Myofascial Pain Syndrome- Symptoms, Causes, Types, Diagnosis, and Treatment

Introduction

Myofascial pain syndrome (MPS) is a long-term pain condition that affects the musculoskeletal system. Many people experience muscle pain at some point when it resolves on its own, but for some others, the pain persists. For people who experience myofascial pain syndrome, some points act as trigger points. When these pressure points are stimulated, pain is felt in a different part of the body. Such muscle pain is caused due to continuous contraction of the muscle. Treatment involves physical therapy and injection in the trigger spots.

What Is Meant by Myofascial Pain Syndrome?

Myofascial pain syndrome is a condition that causes pain in the muscle and fascia (the thin, white connective tissue that is present around every muscle). Fascia wraps every level of muscle - single muscle, muscle fiber, and all muscle groups.

What Are the Functions of Fascia?

Fascia helps hold the muscles together, which helps to stretch and contract. Fascia provides a smooth surface where individual muscle fibers, a single muscle, and a group of muscles can move against each other without creating friction, tearing, or other issues. Fascia is present all over the body. Every organ and blood vessel is interlinked or surrounded by fascia. Fascia is complex and has nerve endings.

How Is Myofascial Pain Syndrome Initiated?

Myofascial pain syndrome is a common issue where the person experiences pain in a specific muscle in some body area. The pain caused is associated with one or more trigger points, which appear as small nodules, bumps, or knots in the muscle. When these trigger points are seen under the microscope, these are viewed within a taut band (the tight muscle similar to the cord or tendon).

When muscle fibers are contracted, blood flow ceases. If blood flow is stopped, the oxygen supply to the muscle reduces. Waste substances also accumulate in these fibers. These irritate the trigger point, which reacts with pain signals. Due to this pain sensation, the brain signals not to use this part of the muscle. Reduced use of these muscles results in muscle tightening, causing weakness and causing decreased range of motion. In addition, the muscle present around the affected muscle works harder to do the work of the affected muscle. Trigger spots may also be added to these muscles and add to the pain caused.

Trigger points can be formed in many muscles at the same time. This is the reason why pain is left during movement. Trigger points can cause pain at that point or in the nearby spot, where the pain is called referred pain.

Where Does This Pain Usually Occur in the Body?

Myofascial pain can occur in any muscle in the body, but it usually occurs in:

• Sternocleidomastoid:

The primary function of this muscle is that it helps rotate and flex the neck. It is on both sides of the neck, running from the skull to the collar and breast bones.

• Trapezius:

This large, flat, triangular muscle helps the head tilt and turn the head and neck, steadies the shoulder, and twists the arms. The muscle is present till the middle of the back to the base of the skull.

• Levator Scapula:

This is a pair of muscles that helps in rotating and raising the shoulder blades. They are present between the first four cervical vertebrae and the top of the shoulder.

• Infraspinatus:

It is a triangular muscle on each shoulder blade that rotates and stabilizes the shoulder joints.

• Rhomboids:

This pair of muscles help pull the shoulder blades together when contracted and attach the upper blade to the shoulder blade. These muscles are present diagonally from the neck and chest vertebrae to the down of the spine.

What Are the Symptoms of This Condition?

The symptoms associated with myofascial pain syndrome vary for different people. Sometimes the pain is very acute and causes a flare-up of symptoms. However, most of the time, the pain is dull.

Some Common Signs and Symptoms of This Condition Are:

• Pain that is deep aching, throbbing, tight, and stiff.

• Trigger points are small nodules or knots in the muscles that induce pain when triggered.

• The muscle that is sore or tender.

• Weakness of the affected muscle.

• Limited movements in the affected area.

People Affected by These Conditions Will Have Other Health-Related Issues, Such As:

• Headaches.

• Poor sleep.

• Stress, anxiety, and depression.

• Fatigue.

What Are the Causes of This Condition?

• Muscle injury.

• Muscle strain.

• Repetitive use of muscle.

• Muscle weakness.

• Reduced muscle activity.

• Poor posture.

• Living in a cold environment.

• Emotional stress.

• Pinched nerves.

Other Factors Which Contribute to the Cause of Myofascial Pain Syndrome Are:

• Metabolic or hormonal problems.

• Vitamin deficiency.

• Presence of chronic infection.

What Are the Types of Trigger Points?

• Active Trigger Point: These trigger points are present within the muscle, and any pressure on these points results in local and regional pain.

• Latent Trigger Point: These trigger points have the potential to get activated and cause pain, but they stay dormant.

• Secondary Trigger Point: It is present in the muscle other than the active trigger point. Therefore, it can be triggered at the same time as an active trigger point.

• Satellite Trigger Point: It is usually inactive as it is overlapped with another active trigger point.

How Is This Condition Diagnosed?

Myofascial pain syndrome is an underdiagnosed condition that can be mistaken for any nerve, bone, tendon, or ligament issues. But actually, the problem is with the muscle. No imaging tests, blood tests, electromyography, or muscle biopsy can help diagnose this condition. At the same time, there are no visible signs of redness, swelling, or muscle warmth.

The best method used to diagnose this condition is the physical examination of the muscle, where the doctors feel for a taut band of muscle and then find the exact spot of pain. Stimulating the trigger points also induces pain at the exact or near the trigger point.

How Is This Condition Treated?

A combination of treatment methods helps to treat this condition. Some treatment methods are:

• Physical therapy.

• Dry needling, where small thin needles are inserted into the trigger points, reduces tightness, enhances blood flow, and lowers the pain.

• Wet needling or trigger point injection where Lidocaine is injected to the trigger point to reduce pain.

• Spray and stretch.

• The cold laser is used to release the relieving chemicals.

• Ultrasound.

• TENS therapy (transcutaneous electric nerve stimulation).

• Acupuncture and relaxation therapies.

Medications That Are Used Include

• Painkillers.

• Steroids.

• Non-steroidal anti-inflammatory drugs.

• Muscle relaxant.

• Antidepressants.

• Sedatives.

Some Home Remedies Are:

• Heat.

• Exercise.

• Over-the-counter painkillers.

• Relaxation methods like yoga.

• Dietary changes.

• Soaking in hot water.

• Massages.

Conclusion

Myofascial pain syndrome is a condition that causes pain in any muscle, where some trigger points induce pain. This pain causes restriction of movement. Such pain can be treated very well, but the diagnosis of this condition is very difficult and it can not be identified through any tests. Medications, home therapy, and physical therapies help in the treatment of this condition, where comprehensive treatment acts the best.