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Living With Chronic Pain

Myofascial Pain

We all get an occasional muscle pain that resolves with rest and time. But when the muscle pain becomes persistent and interferes with activity it may have progressed to myofascial pain.

Myo stands for muscle, fascia is anything the affects the thin white connective tissue wrapped around every muscle, organ and blood vessel. Think if it as an orange. The rind is our skin, the orange itself our muscles and that white around the entire orange, keeping it together, is the fascia. 

Fascia wraps our muscle tissue together and provides a slick surface, so they contract and stretch as a group, allowing them to move and function better without friction or shearing forces. Filled with abundant nerve endings, the fascia gives us constant up to date feedback as to how well the muscle is functioning. When hurt they also transmit pain.

Muscles react to any perceived slight. Pick up the baby wrong, grab the milk too quickly, carry a heavy purse, twist while lifting, and muscles respond. When the pain persists, it may have expanded to a more difficult process to treat -myofascial pain syndrome.

Myofascial pain syndrome 

Over 85% of us will experience myofascial pain in our lifetime. Even so, it is often overlooked, misdiagnosed or thought to be just a strain or sprain. Myofasial pain isn’t a routine muscle ache, it’s caused by “trigger points” or knots within a muscle group. Under a microscope it’s a tight strand of muscle that feels like a cord or tendon. The “knot” is numerous segments of nearby muscle fibers that are stuck in a contracted state which prevents blood flow, oxygen and nutrients from penetrating. Waste products build up, irritating the fibers more, which then sends pain signals to the brain. It reacts by telling the muscle to stop moving which actually worsens the situation, causing it to tighten further and create more pain with any range of motion. The results- weak, painful muscles we don’t move. This spreads to other muscles that have to work harder to compensate for its loss.

Trigger points can develop in any muscle group and feel like it’s shifting and moving when multiple sites are affected. They can be tender not only at the knot but refer pain to nearby areas.

It’s not an autoimmune disease.

How is myofascial pain syndrome different from fibromyalgia?

Fibromyalgia is a more a widespread muscular pain felt everywhere along with bowel issues, headaches, mood changes and generalized fatigue. Myofascial pain syndrome is a localized muscle disorder affecting specific muscles group like the shoulder blade, neck, and jaw. Myofascial pain syndrome is characterized by ropey, taut trigger points that can trigger referred pain caused by injury or overuse. Fibromyalgia is associated with more multiple widespread tender points different from trigger points in that they do not refer pain. It involves both sides of the body and is felt in both muscles and joints without the normal redness, swelling or warmth seen with inflammation. It’s believed to be caused by the brain amplifying pain signals. Some believe fibromyalgia starts as a myofascial pain syndrome that expands over time. 

Although myofascial pain can occur in any muscle there are a few more commonly affected

  • Sternocleidomastoid- the large group of muscles on both sides of the neck that allows it to flex and rotate. They run from the skull behind the ear to the collar and breast bones.
  • Trapezius-a large, triangular, flat muscle in our upper back that tilts the neck up and back, rotates the neck, moves the shoulders and twists the arms. It extends from the base of the skull to our muddle back.
  • Levator Scapulae – running from the fourth cervical vertebra to the top of the shoulders, they raise and rotate our shoulder blades.
  • Infraspinatous – one of four muscles in the rotator cuff group, it helps to rotate and stabilize our shoulder joints. It’s a triangular muscle on the back side of our shoulder blades.
  • Rhomboids – They run diagonally from the neck and thoracic vertebra to the shoulder blades. This upper back muscle attaches our arms to the shoulder blade.

Causes and risk factors

Most occur from overuse, trauma or constant stress on a muscle group from anxiety- keeping shoulders, neck and upper back tight, grinding teeth. Trigger points can arise from heavy lifting, sleeping in an awkward position or sitting at a computer all day long. It’s a combination of issues that set us up for pain:

  • poor posture
  • staying in one position all day long or at night
  • poor diet
  • sedentary lifestyle
  • injury or trauma
  • lack of sleep, fatigue
  • hormonal changes e.g. menopause, pregnancy 
  • obesity
  • smoking 
  • inflammatory conditions
  • chronic pain
  • cold conditions 
  • alcohol
  • chronic stress, anxiety

Myofascial pain is extremely common and problematic. Once it progresses to a persistent, ongoing pain it can interfere with activity, sleep, and work. Getting it diagnosed and treated quickly is imperative. Next week I’ll discuss signs, symptoms, diagnosis and the best treatment options.

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