Myofascial Pain Syndrome

Pain from muscle tension is something most people have experienced. Muscles and surrounding connective tissues can be strained and sprained through sports or other activities. You may suddenly find yourself rubbing a tense muscle in your neck or back if you’re experiencing stress from a job or anxiety-inducing situation. But the pain associated with Myofascial Pain Syndrome (MPS) often does not resolve and can even worsen as time progresses.

Myofascial Pain Syndrome is a significantly painful chronic condition. MPS can happen after repetitive contraction of a muscle. It can affect a single muscle or a group of muscles. This can be brought on by continuous movements utilized as a part of employment, interests, or by muscle tension due to stress. When pressure is placed on certain sensitive points (known as trigger points) in muscles, it can cause severe, chronic pain in both the muscle itself and in other parts of your body that seemingly have no correlation with the injured muscle. This is known as referred pain.

Symptoms of Myofascial Pain Syndrome

Signs and symptoms of myofascial pain syndrome might include:

• Deep, aching pain in a muscle
• Pain that persists or worsens, especially with activity or stress
• A tender “knot”, or trigger point, in a muscle
• Difficulty sleeping due to pain

Causes of Myofascial Pain Syndrome

Trigger points can form in muscles after overuse or an injury to a muscle or group of muscles, ligament, or tendon. These trigger points are tight areas of muscle tissue that are extremely sensitive and can cause pain throughout the muscle.

MPS is caused by some kind of stimulus that leads to the formation of trigger points in the muscles.

• Muscle Injury. Trigger points in a muscle may be caused by an acute injury or repeated stress to the muscle.  Injury can also be caused by poor posture from such a common condition as general fatigue.
• Medical Conditions. Certain medical conditions can predispose and individual to developing MPS. This can include conditions such as stomach irritation and heart attacks due to the strain placed on muscles. Certain back injuries, such as injury to the intervertebral discs, can also contribute to MPS.
• Lack of Activity. In the event of an acute injury, certain muscle groups may need to be rested. This can involve an arm in a sling or a leg in a brace. However, not utilizing these muscles as one normally would can lead to tension.
• Stress and Anxiety. It is possible that individuals who clench their muscles more, such as those who experience frequent stress and anxiety, may develop trigger points in their muscles more frequently than others. The muscle clenching may act as a form of repeated strain, causing trigger points.

Diagnosing Myofascial Pain Syndrome

Diagnosis of MPS requires a physical exam by a doctor. The doctor will push on the painful muscles in a certain way in an attempt to elicit a response, such as muscle twitching, at a trigger point.

There are four different types of trigger points that may be identified in patients with Myofascial Pain Syndrome.

• Active Trigger Point. An active trigger point is an extremely tender area usually located within a skeletal muscle.
• Latent Trigger Point. A latent trigger point is an inactive area that could possibly act like an active trigger point.
• Secondary Trigger Point. A secondary trigger point is a very tender spot in a muscle that can become an active trigger point as a result of the presence of a trigger point in another muscle.
• Satellite Myofascial Point. A satellite myofascial point is a very tender spot that actually becomes inactive because it is located in a muscle area that is already involved in trigger pain.

It is important to remember that there can be numerous causes of muscle pain. Your doctor may recommend additional testing to rule out any other conditions.

Treatment of Myofascial Pain Syndrome

Treating MPS typically involves medications, trigger point injections, and/or physical therapy. Relief of MPS may necessitate more than one mode of therapy.

Medications

Medications utilized for MPS include:

• Pain relievers. Over-the-counter pain relievers, including ibuprofen (Advil, Motrin) and naproxen sodium (Aleve) may be effective. Depending on the severity of your pain, your doctor may recommend stronger pain relievers.
• Antidepressants. Some antidepressants have pain-relieving properties. Additionally, they can be used to treat co-existing conditions, such as depression or insomnia. In particular, the tricyclic antidepressant amitriptyline seems to be effective in easing MPS pain and helping with sleep.
• Sedatives. As some individuals with MPS may experience poor sleep as a result of their pain and/or anxiety, clonazepam (Klonopin) can be used. This medication must be used with care, as it can cause sleepiness and be habit-forming.

Physical Therapy

A physical therapist can design a therapy program to help relieve your pain based on where your pain is located, as well as its severity. Physical therapy to help alleviate the pain of MPS might include:

Stretching. You may be taught gentle stretches that pinpoint the affected muscle. This may help ease the pain caused by the trigger point. Alternatively, a method known as “stretch and spray” may be used. This technique involves spraying the affected muscle with a numbing agent and then slowly and gently stretching the muscle.

Correction of Posture. Fixing your posture can help with the pain caused by MPS, especially if the pain is in your neck. Strengthening the muscles that surround the trigger point can help avoid any one particular muscle from being overworked.

Massage. A physical therapist may use a particular kind of massage to alleviate the pain of MPS. This type of massage may use long strokes along the muscles or heavy pressure to release the tension causing the trigger points.

Heat. The application of heat, through a hot pack, heating pad, or a hot shower, can help relieve muscle tension and pain.

Ultrasound. This sort of treatment uses sound waves to improve the circulation of blood to the affected muscles, which may promote healing.

Needle Procedures

Needles can be used in several different ways to help alleviate the pain of MPS.

• Trigger Point Injections. The injections of numbing agents and/or steroids directly into the trigger point may be effective in relieving pain. Several injections can be done in one office visit.
• Dry Needling. This procedure involves the insertion of a needle into the area surrounding the trigger point, as well as the trigger point itself. Although no medication is involved, simply the insertion of the needle can help break up muscle tension.

Self-Care

There are numerous ways you can help yourself manage the pain of Myofascial Pain Syndrome. It is important to engage in various forms of self-care to make yourself as comfortable as possible.

Exercise. Engaging in mild exercise can help improve your pain. When you are able to, get up and move around.

Relax. One of the most common treatments suggested by doctors for any condition, finding ways to relax can actually help with the symptoms of MPS. Stress, anxiety, and the tension caused by them, can worsen your pain. Find ways to relax that are helpful to you.

Treat your body well. Use common sense. It is well known that eating a healthy diet and getting enough sleep is beneficial to overall health and wellness. Engaging in these healthy activities can only improve how you feel on a day-to-day basis.