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Myofascial Pain Syndrome
Trigger Points
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Muscles, ligaments and their coverings can become sore and irritated from repetitive or over use. This soreness can develop into disabling pain, which can reduce or eliminate a person's ability to perform jobs which involves the affected muscle groups. This condition, termed Myofascial Pain Syndrome (MPS) often occurs in persons who perform repetitive tasks involving the muscles of the forearms, upper arms, shoulders and neck. Activities such as typing, data entry or other frequent use of keyboards are common causes. Triggered muscles also come from accidents, from poor posture and sometimes from sustained level of lifestyle stress.
Though common, myofascial pain syndrome can be difficult to recognize and distinguish from underlying entities. It is often confused with fibromyalgia. Diagnosis hinges on the identification of painful muscle trigger points that, when palpated, create local twitch responses and refer pain in predictable patterns. With appropriate treatment, such as stretch and spray, trigger point injections, or massage therapy, prognosis is good.
Myofascial pain is a common, but poorly understood, source of pain for many patients. Janet Travell, MD, developed the concept of myofascial pain syndrome in the 1950s. According to Simons and Travell , the syndrome is defined by the presence of trigger points. These taut bands of muscle fibers are "ropy" and tender and, when pressed, create a local twitch response that is an involuntary shortening of the fibrous muscle band.
Prevalence
Myofascial pain syndrome is common. In one study of patients with pain complaints, 31% had acute trigger points. Trigger points have been described in all age-groups and in both sexes. The syndrome most often occurs between the ages of 30 and 60 years; prevalence declines with advancing age. A 1950s study of asymptomatic Air Force recruits found tender spots indicative of latent trigger points in 54% of the women and 45% of the men. The study also noted referred pain with palpation in 5% of the recruits.
To accurately diagnose myofascial pain syndrome, a thorough history and physical evaluation are essential. The history should include a detailed pain history, including when and how the pain started, the exact location of the pain, what it feels like, which treatment modalities have been attempted (and their results), and any history of trauma, overuse, or concurrent illness. The patient should point to the exact location of the pain, rate the pain on a scale of 0 to 10, and review what makes the pain better or worse.
Fascia
All of the structures in the body are surrounded, protected and supported by connective tissue. This matrix connects the body's organs and systems, and at the same time provides compartmentalization between them. This is what is known as "fascia". The fascia is a continuous elastic sheath that provides structural support for the skeleton and soft tissues (i.e., muscles, tendons and organs). It surrounds the muscles and is known as the fascial envelope.
Trigger Points
Think of triggered areas as "stuck spots" which must be loosened up. The condition is marked by inflammation, tenderness and eventually weakness in the muscles, ligaments, fascia and joints. Usually, small areas of extreme tenderness can be identified by pressing on the affected muscles. These spots are called "trigger points" - in addition to being tender, they feel like hard, usually round areas or knots. Trigger points can be thought of as areas of stuck, tangled muscle fibers which don't release in the normal way, even when the muscle is relaxed. Sometimes these trigger points are joined together along the length of the muscle and feel like tight, hard bands, rather than like individual hard spots in the muscles.
Motor vehicle accidents and falls, particularly when "whiplash" type injuries occur, are major sources of triggered muscle. Often people who've been suffering from headaches, "TMJ," neck and back pain, have pain that is traceable to motor vehicle accidents, sometimes years and years ago. In an accident your muscles are very suddenly stretched. This invokes a powerful "stretch reflex" in which the muscles contract just as powerfully as they were stretched by the sudden acceleration / deceleration during the accident. We think it is this sudden stretch/contraction that creates the stuck, shortened and painful muscles.
This syndrome is also usually associated with carrying excess tension in and around the affected muscles. This excess tension may become worse as the pain increases and the person begins to unconsciously "guard" or attempts to immobilize the sore area. This is a natural response, but unfortunately it makes matters worse. Tension around the triggered areas make the triggering and the pain worse. The increased pain then creates more tension and a vicious cycle is established. MPS can be associated with or even mistaken for arthritis or carpal tunnel syndrome.
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