• Robin R Varghese, PT.

Know the pain before you treat it. Still wondering as to what could be the cause of your pain?


Myofascial pain and the cause for it

  • Pain that causes inflammation or irritation of muscle or the fascia surrounding the muscle is called as Myofascial pain.

  • They start from the muscle and produces sensory, motor and autonomic symptoms and are caused by myofascial trigger points

  • MPS has been described as a soft tissue pain syndrome where the pain is present primarily in a single area or quadrant of the body

  • It can be :

  • acute or chronic;

  • it can also be post-traumatic, lasting beyond the “normal” time of healing, usually over 3 or 6 months

What are these Trigger points?


Trigger points are focal areas of tenderness caused by hypercontracted muscle tissue.

  • They are usually a taut band of skeletal muscle which is painful on compression or deep palpation.

  • They can give rise to characteristic Referred Pain, motor dysfunction and autonomic phenomena.

  • The initiation of the myofascial trigger point is yet not know.

  • It may be induced by muscle overuse, unaccustomed exercise, repetitive eccentric exercise, muscle trauma, and/or psychological stress.

  • It is classified into active and latent trigger points.

An active trigger point is one with spontaneous pain or pain in response to movement that can trigger local or referred pain.

A latent trigger point is a sensitive spot with pain or discomfort only elicited in response to compression.

  • Trigger points can lead to:

  • Pain on compression.

  • Local twitch response.

  • Muscle tightness. · Local myasthenia. (The muscle with a trigger point may be weak, but usually no atrophy can be noticed.)

  • Associated localized autonomic phenomena, including vasoconstriction, pilomotor response and hypersecretion.

Causes of trigger points

Low-level muscle contractions

Muscle contractures

Direct trauma

Muscle overload

Postural stress

Unaccustomed eccentric contractions

Eccentric contractions in unconditioned muscle

Maximal or submaximal concentric contractions


What exactly happens

The initial change in muscle that is associated with myofascial pain is the development of the taut band, which is a motor abnormality. This motor abnormality is explained by a mechanism called Integrated Hypothesis.


  • The hypothesis is a six -link chain that starts with the abnormal release of acetylcholine .

  • This triggers the formation of taut band in the muscle.

  • The band then constricts blood flow that leads to local hypoxia.

  • This reduces the ATP and leads to tissue distress causing the release of sensitizing substance.

  • This leads to the activation of nociceptors and autonomic modulation.

  • Activated nociceptors causes pain and the activation of autonomic modulation leads to the first step, the abnormal acetylcholine release.

  • The end result is the tenderness and pain observed in myofascial trigger points.


The pH of the active trigger point region gets decreased as low as pH 4 (normal pH value is 7,4) causing muscle pain and tenderness as well as a decrease in acetylcholine esterase activity resulting in sustained muscle contractions.


Perpetuating Factors

In some cases, there may be perpetuating factors that have a feed-forward effect on myofascial pain. These In some cases, Certain perpetuating factors may factors may make the pain and tenderness more chronic and also can lead to referred pain. These factors are classified as:

Mechanical

Metabolic

Psychosocial

Other

Hypothyroidism

Stress

​Infectious diseas

Iron insufficiency

Anxiety

Parasitic disease

Joint hypermobility

Vit D insufficiency

Polymyalgia Rheumatica

Muscle overuse

Vit C Insufficiency

Use of Statin class drugs

Vit B12 Insufficiency

In some cases, managing and correcting an identified perpetuating factor may lead to a complete resolution of pain and may be the sole therapeutic approach needed to provide relief to the patient’s symptoms.


Are Myofascial pain and Fibromyalgia the same

No, they are not the same.

Main differences between myofascial pain and fibromyalgia are:

Myofascial pain

Fibromyalgia

Local pain

Widespread pain

Regional pain

Bilateral and axial pain

Presence of taut band

Absence of taut band

Referred pain

Presence of atleast 11 tender points

Treatment for Myofascial pain and Trigger points


Non-invasive techniques

Therapeutic Ultrasound

Low-level laser therapy,

Transcutaneous Electrical Nerve Stimulation (TENS)

Drug therapy (e.g. myorelaxants) and

Ph

ysical and manual therapy techniques such as:

· Stretching techniques

· Post-isometric relaxation

· Active Release Techniques

· Trigger point pressure release

· Muscle energy techniques

. Myofascial release techniques.

. Manual techniques associated with home exercises and ergonomics are to be recommended.


Invasive methods:

· Dry needling

· Anesthetic injections

· Botulin toxin A injection (inconclusive evidence found)


Myofascial trigger points are very common in shoulder girdle muscles; mainly in the infraspinatus muscle and upper trapezius. If you are suffering from pain that you are not sure of the cause, we are here to help you. We at Valley Healing hands, Brownsville, Texas provide the best physical therapy services for myofascial pain syndrome and trigger point pain. We have the best of therapists who are skilled with manual therapy and soft tissue manipulations and will be more than willing to address you pain condition. Check out what our patients have to say about us and reach out to us for an evaluation. Patients love our services, you too will!



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