Many people actually thought that myofascial pain is an alternative term for fibromyalgia. In fact, this is not true. Though these two conditions are in some ways similar and are known to be related in one way or the other, they actually have different symptoms. Therefore, a different treatment approach or diagnosis is required.
Muscle pain is rather common to most people at some point in their lives. In fact, most of the time, the achy muscles will just recover on its own in a matter of days. But as for those who suffer from myofascial pain syndrome (MPS), they experienced persistent muscle pain which gets worse over time.
What Is Myofascial Pain Syndrome
Like fibromyalgia, MPS is a chronic, non-fatal, non-inflammatory condition that affects the fascia or connective tissues which cover the muscles. It is a disorder in which some doctors are skeptical in accepting it as a “real disorder” especially with it unknown cause or cure as well as the difficulties in diagnosis. Chronic myofascial pain (CMP) is another term for this condition instead of fibromyalgia.
Myofascial pain differs from the widespread pain as in the case of fibromyalgia. In MPS, the pain centres around the “trigger points” which can be felt as nodules or rope-like bands under the skin. These trigger points can either be active or latent, leading to referred or localized pain.
When these trigger points are active, pressing or touching will cause referred pain (pain that is felt in different area of the body). As such, they tend to causes continual pain, a reduction in muscle elasticity and muscle weakness. At times, they may give rise to secondary trigger points which develop within the area of referred pain. As such, a localized pain pattern can spread to other and larger areas of the body.
When trigger points are latent, any applied pressure will only cause tenderness in that particular spot and not referred pain. Though the pain is less severe, they can cause stiffness and restricted range of motion. However, latent trigger points can become active due to several causes like psychological stress, muscle tension and poor posture.
Typically, myofascial pain can affect any of the skeletal muscles in the body. However, usually it causes regional pain in the neck, shoulders, pelvis, lower back, arms and legs. Besides, it is also a common cause of headaches as well as jaw and facial pain.
Many sufferers actually reported that myofascial pain is only felt in limited areas of the body like one side in the neck or shoulder area. However, this does not mean the pain is static. In fact, it can change location from one part of the body to another from day to day, as well as triggering different types of pain and sensations.
Who are affected by myofascial pain syndrome?
Generally, MPS affect the young and elderly as well as male and female equally. Statistics find that it is most commonly found in people between 20 to 50 years old.
Symptoms Of Myofascial Pain Syndrome
Though MPS is not an inflammatory or degenerative condition, the pain can range from mild to severe and incapacitating. This often leads to several distressing symptoms experienced by the sufferers. Typically, MPS sufferers describe the pain as dull and non-pulsating which can be felt deep inside the muscle. Some even experienced throbbing or stabbing pains and burning sensation as in the case of fibromyalgia.
Besides the pain which is the main symptom of MPS, the trigger points can also develop several other symptoms such as:
- Muscle twitches when the trigger points are touched
- Stiffness can be felt in the muscle or the joint which is closer to the affected muscle
- Numbness which is felt particularly in the extremities
- An area of tension in the muscle that feels like a knot and can be very sensitive to the touch
- Clicking or popping of the joints
- Trembling sensations in the arm or leg
- Tension-type headaches or migraines
- Restricted movement of the joints especially in the jaw
- Body balancing problems
- Severe or long term muscle weakness that causes the sufferers to lose strength and not able to hold on or grip objects
- Ear pain and tinnitus
- Sweating, nausea and dizziness
- Changes in skin temperature
- Memory dysfunction
- Double or blurred vision
Most of the times, these symptoms along with the pain can also lead to sleep disorders. This is because either the sufferer is struggling to find a comfortable sleeping posture or they hit a trigger point while moving and become awake.
Other psychological issues such as depression or anxiety are also common among myofascial pain syndrome patients because of the chronic pain. In fact, the tensing of the muscles which is characteristic among anxiety sufferers, are also believed to contribute to the development of trigger points. This explains why MPS sufferers with negative emotions can experience deep and intense pain.
9 Possible Causes Of Myofascial Pain
- Abnormal muscle stress
In some cases, abnormal muscle stress due to skeletal abnormalities can lead to the development of new trigger points and the resulting myofascial pain. This is commonly found in people who have leg lengths discrepancies or different toes or feet sizes. As such, certain part of the muscles tends to withstand more stress and pressure as compare to others.
- Accident and injuries
Motor car accidents, especially those have whiplash injuries and falls are believed to be directly responsible for the onset of MPS. This is because the muscles experienced violet stretching and sudden contraction during the accidents. Therefore, the muscle fibers become tangled, shortened and stuck which do not released in the way that they suppose to, even when the muscles relax.
The sensitive areas of tight muscle fibers which are created are the trigger points, characterized by the tight and hard bands under the skin. These causes strain and pain throughout the muscles especially if it is being stretched again.
Generally, there is a school of thought which links the depression frequently experienced by sufferers of MPS. Serotonin is a neurotransmitter which is responsible for regulating not only mood but also pain. It is believed that MPS is caused by the body’s inability to interpret pain correctly, a drop in levels may actually be the main cause to the condition.
- Poor posture
Poor posture and/ or sitting for long period of time is also believed to be the cause of the formation of trigger points. People who are desk-bound for lengthy periods can often impose undue stress on their shoulders, neck, forearms and upper arms.
Once the pain start to worsen, they may try to compensate by adopting unnatural positions which adds to the soreness and discomfort, making the muscles get stuck.
- Stress and anxiety
If we feel stress or anxious, our muscles become tense and locked. When the tension becomes a chronic issue for months and years, this can cause the formation of trigger points particularly around the neck and shoulder areas.
- Nutritional deficiencies
A few studies actually reported that as many as one in four patients who are suffering from chronic conditions had deficiency in vitamin D. In fact, vitamin D is essential for protecting against muscle weakness as well as regulating the balance and absorption of calcium and phosphate in the body.
Low levels of iron, calcium, vitamin C, potassium and various B vitamins may also play an important role in either causing or alleviating the symptoms of myofascial pain syndrome. Magnesium deficiency, which is believed to be responsible for chronic fatigue, chronic pain, insomnia, depression, cognitive dysfunction, depression and anxiety, IBS and digestive dysfunction, tremors and other conditions may also be the key factor that assist the transmission of nerve and muscle impulses.
Though nutritional deficiencies being the cause of MPS is not clear, but many findings have actually proven that people who make adjustments to their diet had reduced pain.
- Sleep Deprivation
In MPS, the persistent pain and the pressure on the trigger points makes the sufferer toss and move around in the night. This can cause severe restlessness and it is believed that the lack of sleep may increase the intensity of pain. Though the this reasoning still varied among many doctors, it is believed that the underlying causes of sleep disorders may in some way contribute to the onset of the condition.
- Oral habits
Many time and effort had been put in the research of MPS by the dental profession because MPS had made many sufferers to experience pain in the face and the jaw, which may related to temporomandibular joint disorder (TMJD). TMJD refers to acute or chronic inflammation of the jaw joint which had many symptoms similar to MPS such as:
- Jaw pain or tenderness in the jaw
- Restricted ability to open or close the mouth
- Neck and shoulder pain
- Headaches and tinnitus
- Dull and aching pain in the face
- Repetitive and unconscious movements of the jaw, a misaligned ‘bite’ or the lack of an overbite, jaw thrusting, persistent gum chewing, nail biting as well as DJD (degenerative joint disease) can all play a part in TMJD or responsible for the formation of trigger points.
- Other infections and conditions
Though there is no conclusive evidence, chronic infections, hypolycaemia (abnormal low blood sugar level), hypothyroidism, connective tissue disease or diseases of internal body organs may be implicated as causes for MPS.
Diagnosing Myofascial Pain Syndrome
Since MPS is so poorly understood till today, diagnosis of myofascial pain syndrome is often difficult and sufferers can experience chronic pain when they are not being treated properly or does not know how to manage the condition.
Besides, many doctors may lack the knowledge or training in relation to the condition, especially when they are others who do not accept it as a form of disorder. Therefore, most suffers may find themselves moving from specialist to specialist before they can get an accurate diagnosis. Still, diagnosing of MPS can still be carried out effectively through the examination of a patient’s medical history and clinical examination.
In fact, the most reliable way is through the location and manual manipulation of trigger points. Typically, these tend to appear in fairly characteristic locations (over 70% of them correspond with the acupuncture points which are used to treat pain).
Usually, the doctor will check your reactions upon exploring the various points on your body, particularly taking note of your response when sensitive areas are found. Next, a pressure algometer may be used to ensure that the pressure applied is consistent across all trigger points.
After locating the trigger points, the doctor will then palpate or manipulate them in order to detect the presence of nodules under the surface of the skin. Direct finger pressure and flat palpation will help to examine the surface of the muscle, while pincer palpation will allow evaluation of the deeper layers.
When referred pain is detected, it may take 2 to 5 seconds before the pain is felt. Manipulation of the trigger points may cause muscle twitches, localize sweating, temperature changes and other sensory reactions. Some doctors may use other types of complementary tests such as ultrasound, electromyography (detects the electrical activity in the muscles) and thermography (detect the levels of heat produced in specific parts of the body).
Usually, throughout the course of diagnosis process, the doctor may rule out other possible causes of your symptoms as well as an existing condition which might be causing the muscle pain. You may also need to undergo other tests or examination as this helps in an accurate diagnosis of myofascial pain syndrome. As such, effective treatment can commence in the shortest possible time which can helps to relieve the symptoms.
Treatment For Myofascial Pain Syndrome
Generally, the treatment for MPS will adopt a combine approach that include the use of medications, physical therapies and trigger point injections as well as some native remedies. Tricyclic anti-depressants have shown to work effectively for MPS sufferers and helps in better sleep.
Physical therapies such as stretching exercises and massage are also able to relieve the pain. Gentle forms of exercise help patients to cope with the pain better while relaxation techniques is also effective in reducing the stress and tension that builds up the pain sensations.
Besides, physical therapists also help to correct the poor postures which may be the cause of the pain. Otherwise, trigger point injections are used in some cases to relieve the muscles tension experienced by the sufferers.
Complementary therapies or alternative treatments that include acupuncture, yoga, Alexander technique are also getting popular in recent years which prove to be effective for some patients. Myofascial release technique is a more common approach for treatment as it focus on releasing restrictions in the muscle fascia, restoring elasticity and hydration.