Muscles can cause many seemingly different pain conditions. Pulled muscles can cause mild soreness, as well as very severe sharp and stabling or radiating pain. Old injuries like recurrent back and shoulder problems that seem to “act up” after certain physical activities are mostly related to muscle and not disc or spine. Other myofascial related conditions include back pain, pelvic pain,plantar fasciitis, neck pain, TMJ syndrome, and various forms of headache–including migraine.
What is Myofascial Pain?
Myofascial is a word derived from the words “myo” which means muscle, and “fascia” which is the connective tissue that covers and intertwines with muscle. Myofascial pain is generated by hyperactive small areas of irritability in muscle, tendon, or its associated fascia that are called myofascial trigger points.
What is a trigger point?
When muscles contract, they shorten. A trigger point is a part of the muscle that got stuck in a contracted state. It is also a place where the autonomic nervous system interacts with the muscle to set its baseline of tension.
How do trigger points form?
Trigger points form in muscle, tendon, and fascia as a response to injury. The injury can be from repetitive strain and micro trauma, crush injury, sudden strain, bone fracture, and other mechanisms.
How do we find Trigger Points?
A trained examiner can usually feel these trigger points. The diagnosis is determined by physical examination, and not by medical tests such as X-ray, CT and MRI scans. Trigger points can be felt as nodules or knots of tightness within a ropey band of muscle. The trigger points are located in the tightest parts of the ropey bands.
What do trigger points cause?
Trigger points cause continued shortening of a muscle restricting motion, weakness of the muscle, and pain. The pain can be numbness, tingling, burning, aching, cramping, sharp, dull, radiating–there is no sensation we can describe that cannot come from muscle and the strings of fascia that go through it.
- an example of muscle shortening is when the hamstrings are so short that we can’t touch our toes with our knees straight
- examples of muscle weakness can occur anywhere a muscle has been previously injured. The weakened muscle may not be smaller than normal, just weaker.
- trigger points also cause referred pain symptoms. This referred pain can be quite severe and distant from the original source. Examples include pain that radiates down the leg from the lower back and buttocks, or goes down the arm and into the hand from the neck and upper back, or goes into the head from the neck, upper shoulders, and jaw.
- trigger points also cause headaches. They cause all kinds of headaches, including tension headache and migraine headache.
What other conditions are caused by trigger points?
Repetitive strain and repetitive motion cause trigger points to form in the overused muscles. Trigger points in forearm muscles cause the pain of tennis elbow and golfer’s elbow. This pain is generally and mistakenly thought to be caused by inflammation or scar tissue. Trigger points in the forearm muscles near the elbow also cause wrist pain and tenderness. Trigger points in buttocks muscles cause symptoms that are often diagnosed as bursitis and inflammation of the hip joint. Buttocks muscle trigger points also cause lower back pain and radiate pain and numbness down the leg.
Trigger points also cause growing pains. These typically occur in children, and are usually located in their legs and sometimes refer pain to joints like the knees, ankles, and feet.
Trigger points also cause phantom limb pain after amputation. They are mostly located in the muscles of the stump in the upper or lower extremity. They cause radiating pain that goes into the missing hand or foot. It can be burning, aching, sharp, numbing or tingling. Sometimes it seems like all these sensations occur at the same time.
What can be done to help the person with this diagnosis?
There are many things that can be done to help adults and children with myofascial pain. These include body work such as myofascial release, Chiropractic, acupuncture, stretching and myofascial trigger point injections. Other injection techniques include prolotherapy, platelet rich plasma/stem cell therapy, and neural therapy. Pain, stress, and tension can be treated with Acupuncture, Thought Field Therapy, BioFeedback, EEG BioFeedback, and Heartmath biofeedback. Other helpful modalities include Healing Touch, Environmental Detoxification, Aroma Therapy, Photon Therapy (infrared light), and Massage Therapy.
Nutrition is also important for reduction of pain, relief from fatigue and improvement in total body wellness. Nutritional supplementation and various therapies can make a tremendous difference in giving the body support for healing. Since nutritional change is likely to be very important for a change toward health, we provide one on one sessions under Dr. Blatman’s direction to help our patients make these changes as easily as possible. In addition, food sensitivity testing can be added to the healing program for further reduction of bowel problems, headache, pain, fatigue and mental cloudiness.
Another consideration is stress management. There are central nervous system mechanisms that make muscles generate more discomfort when we are under more stress. Since we do not live in a stress free environment, we can often be helped by techniques that change how we respond to stress. A good night’s sleep is also very important in healing our bodies. Sleep deprivation in normal people causes fatigue and diffuse pain patterns to occur. Medication that is not addictive may be prescribed to help restore normal sleep patterns. This often has a beneficial effect on the pain level and fatigue of fibromyalgia.
Is there hope?
Of course there is hope.
Research is helping doctors to understand more about body mechanisms involved in causing myofascial pain. Also, more and more doctors and therapists are learning to treat the pain patterns caused by trigger points.
About the Author:
Hal S. Blatman, MD is the founder and medical director of The Blatman Health and Wellness Center (formerly The Blatman Pain Clinic), and a globally recognized specialist in myofascial pain. He is board certified in both Pain Management and Occupational and Environmental medicine. More information is available at blatmanhealthandwellness.com or by calling 513-956-3200