Myofascial Pain; Symptoms, Diagnosis, and Treatment

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.

Medications

Analgesics
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
Steroids
Anti-depressants
Chronic pain medications such as gabapentin
Sleep aids to improve sleep quality

Home remedies

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.