When a strain or strain doesn’t respond to normal treatments, or a knot appears in a muscle group, it may have progressed to a myofascial pain. This is when not only the muscles are involved but the fascia that envelopes it as well. Myofascial pain syndrome often occurs after trauma, injury, chronic inflammation, arthritis or one of the many risk factors described in last week’s post about myofascial pain.
Myofascial pain symptoms
- A knot or trigger point in a muscle that won’t go away
- Pain deep in a muscle group
- Worsened by moving the affected muscle group
- Progressive muscle weakness and loss of motion
- Repeated chronic pain that doesn’t improve
- A muscle injury that “acts up” with minimal activity
- Painful knots that hurt when pressed and cause referred pain
- Interferes with sleep
- Tightness that seems to stay in one area. For example, the neck or shoulder blades
- Resistant to routine treatments that normally help
Diagnosing myofascial pain
There are no tests, whether images, labs, electrical studies or biopsies, that can diagnose myofascial pain. Sometimes there aren’t even visible signs of redness, swelling or warmth. Therefore, it is diagnosed by symptoms and the detection of painful trigger points that hurt when touched and refer pain.
There are four types of trigger points.
- Active – knots found within a muscle group that are painful when pressed, cause referred pain and can produce a twitch when touched.
- Latent- a knot that’s not currently active but can become so at any time. They can remain latent for years and become active with trauma or stress.
- Secondary trigger point- sits in a muscle other than the one that’s currently painful, but can be activated at any time when another muscle is stressed.
- Satellite- inactivated by an overlap with a currently painful trigger point but can be activated when it’s near a trigger point that becomes painful.
Treatments for myofascial pain
- Physical therapy- Normal fascia is pliable and elastic. By focusing on areas that are stiff or tightened with light pressure, massage and stretching the tension is released.
- Dry needling– thin needles are pushed into the band if knotted fibers to break them up, allow blood flow and disperse the spasm.
- Wet needling- injecting a steroid, analgesic or anesthetic to break up the knot and relieve pain.
- Spraying a coolant- cooling a tight knot while gently stretching and mobilizing it to release the spasm.
- Laser therapy– to stimulate endogenous endorphin and opioid release.
- Ultrasound- using sound waves to penetrate the taut band of fibers and ultimately breaks it up.
- Tens unit– pads are placed over the trigger point and electrical stimulation through low voltage electricity breaks up the knot.
- Acupuncture, relaxation techniques, biofeedback.
- Massage therapy using acupressure (read how to self-massage, here).
- Myofascial release by applying direct or indirect pressure to trigger points loosening and releasing the spasm. This works a broader area of muscles not just the trigger point to release tension throughout the body.
- Nonsteroidal anti-inflammatory medications (NSAIDs). Do not use if on anti-coagulants, have renal, GI, or liver issues. Always clear with your provider before using.
- Topical creams/ patches
- Muscle relaxants
- Chronic pain medications such as gabapentin
- Sleep aids to improve sleep quality
- Hot/ cold packs
- Gentle range of motion and exercise
- Dietary changes. Stop ingesting foods that stimulate inflammation, for example, sugar (even sugar substitutes), red meats, processed foods, refined carbohydrates, dairy, fried foods.
- Massage therapy
- Warm baths / showers
- Relaxation techniques
- Improve sleep
- Reduce stress
- Avoid repetitive actions
- Maintain good posture
- Ergonomic improvements
- Exercise, exercise, exercise. The more the muscles stretch and are kept mobile the less they will spasm. In the end, this also reduces stress by releasing “the fight or flight” we’ve bottled up and encourage the release of our own endogenous opioids.
Chronic muscle aches are not normal. If one persists, see your healthcare provider to learn which treatment options are best for you.