndrome, a common comorbid disorder to fibromyalgia, which often overlaps with CFS.

Fikree A, Grahame R, Aktar R, Farmer AD, Hakim AJ, Morris JK, Knowles CH, Aziz Q.. A Prospective Evaluation of Undiagnosed Joint Hypermobility Syndrome in Patients with Gastrointestinal Symptoms. Clin Gastroenterol Hepatol. [Jan 15 Epub ahead of print.]

“Many upper and lower GI symptoms increased with increasing severity of JHS phenotype. Upper GI symptoms were dependent on autonomic and chronic pain factors. JHS is common in GI clinics, with increased burden of upper GI and extraintestinal symptoms and poorer quality of life. Recognition of JHS will facilitate multidisciplinary management of GI and extra-GI manifestations.”

French investigators noted some stark realities in fibromyalgia patients.

“Some patients suffering from fibromyalgia present with clinical signs and alterations in the histopathology, immunohistochemistry and ultrastructure of the dermis similar to the Ehlers-Danlos syndrome, hypermobile type (EDSH). Some types of fibromyalgia possibly represent an undiagnosed EDSH.”

Hermanns-Lê T, Piérard GE, Angenot P. [Fibromyalgia: an unrecognized Ehlers-Danlos syndrome hypermobile type?] Rev Med Liege. 2013 Jan;68(1):22-4.

I can only speak from what I found in my literature review for the 434 page book and my own personal experiences. A stark reality for me is that my own skin is that of someone on long term steroid therapy, but I don’t even tolerate steroids. My wounds heal so slowly that one of my doctors said I should always have a wound care specialist. My skin connective tissue tears like paper and bruises from a feather touch. I have had four shoulder surgeries, one complete reconstruction because it would not stay put, and the other three because of tendon and cuff tears. My hips still pop in and out at will, only contributing to fall risk and aggravation and development of more trigger points, piriformis and sacroiliac pain, and hip bursitis. I have suffered many severe joint sprains throughout my life. I can still put my hands flat on the floor and my therapists are amazed at my flexibility in light of my age and the severe myofascial pain syndrome. And yes, before arthritis, I was what many referred to as double-jointed.

Are our doctors giving this connection serious consideration? 

Could this explain why so many FM and CFS patients 

are susceptible to myofascial pain syndrome?

Keep up the good work Dr. Rowe and fellow astute investigators. A physician should never underestimate the value of a skilled physical exam. We salute you.

~ • ~ • ~ • ~ • ~ • ~

"Adversity is only an obstacle if we fail to see opportunity."

Celeste Cooper, RN

Author, patient/ advocate, fibromyalgia health expert

Books:

Read about Celeste and access to her books at Author Central here

Broken Body, Wounded Spirit: Balancing the See Saw of Chronic Pain [Four book series]

Integrative Therapies for Fibromyalgia, Chronic Fatigue Syndrome, and Myofascial Pain 

Advocacy: 

Fibromyalgia expert on Sharecare, here. 

Participant in the Pain Acition Alliance to Implement a National Strategy, here.

Website: http://www.TheseThree.com

All answers and blogs are based on the author's opinions and writing and are not meant to replace medical advice.  

Is there a therapy for you? The role of treatments in chronic pain by Celeste Cooper

Body-work is important to the health of muscles that are dysfunctional, such as seen in myofascial pain syndrome. Myofascial pain syndrome  (MPS) is thought by many experts to be a main peripheral pain generator in most chronic pain conditions.  Chronic myofascial pain from sustained, untreated, or undertreated myofascial trigger points (knotted up pieces of muscle fiber that can be easily felt unless the muscle involved is too tight, too deep, or behind bone) is thought to be kept in perpetuity by the metabolic and autonomic effects of both FM and ME/CFS, meaning it makes treatment more difficult to sustain than it does in other patient populations.

Until myofascial trigger points are treated and muscle fiber is returned to its normal resting length, a sustained hold of the muscles involved, whether it be through Yoga or prescribed by a physical therapist, will not only discondition the muscle, it can create more pain and further development of MTrPs.  This is because the muscle has already reached its maximal capacity of stretch when trigger points are involved. More pain and dysfunction should not be the goal of therapies, but some do not realize they are doing more harm than good because they do not understand the pathophysiology behind trigger points. These same recommended therapies are helpful on down the road AFTER the muscle is returned to its normal state. We must educate those who treat us. We talk more about this in the next edition of Broken Body Wounded Spirit: Balancing the See-Saw of Chronic Pain, Spring Devotions, and our BIG book (here)  is devoted to understanding the role of chronic myofascial pain from trigger points in both FM and ME/CFS.  

Optimally, we need someone standing beside us using trigger point pressure and stroking the MTrPs as we move the muscle through its range of motion in order to coax the muscle back to its normal resting length. This is the theory behind Active Release Therapy, and though MTrPs are not addressed specifically in Feldenkrais Movement Therapy,  Alexander Technique, and Craniosacral Therapy, these therapies do help with restrictions found in skeletal muscle and connective tissue.  Spray and Stretch, Myofascial Release, and Myofascial Trigger Point Therapies are massage-like therapies .  

Addressing perpetuating factors with body work is done in Ashton Patterning, and Trager Work and an important part of prevention. Therapies for addressing the mechanical and emotional aspects of body-work are Hellerwork, T'ai Chi, Yoga, and Rosen Method.  The success or failure of each therapy is dependent upon patient dedication, education, and a therapist who is skilled in communicating with our body.  

All these therapies, including self treatment, are discussed at length in Integrative Therapies for Fibromyalgia, Chronic Fatigue Syndrome, and Myofascial Pain and throughout the Broken Body, Wounded Spirit series. Read more about the books here. 

My New Year’s resolution is to educate others on the myofascial and its role in chronic pain. Many of these therapies are not covered by insurance. However,we have evidence based research to show that body-work treatments are more effective than medications and other invasive treatments in treatment of soft tissue dysfunction as the result of a musculoskeletal problem. We need  to move integrative therapies into mainstream. If we can convince Medicare, Medicaid and private insurance companies that therapies such as these are more cost effective, we have a chance.

For now, some of the therapies can be costly. Most of us with disabling chronic pain have limited financial resources, myself included. For this reason, I believe self care through the use of tennis balls, a Theracane, mechanical massagers, rolling pins, swim noodles, Yoga balls and practicing gentle movement and stretch therapies are good alternatives. 

You can find helpful links on my website here. 

~ • ~ • ~ • ~ • ~ • ~

All answers and blogs are based on the author's opinions and writing and are not meant to replace medical advice.

Celeste Cooper is a retired RN, educator, fibromyalgia patient, and lead author of the Broken Body Wounded Spirit: Balancing the See Saw of Chronic Pain devotional series (coauthor, Jeff Miller PhD), and Integrative Therapies for Fibromyalgia, Chronic Fatigue Syndrome and Myofascial Pain: The Mind-Body Connection (coauthor, Jeff Miller PhD) She is a fibromyalgia expert for Dr. Oz, et al., at Sharecare.com, here, and she advocates for all chronic pain patients as a participant in the Pain Action Alliance to Implement a National Strategy, here. You can read more educational information and about her books on her website, http://TheseThree.com

Scream “4,”Cervicogenic Migraine and Myofascial Trigger points: June Awareness

Feature

Cervicogenic Migraines and Myofascial Trigger Points

Migraine headaches are not only a severe pain source in their own right, they also co-exist more frequently with fibromyalgia (FM) and chronic fatigue syndrome (ME/CFS), which overlaps with many other painful conditions, the domino effect.  Because they originate within the central nervous system, they can be a great factor in decreasing our pain threshold, every  nerve ending is fresh, raw and exposed.  

Cervicogenic migraine is a migraine attack that is perpetuated or preceded by neck pain. You know this excruciating pain is generated from the peripheral nervous system (anything outside the brain) when you feel a golf ball size muscle at the base of the skull, or the muscles that hold your head up are tighter than guitar strings. You know it is a migraine because it has all the same hallmark symptoms. An aura, preceding symptoms warning you of the impending attack,  may or may not be present, but migraines generally manifest themselves on one side of the head and are often accompanied by other symptoms, such as extreme sensitivity to light and sound, vomiting or nausea, blurred vision, lethargy, etc. This is the description of a cervicogenic migraine. You can read about other types of severe headaches on my website here. 

“A myofascial trigger point (TrP) is a self-sustaining, irritable area in the
muscle that can be felt as a nodule in a taut band. This irritated spot causes
the muscle to gradually shorten, interfering with the motion function of the
muscle and causing weakness and pain.” (Book excerpt, here) 

A common cause of cervicogenic migraine shares the overlapping condition to FM and ME/CFS called myofascial pain syndrome, read more here. Usually you start to feel the muscles in your neck tighten, or you feel a golf ball at the base of your skull scream F-O-R-E  or “4.”  They are doing this because some of the muscle fibers that make up the muscles are shortening causing pea sized knots you can easily feel unless the muscle is too rigid, in which case you can track the offending trigger point (TrP) by its referral pain pattern. Now, check that side of your face too.  Most likely you will feel tiny little strings of fine little muscles in the temple or around the eye.  These muscles are responsible for our facial function and expression.  I am not going to get to windy on the subject, and I could, but understanding this simple phenomenon could help bring you some relief.  We discuss all this at length in our book, here, but there are some key points to get your started on trigger point pressure therapy:

• Find the knots just mentioned
• If the muscle is too tight, you may have to massage it to get it to relax enough to locate the TrP. If you can get someone else to do it, all the better.
• If you have them and you are not too sensitive to odors, use essential oils to massage.
• Once you locate the knotted up piece of muscle (in the neck usually about the size of a pea, unless it is in one of the tiny muscles between the neck bones or on the face), hold pressure (about 80% of maximum) for 30 seconds or so. Try to locally stretch the TrP coaxing it back to its normal resting length. Do this periodically to tolerance and ability.

The neck muscles can get sassy for a number of reasons, stress (psychological or physical), degenerative neck disease, or the presence of myofascial pain syndrome, which is not uncommon in migraine either.  

Treating all of these TrPs can help with the attack, as can identifying the perpetuating factors. Once you become an expert at pressure therapy, and you have plenty of training ground to learn from, do this as preventative therapy. It is when you neglect your muscles that you are more likely to have this type of migraine, and the greater the neglect, usually, the more intense the headache and more difficult to treat.

If these types of headaches are a chronic problem, see a physician because other tests and treatments may be indicated.

In healing and hope, Celeste

All answers and blogs are based on the author's opinions and writing and are not meant to replace medical advice.  For more information about the author see http://TheseThree.com

Pelvic Pain, Bladder Disorders, Prostate Problems, Fibromyalgia, Chronic Fatigue Syndrome, and Other Female and Male Related troubles: Is it more than co-incidence?

The muscles in the pelvic girdle are what keep our organs from falling to the floor. These muscles make up the perineum, the urogenital triangle, and the anal triangle. They support the rectum, the vagina/penis, and the urethra, but they may not be the only muscles involved in your pain and dysfunction.

Causes

Pelvic pain can be from many causes such as, vulvodynia, irritable bladder or interstitial cystitis, infection, vaginal atrophy, prostate problems/pain, testicular and or pain in the penis, pain in the urethra (where your urine comes out), rectal pain, ovarian cysts, ectopic pregnancy, neuralgia, endometriosis, inflammatory bowel diseases, irritable bowel syndrome, diverticulitis, and myofascial trigger points (MTrPs), but for this blog we are looking specifically at the bladder and the perineum (area of the urethra, penis, vagina, and rectum).

Myofascial trigger points have been identified as the greatest aggravator of chronic pelvic pain, and pain is not the only symptom. Pelvic floor problems can also cause a decrease in urine flow in men and women, erectile dysfunction, urinary retention (setting the stage for infection), urgency (always feeling like you have to urinate), and constipation.

For more on myofascial trigger points and myofascial pain see “Myofascial Pain” at my website and
 my blog: Points That Need More Than Pondering: Defining Myofascial Trigger Points


Offending trigger points

Myofascial trigger points in adductor magnus (thigh), or internal oblique (abdomen), are capable of causing bladder pain and frequency, and MTrPs in the adductor magnus can cause a host of referred pain to groin and inner thigh, pelvic and pubic bones, rectum and vagina and can cause menstrual cramping (as can MTrPs in the rectus abdominus, abdomen), and trigger points in the internal oblique can also cause bladder difficulties. The muscles of the pelvis, and the multi-layered muscles of the pelvic floor can become tight, unforgiving and short due to MTrPs. Myofascial trigger points in pelvic related muscles can refer pain to the urethra, rectum, coccyx, or the crease of the buttocks.

This is speaking in generalities, but it’s important to understand that the source of your pain can be close by or well away from pelvis itself.  Treating MTrPs, whether active (painful without touching) or latent (only painful with touched) that refer pain to a specific region is just as important as treating those directly relatable. Often times, those who claim to know myofascial trigger points do not understand the complexity, this includes physicians, physical therapists, and body workers.


Chronic myofascial pain in fibromyalgia, chronic fatigue syndrome, and pelvic dysfunction

Myofascial pain syndrome often co-exists in fibromyalgia, and has been identified in some chronic fatigue syndrome (ME/CFS) patients, chronic pelvic and bowel disorders.  Myofascial trigger points are a peripheral nerve to muscle problem that lends to centralized (amplified) pain in fibromyalgia, interstitial cystitis, bladder difficulties, ME/CFS, IBS, and other overlapping conditions.  This hypersensitive state is also present in these disorders. Ignoring the obvious bloodies the diagnostic waters and most importantly delays appropriate treatments and leads to flawed research.


Therapies

It is important to identify perpetuating factors, such as, co-existing hip problems, piriformis syndrome, pudendal neuralgia, low back or sacroiliac joint dysfunction, and other overlapping conditions, bringing them under control when possible. Pay close attention to aggravating factors such as, sitting too long or on hard surfaces and chairs that can’t be adjusted to your body type, over activity, infection, poor posture, wearing pants that are too tight, consuming offending foods, etc.

There are a variety of therapies to help you, including intravaginal and pelvic floor trigger point injections, external and internal massage of the perineum and in women the vagina, biofeedback, bladder retraining, transcutaneous electrical nerve stimulation (TENS), tennis ball therapy (as discussed in our book),
acupuncture, dietary changes, over-the-counter probiotics for the bladder, stretching movements, topical analgesics (such as oragel), oral analgesics, and of course specific myofascial therapy by a trained specialist. Sometimes, all are necessary.

Seldom are doctors well informed about myofascial pain s and trigger points, so I am a firm believer that women should see a urogynecologist, that men should see a urologist and in both cases, the physician should understand the role of the myofascial in chronic pelvic pain.  The same is true for the physical therapist. Why? Those who do not understand the role of trigger points chronic pelvic pain and dysfunction may suggest traditional therapies, such as, Kegel exercise, which can worsen your symptoms, and when co-existing conditions such as piriformis syndrome, spinal disease, IBS, etc. are involved; a host of referral patterns are involved.  This is why identifying ALL your pain patterns (whether you feel a trigger point there or not) is important information for your specially trained healthcare provider.

Always discuss your symptoms with your doctor to make sure other causes are ruled out. If your pain and dysfunction is not found to be from another source, please look for those myofascial trigger points and a specialized therapist, they are treatable.

Resources for you:

IC and Irritable bladder
Blatman Pain Clinic
What Your OB/GYN Should Know About FMS and CMP by Devin J. Starlanyl
Pelvic Floor Myofascial Trigger Points: Manual Therapy for Interstitial Cystitis and the Urgency-Frequency Syndrome by Jerome Weiss
Fibro Care Center
National Association of Myofascial Trigger Point Therapists
ICA – Physical Therapy
ICA – Pelvic Floor Dysfunction
International Myopain Society
IC Network


(Signature line appended, March 2018)

In healing,

Celeste Cooper, RN / Author, Freelancer, Advocate

Think adversity?-See opportunity!

http://www.CelesteCooper.com

~ • ~ • ~ • ~ • ~ • ~

Learn more about Celeste’s books here. Subscribe to posts by using the information in the upper right hand corner or use the share buttons to share with others.

All blogs and comments are based on the author's opinions and are not meant to replace medical advice.  

Human Touch: Soft Tissue and Massage Therapy in Chronic Pain Conditions

Massage therapy can be very beneficial when the right technique is artfully executed by an intuitive and skilled therapist. Touch and hands-on methods are a good adjunctive therapy in treatment of fibromyalgia, joint pain, chronic fatigue syndrome, myalgias, and other musculoskeletal disorders from head to toe. The myofascia (muscle covering) is connected throughout the entire body, therefore addressing local restrictions may help with pain in other areas of the body and massage therapists understand this relationship.

If myofascial pain syndrome (MPS) is present, as seen in many disorders from fibromyalgia and chronic fatigue/myalgic encephalomyelitis, migraine, spinal degeneration, interstitial cystitis, irritable bladder, arthritic joints, post surgical scaring, etc, a specialized myofascial trigger point therapist is recommended. 

Myofascial pain syndrome is a great peripheral pain generator adding to the amplification of pain and upsets in brain orchestration seen in fibromyalgia, and though centralization is not discussed in chronic fatigue syndrome, there is also a brain manifestation leaving these patients at risk for many of the overlapping disorders seen in both FM and CFS and each other.  Myofascial trigger points, knotted up pieces of muscle fiber that can be easily felt unless behind bone or other muscles, they radiate pain and other symptoms in a specific pattern according to their location.  Myofascial trigger points are great neurological imitators, and prevalent in many pain disabilities. More information on MPS, FM and CFS/ME can be found at http://TheseThree.com under the disorder/diseases tab.

If you do not tolerate myofascial manipulation, gentle massage and stretch is indicated in the beginning. More pain does not indicate more gain in all cases. A good therapist will know this and work with you. The feedback we provide our brain teaches it how to respond, and it is important to know it will react according to how we teach it. Certainly, we wouldn't put a child on a bicycle without first using training wheels.

The greatest consideration is that your massage therapist becertified by a peer reviewed organization,  or in your state if your state requires such certification.

Particular hands-on therapies are discussed at length in Integrative Integrative Therapies for Fibromyalgia, ChronicFatigue Syndrome, and Myofascial Pain: The Mind-Body Connection, and the resource section is one of the most extensive available.

Paying it forward for chronic pain and neuro-endocrine-immune disorders. Celeste, RN, author, pain patient/activist, educator, and fibromyalgia health expert.

About the books written for you:

BrokenBody Wounded Spirit: Balancing the See Saw of Chronic Pain.

IntegrativeTherapies for Fibromyalgia, Chronic Fatigue Syndrome, and Myofascial Pain: TheMind-Body Connection

Contributing author to FibromyalgiaInsider Secrets: 10 Top Experts, 2^nd Ed. 

All blogs, posts and answers are not meant to replace medical advice.

KaleidoPain News, 9-11-2012

“Use what talent you possess:  

the woods would be very silent if no birds sang except those that sang best.” 

~Henry Van Dyke, American author, poet, 1852 – 1933.

*Tips for writing your own affirmations www.thesethree.com/Key_to_Affirmations.html

*Tips on journaling www.thesethree.com/Journaling.html

CELESTE’s BLOGSPEAK

Who Should Be Prescribing Our Pills?

Demanding body, cellular strength, LGS:  Are we what we eat?

Notes:

Blogs also available at Sharecare www.sharecare.com/user/celeste-cooper/blogs

See past blog links at www.thesethree.com/Featured_Blog_Links.html

HEALTHY HABITS

Johns Hopkins Health Alert! Lifestyle Factors and Cognitive Decline: What's the Link?

Five Caffiene-Free Ways to Boost Your Energy via Kate Bartolotta 

FEATURING Q&A by Celeste at Sharecare

Can an old trauma lead to fibromyalgia?

Are there alternative treatments for fibromyalgia?

*Follow all answers by Celeste at  www.sharecare.com/user/celeste-cooper/answers

ANNOUNCEMENTS

Check out the announcement on the home page of www.TheseThree.com

“Everyone challenged by chronic pain - please join us wherever you are in the world on September 16th for a day sure to enlighten, inspire, educate and empower! To watch, simply view the live stream either here,  www.forgrace.org/women/in/pain/C265/  , on the 2012 Women In Pain 

Marly Silverman is retiring and she is handing off PANDORA (Patient Alliance for NEI Disorders Organization, Research and Advocacy) to capable hands. Read the news. 

IN THE NEWS

Which Endocrine Problems Cause Fatigue And How Does Salt Affect This? - Dr. Friedman (VIDEO)

From FDA Approvals > Medscape Medical News, New Option for Constipation: FDA Approves Linaclotide by Nancy A. Melville 

Pain Misdiagnosis and CRPS Spotlighted by FOX 11 LA.

TNX-102, sublingual low dose cyclobenzaprine, for Fibromyalgia

Fibromyalgia has been unrecognized by the Social Security Administration in the listing of impairments.  Times are changing, “medically determinable impairment (MDI) of fibromyalgia (FM), “  see Social Security Ruling, SSR 12-2p; Titles II and XVI: Evaluation of Fibromyalgia.

NEWS FOR YOU from Celeste

“Osteoarthritis” www.thesethree.com/Osteoarthritis.html

More “NEWS FOR YOU”  at www.TheseThree.com 

ROLFING THE RESEARCH 

This months featured research at www.thesethree.com/Featured_Research.html

BOOK REVIEWS

I just finished reading an excellent book by Anita Moorjani called "Dying to be me". It is highly recommended for us, who struggle on a daily basis to live with this FM-thingie! Her book - about her Near Death experience and the resulting healing from stage 4B Lymphoma puts it all into perspective. To say I finally made peace with my illness is an understatement.

--review by Elke Hutton

"When Movement Hurts: A Self-Help Manual for Treating Trigger Points" by Barbara Headley MS PT. It gives many of the most common trigger points. The muscle sections contain associated diagnoses, signs and symptoms, causes, management tips, and prevention hints. There is a chapter that deals with other causes of muscle pain, one on exercise, and one on repetitive stress, and one dealing with chronic postural stress. The author is an authority on trigger points and well loved by many of us in the field. Her teachers included Janet Travell and David Simons.

--Review by Devin Starlanyl, author and advocate for fibromyalgia and myofascial pain syndrome.

ABOUT OUR BOOKS  

www.thesethree.com/About_the_Books_WPCN.html

FEATURED WEBSITE OR BLOG!

The National Fibromyalgia and Chronic Pain Association.  I hope you will join me by supporting the NFMCPA however you can.  They work behind the scenes, collaborate, educate, advocate, and network within political and health organizations that are striving to make a difference in our lives.  (Disclaimer, I do not work for the NFMCPA) 

How To Get Well From ME (CFS)? 10 Areas Of Treatment To Look At by GetWellFrom ME.  [Inspiring overview, Cc] 

Fantastic presentation for some patients with fatigue, with valuable information. Which Endocrine Problems Cause Fatigue And How Does Salt Affect This? - Dr. Friedman (VIDEO)

COMMENT CORNER 

This review is for: Integrative Therapies for Fibromyalgia, Chronic Fatigue Syndrome, and Myofascial Pain: The Mind-Body Connection (Paperback) 5.0 out of 5 stars The holistic approaches presented are great resources for anyone dealing with these conditions!, July 8, 2012 

By Lyn, Massage Therapist 

I know how debilitating these conditions can be for my clients and how important it is for them to gain control in managing their symptoms. This thoroughly researched book provides a variety of practical solutions to managing a myriad of symptoms. The science is presented in easily understandable terms; the focus on mind, body and spirit is truly integrative. Tips provided for dealing with the challenges of securing treatment in our broken health care system are not found in other books. This is an excellent resource! 

POINT TO PONDER    (Sneak Peek from our soon to be released, Broken Body, Wounded Spirit: Balancing the See Saw of Chronic Pain, a series beginning with “Fall Devotions”)

Do I exude the pleasures I seek in others? 

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The KaleidoPain newsletter is for you, join in and submit one of your inspiring moments or book review's. Make a contribution and share with others. To submit contributions put "inspiring moment" or "book review" in the subject line and email to Celeste@TheseThree.com

*This virtual newsletter is for informational purpose only and is not meant as medical advice.