What is Myofascial Pain?

Irritation or inflammation of surrounding fascia or muscles causes myofascial pain. The condition of myofascial pain syndrome (MPS) results from hyper-contracted muscles, creating a situation in which sensory, motor, and autonomic symptoms develop which are caused by a myofascial trigger point. In this condition, a taut band of muscle tissue can cause pain when compressed or deeply palpated, and can also result in typical referral pain, motor dysfunction, and autonomic symptoms.

Cause of Myofascial Pain Syndrome:

  1. Muscle Contractures
  2. Direct Trauma
  3. Muscle Overload
  4. Postural Stress
  5. Eccentric contractions in unconditioned muscle
  6. Also, maximal or submaximal concentric contractions, etc.

There are some aggravating factors for myofascial pain such as

  • Scoliosis
  • Leg length discrepancies
  • Joint hypermobility
  • Muscle overuse
  • Iron insufficiency
  • Vitamin D, C, & B12 insufficiency
  • Stress & Anxiety, etc.

Classification & Symptoms of Myofascial Pain Syndrome:

Myofascial trigger points come in two types, active and latent. Active trigger points are those that cause a spontaneous occurrence of pain or pain that is triggered by movements. Pressure on a latent trigger point brings out its sensitivity.

Myofascial trigger point has the following symptoms:

  1. Pain on compression
  2. Local twitch response
  3. Muscle tightness
  4. Local myasthenia
  5. Limited ROM of affected muscle

Physiotherapy Treatment:

Non-invasive techniques such as-

  • Therapeutic Ultrasound
  • Laser Therapy
  • TENS
  • Cryo-air

Physiotherapy technique such as-

  • Firstly, Stretching techniques-
    • stretching while application of cryo-air or vapor-coolant spray can quickly cool the skin. Dropping the skin temperature causes a temporary reduction of pain, allowing the muscles to fully stretch, thereby releasing the trigger point.
  • Secondly, Post-isometric relaxation-
    • To prevent trigger points from forming in muscles, a series of gentle isometric contractions is imposed on the muscle at its full, pain-free length instead of direct stretching. As the muscle relaxes after each contraction, some additional range of motion is possible without pain. In order to capture this additional range of motion, the therapist passively stretches the muscle between each contraction. The cycle of contracting-relaxing-stretching continues till the muscle reaches a normal range of motion without pain.
  • Thirdly, Active release techniques-
    • By removing fibrosis and adhesions from tissues, Active Release Techniques can alleviate tissue tension and release tissues from overload due to repetitive use. Clinical interventions employing manual therapy include compressive, tensile, and shearing forces to treat repetitive strain injuries, cumulative trauma injuries, and lesions with constant pressure. An injured area is treated by deep tension applied to a tender body part and through patient participation the injured site is actively lengthened from a short to a long position. A contact point is positioned close to the lesion, and the patient is caused to move in such a way that longitudinal sliding motions are produced in soft tissues under the contact point, such as nerves, muscles, ligaments under the contact point.
  • Trigger point pressure release-
    • There are two effective variations of this method (1) The sustained pressure technique, & (2) The micro stripping technique. By applying pressure to the trigger point slowly using your fingers, thumbs, or elbows, you can create sustained pressure. Hold for 4-8 seconds before releasing. The micro stripping release method involves using a supported thumb contact or thumb over the thumb to apply a short stripping stroke across the trigger point parallel with the muscle fibers. This technique can release contracted fibers from the trigger point. This technique involves applying pressure to one side of the trigger point before moving that pressure slowly through the trigger point to the other side.
  • Muscle energy technique (MET)
  • Soft tissue mobilization/or Massage
    • There is an application of a certain amount of pressure to release trigger points

And, the invasive technique includes- Dryneedling, & Wet cupping.