Repetitive Strain Injury and Myofascial Pain Syndrome

Extensive information is available online about repetitive strain injury (RSI), including suggestions for people with myofascial pain, which is localized in the muscles (myo) and their connective tissues (fascia). As a chronic condition, myofascial pain syndrome remains a mystery to many people, including physicians, chiropractors, and other healthcare practitioners.

The key to alleviating the pain is to understand its source: the fascia, not the injury site. As practitioners of functional medicine, Dr. Blatman and his team of providers offer many natural remedies that harness the body’s healing capacities. First, let’s take a deeper dive into myofascial pain.

Trigger Points and Myofacial Pain

In overused, fatigued, and strained muscles, knots called trigger points form in the muscle and its associated fascia, which serves to hold muscle fibers together, connect muscles to bone, and keep bones connected. Trigger points can feel like small knots within tight, ropy bands of muscle, thereby forming the taught or ropy band.

Each trigger point generates two pain patterns. One pain pattern is concentrated, causing localized soreness and tenderness. The other is deferred or distant, typically interpreted by the brain as numbness, tingling, burning, or aching. All trigger points may generate some degree of these pain patterns all the time and also cause the muscle to cramp.

Trigger points may be classified as active, latent, or satellite. An active trigger point is a hyperirritable focus in the muscle or its fascia that generates pain. It will usually cause more pain when the muscle is used.

A latent trigger point is less tender than an active one and commonly produces pain when pressure is applied. It generally restricts motion, prevents full muscle lengthening, and causes weakness without much, if any, noticeable pain.

When a trigger point is active and refers a strong level of pain to another area of the body, muscles in this other area develop satellite trigger points. A satellite trigger point develops within the zone of referred pain from an active trigger point somewhere else in the body. In this way, a localized pain pattern may spread to other, larger areas of the body.

The Role of Repetitive Strain in Trigger Points

RSIs refer to injuries incurred from repetitive movements, such as swinging a golf club, playing a violin, repeated bending, or typing on a keyboard for extended periods. An RSI causes new trigger points to form. Sustained muscle contractions to maintain a position or your posture will also activate trigger points. An RSI also leads to latent trigger points within the injured muscles. Common RSI diagnoses that have a strong myofascial component include tennis elbow, golfer’s elbow, hip bursitis, and shoulder bursitis.

Many medical professionals have been taught that RSIs cause inflammation of the overused tissues. This can indeed occur. In extreme circumstances, there may be physical evidence of an inflammatory condition, such as crepitus, characterized by the “creaking” that occurs as poorly lubricated tendons fail to glide smoothly. Crepitus can sometimes be felt in swollen, injured tissues and can be serious.

However, this inflammation model isn’t the only explanation for RSI-related pain, and therefore shouldn’t be the only one that informs treatment, which often involves non-steroidal anti-inflammatory drugs (NSAIDs). Drug manufacturers continue to educate the public about inflammation to promote products such as Naprosyn and Motrin. Unfortunately, NSAIDs can be dangerous. There are approximately 100,000 hospitalizations and 17,000 deaths in the U.S. annually due to their side effects.

Most of the time, however, the primary pathology resulting from repetitive strain injury is not inflammation but myofascial pain generated by trigger points in the injured muscles. Over time, satellite and latent trigger points also contribute to the larger pain pattern.

Safe and Effective RSI Treatment with Holistic and Functional Medicine

Because of the myofascial sources of RSI-related pain, Dr. Blatman stresses that more integrative treatment of this component of the condition will generally result in greater therapeutic success. The first step in targeting myofascial pain is to mitigate the factors that can perpetuate or worsen it.

When you consult with a professional at Blatman Health and Wellness Center, you’ll receive a thorough evaluation of your RSI pain and what caused your injury. To ensure proper treatment, we examine the following factors to assess their role in your pain:

• Diet
• Nutrition
• Ergonomics
• Stress management
• Hormonal balance
• Other factors

Then, your provider will recommend treatments to reduce your pain-causing trigger points. This will likely involve one or more of the following physical techniques:

• Acupressure to maintain pressure on a trigger point
• Stretching the involved muscles to a more normal resting length
• Use of fluoro-methane or other vapo-coolant spray
• Massage therapy
• Trigger-point injections with no cortisone
• Myotherapy
• Chiropractic adjustment

Mental work, such as relaxation therapy and biofeedback, may be an effective supplement to your treatment plan and even reduce the stress associated with your pain.

For more information on trigger points and myofascial pain, you can consult the medical text by Travell and Simons: Myofascial Pain and Dysfunction, The Trigger Point Manual, available through Amazon.com, your local medical library, or bookstore.

For Cincinnati or New York City residents living with RSI-related pain, you can do more than just read about it; there’s help close by. For more information or to schedule a thorough consultation, complete our online contact form. With a comprehensive treatment plan, you can achieve pain relief and restore your quality of life.