Myofascial pain is a pain disorder that is characterized by aching muscles, sensitive spots (or trigger points) on the muscles and muscle stiffness. It often reduces the patient's normal range of motion and movement.
Myofascial pain most commonly affects the neck, shoulders, back and jaw, however pain can be felt anywhere in the body and may even radiate from the painful origin to other areas. This pain can be felt persistently, or with palpation and movement.
The cause of myofascial pain is not fully understood, but it often appears or worsen with a sedentary lifestyle, stress, physical exertion and poor posture. Treatment may include physiotherapy, stretching exercises, and lifestyle changes.
Common symptoms
The main symptoms of myofascial pain are:
- Increased tension and stiffness in the affected muscle
- Decreased range of motion
- Spontaneous pain or pain when the trigger point is pressed
- Pain that does not go away on its own, or gets worse
- Palpable lumps in the muscles or tight bands under the skin;
- Muscle spasms when palpated
- Pain relief when stretching the muscle
- Myofascial pain can be classified as acute or chronic
Acute myofascial pain usually improves with or without treatment and eventually resolves, while in chronic myofascial pain the symptoms may persist for 6 months or more.
Confirming a diagnosis
A myofascial pain diagnosis can be confirmed by an orthopedic surgeon, rheumatologist or physiotherapist through a physical examination.
The criteria used for diagnosis include the presence of a painful nodule or tight band, a radiating pain pattern, and a local contraction response when pressure is applied to a trigger point.
Causes of trigger points
The causes of myofascial pain are not fully known, but it appears to be related to factors such as muscle overload, repetitive movements, direct trauma, a sedentary lifestyle, stress, vitamin deficiencies, and a lack of sleep.
Chronic muscle tension and poor posture and also ccontribute to this condition.
Treatment options
The main forms of treatment for myofascial pain are:
1. Medication
The doctor may prescribe analgesics (like acetaminophen) and anti-inflammatories (like diclofenac) in oral or topical forms to help manage pain. Muscle relaxants, like cyclobenzaprine, can also be beneficial.
In some cases, the doctor may prescribe saline injections directly into the trigger point or the use of fluoromethane or ethyl chloride sprays, which are also associated with good results.
2. Warm compresses
Applying a warm compress to sore areas for 20 minutes at a time is another great way to relieve muscle pain and boost circulation to the area.
This can be done 2 to 3 times a day, and should be followed up by stretching to eliminate trigger points.
3. Stretching
Stretching can help to relieve muscle tension and release tight tissue that is contributing to pain. It also improves blood flow to the area and help to improve range of motion prior to performing and physical activities.
Stretching can be performed passively, in which affected limbs are stretches and held in place by another person, or actively, when the person themselves performs the stretch.
4. Physiotherapy
During physiotherapy sessions, the PT can use equipment such as a TENS machine or ultrasound to minimize pain. Myofascial release techniques, which involves pressing and applying friction to trigger points, can also help to reduce pain.
The use of rubber balls or foams rollers is also a good strategy to eliminate the trigger points that give rise to myofascial pain.
Some PTs may also recommend dry needling, which involves inserting fine needles into painful areas of the body to relieve pain.
5. Injections
Injections are only indicated for people with very painful, active trigger points that do not respond to other treatments.
Botox, corticosteroids or local anesthetics can be injected to affected areas to relieve pain and improve movement.
6. Lifestyle changes
Some lifestyle changes may be beneficial for treating and preventing worsening of myofascial pain. They are especially important for people with sedentary lifestyles that spend many hours per day sitting.
When sitting, you should remember to maintain your spine aligned and to avoid rounding or hunching your shoulders.
You should aim to get up every hour and stretch the person to promote adequate blood flow and prevent tightness.